전신 및 구강 복합만성질환자의 이환 유형에 따른 외래 의료서비스 이용 비교

엄숙,이경수,최유진 한국구강보건과학회 2019 한국구강보건과학회지 Vol.7 No.3

Objectives: Multiple chronic diseases are expected to exert an increasingly negative influence on the health care system, but there is little concern for these chronic diseases despite that individual chronic diseases have been drawing attention in Korea. The oral cavity is a part of the body, and oral diseases are closely related to systemic health. Specifically, chronic oral diseases, such as dental caries and periodontal diseases, are given considerable weight in terms of the overall use of medical services. The purpose of this study was to examine the state of multiple chronic diseases, including oral diseases, morbidity patterns, and any possible differences in the frequency of using outpatient medical services according to morbidity patterns. Methods: Analysis was based on Korea Health Panel data from 2011. These data were of 40-year-old and older individuals, of whom 2,619 had single chronic conditions and 963 had multiple chronic conditions. All of them had experienced being examined as outpatients. Results: The average utilization frequency of outpatient clinics of a multiple-chronic-condition patient per year was 15.6 times, which was 1.5 times higher than the 6.1 times of a single-chronic-condition patient. The multiple-chronic-disease patients’ utilization frequency of outpatient clinics was compared according to subgroup. Groups 1 and 5 had the highest and lowest utilization frequencies of outpatient clinics, respectively. Conclusions: Chronic disease coordination is necessary to provide quality care and efficient service. The government should promote human resource training policies and programs to support patients with chronic diseases. Moreover, policy development and enforcement for patients with chronic oral disease are needed to defray high non-payment expenditure.

만성질환 유병의 사회계층별 차이 분석

김혜련 ( Kim Hye Lyeon ),김윤신 ( Kim Yun Sin ) 한국보건정보통계학회 2003 보건정보통계학회지 Vol.28 No.2

30세 이상 한방의료기관 외래환자 중 비복합 및 복합만성질환자의 의료이용과 결정요인 - 2011년 한방의료이용 및 한약소비실태조사보고서(보건복지부)자료를 중심으로 -

윤진원,최성용,이선동,Yoon, Jinwon,Choi, Sungyong,Lee, Sundong 대한예방한의학회 2015 대한예방한의학회지 Vol.19 No.1

Objective : To use and its affecting factors of patients' outpatient treatment that have single and multiple chronic illnesses Method : We used the 2011 study by the Ministry of Health and Welfare, "Report on Usage and Consumption of Korean Medicine." This report was conducted on outpatients and inpatients that visited Korean traditional medicine, from August 25th, 2011, to September 30th, 2011. Our research was based on 1729 patients with chronic diseases aged 30 and over who received outpatient treatment during the last three months. Results : There were 1365 patients with non-complex chronic diseases, while there were 364 patients with complex chronis diseases. Patients had 1 - 8 chronic diseases, and the average number (standard deviation) was 1.26 (0.59). There were statistically significant differences by sex(P<0.0001), age(p=0.0045), marriage (p=0.0060), education level(p<0.0001), income level(P=0.0063), and types of health insurance(p=0.0023). The diseases most common among patients with non-complex chronic diseases were: low back pain, arthritis, gastrointestinal disorder, frozen shoulder, side effects from motor accidents, high blood pressure, fracture, stroke, diabetes, cancer, atopic dermatitis, and asthma. The diseases most common among patients with non-complex chronic diseases were: arthritis+low back pain, low back pain+gastrointestinal disorder, low back pain+side effects from motor accidents, low back pain+frozen shoulder, arthritis+gastrointestinal disease, gastrointestinal disease+frozen shoulder, arthritis+low back pain+gastrointestinal disease, high blood pressure+arthritis, arthritis+low back pain+frozen shoulder, arthritis+fracture, and arthritis+side effects from motor accidents. There were statistically significant differences among the usage of medical clinics by: frequently used clinic (p<0.0001), number of treatment (p<0.0001), the cost of outpatient treatment (p=0.0073), the satisfaction rate (p=0.0171), whether the clinic is the preferred clinic (p=0.0040). In model 1, men than women, people who had local benefits instead of type 1 medical aid, and patients with complex chronic diseases were more likely to use Korean medical clinics. In model 2, men than women, people who had local benefits than people with types 1 and 2 medical aids, people who went to pharmacies and Korean medicine pharmacies than people who went to hospitals, people who went to get treatment 1-10 times than people who visited 11-20 times and more than 41 times, and people who spent less than ten thousand Korean won than people who spent 1 to 2 million Korean won, and people without complex chronic diseases were more likely to use Korean medical treatment. Conclusion : There were differences in sociodemographic characteristics and the usage of medical clinics between patients with non-complex chronic diseases and patients with complex chronic diseases. Among patients with complex chronic diseases, women, patients with types 1 and 2 medical aid, patients who used Korean medical clinics, patients who were treated 11-20 times and more than 41 times, and patients who spent 1 million to 2 million Korean won on outpatient treatment used less treatment than patients with non-complex chronic diseases. However, patients with complex chronic diseases used pharmacies and Korean medicine pharmacies more.

만성질환자들의 한의약의료서비스 이용과 결정요인 -제주도 보건소이용 환자를 중심으로-

오종수,한동운,임문혁,홍용석,이영호,노홍인,Oh, Jong-Soo,Han, Dong-Woon,Im, Mun-Hyuk,Hong, Yong-Seok,Lee, Young-Ho,Noh, Hong-In 대한예방한의학회 2009 대한예방한의학회지 Vol.13 No.3

Background : Traditional Korean medicine(TKM) has gained in popularity among chronic patients in recent years. The use of TKM among patients with chronic diseases is common, with about two thirds of patients using some form of TKM in Korea. Objectives : The purpose of this study is to analyze the use of TKM and determine what factors affect to use TKM among patients with chronic diseases. The study also aims to provide information on TKM therapies and assist therapy selection among various TKM therapies for patients with chronic diseases. Methods : The design of the study was descriptive cross-sectional, and data were collected using a 21-item questionnaire. This study was conducted with subjects with confirmed diagnosis of chronic diseases, who live in Jeju Province, Korea. Results : Among the participants, past or current TKM use was 66.7%, with a statistically significant difference in gender and level of health status groups(p<0.05), but no difference in age, marital status, education, occupation, and income groups. The most common therapies of TKM used by the patients included acupuncture(51.1%), physiotherapy(16.8%), cupping(13.5%), and herbal medicine(4.8%). The main benefits from TKM perceived by the patients were chronic diseases management and health promotion. In a logistic regression analysis, significant influencing factors related to TKM use were gender, family income level, the extent of recognition of efficacy, heath status, and health security program. Conclusions : In this study the socio-demographic and health status, recognition of TKM efficacy factors associated with TKM use among patients with chronic diseases were similar to those found in the general population. The findings suggest that due to the relatively high use of TKM among patients with chronic diseases in Korea, this topic should be taken into account in the development of a holistic approach for patients with chronic diseases and an efficient chronic disease management system. Additionally proactive and consistent management of TKM is necessary in the health care system in Korea.

만성질환 의료비 예측과 건강행동시나리오에 따른 절감 효과 분석

조다소리,정기택 경희대학교 경영연구원 2020 의료경영학연구 Vol.14 No.3

The rapid increase of chronic diseases caused by population aging and changes in lifestyle is proceeding all over the world. Chronic diseases are ‘lifestyle-related diseases' that require constant management and tracking. As chronic diseases increase, social and personal burdens also increase. It is essential to identify and predict the cost of chronic diseases. And It is necessary to propose a direction to move forward through the review of health promotion policies. The purpose of the study is to predict the medical expenses as well as the future prevalent population of chronic diseases. Not only this, but also the study simulates health promotion scenarios to propose the milestone to health promotion policies. Future Elderly Model(FEM) is a very useful dynamic microsimulation analysis method to predict future medical conditions(population, expenses etc.) First developed in 2004 by RAND Corp. and CMS(The Centers for Medicare & Medicaid Services), FEM was designed to investigate the medical expenses of Medicare beneficiaries. As FEM is a dynamic microsimulation model, the data should be personal level date with longitudinal design. National Health Insurance Service sample cohort DB(NHID-cohort) is a well-managed cohort database which represents total population. Based on FEM using NHID-cohort(2009~2013), we predicted the prevalent population and medical expenses for 11 chronic diseases by 2015 to 2041 in every two year. The most prevalent population increases disease is hypertension(6,932,380 increment). Chronic renal failure is the disease with the greatest rate of increase(3.68 times) in the prevalent population. The prevalence of hypertension increase(10.62) is the highest, and in 2041 it is estimated that 42.00% of the population over 40 has hypertension. The diseases with high prevalence are diabetes(18.89%), mental and behavioral disorders(18.96%), and neurological diseases(19.05%). The cost of chronic diseases in 2041 was estimated to increase by 61.68 trillion won(3.96 times) compared to 2015, to 82.52 trillion won. Disease with the largest increase in medical expense is mental and behavioral disorders with an increase of 14.76 trillion won, 4.81 times the cost of medical expenses in 2015. Cancer expense increases to 16.33 trillion won. Lastly, the effect of reducing medical expenditure reflecting changes in health status with decreasing smoking and obesity rates is simulated. If smoking rate reduction scenario is successfully implemented, the cost of 11 chronic diseases is predicted to save 15.47 billion won by 2021 and 50.71 billion won by 2041. If obesity rate reduction scenario successfully implemented, the cost of 11 chronic diseases is predicted to save 72 billion won in 2021 and 201.6 billion won in 2041. This study has significant implications for predicting the prevalent population of chronic diseases and increasing medical expenditure as social problems in Korea. It also has the potential to be used as a basic data for policy through improvement of health status through simulation.

Autoimmune Diseases Are Linked to Type IIb Autoimmune Chronic Spontaneous Urticaria

Kolkhir Pavel,Altrichter Sabine,Asero Riccardo,Daschner Alvaro,Ferrer Marta,Giménez-Arnau Ana,Hawro Tomasz,Jakob Thilo,Kinaciyan Tamar,Kromminga Arno,Konstantinou George N,Makris Michael,Metz Martin,S 대한천식알레르기학회 2021 Allergy, Asthma & Immunology Research Vol.13 No.4

Purpose Patients with chronic spontaneous urticaria (CSU) have an increased risk for comorbid autoimmune diseases. In this retrospective multicenter study of CSU patients, we evaluated clinical and laboratory features of CSU associated with a higher risk of comorbid autoimmune diseases. Methods We analyzed records of CSU patients (n = 1,199) for a history or presence of autoimmune diseases. Patients were diagnosed with type IIb autoimmune CSU (aiCSU) if all 3 tests were positive: autologous serum skin test (ASST), basophil histamine release assay (BHRA) and/or basophil activation test (BAT), and IgG autoantibodies against FcεRIα/IgE detected by immunoassay. Results Twenty-eight percent of CSU patients had at least 1 autoimmune disease. The most prevalent autoimmune diseases were Hashimoto's thyroiditis (HT) (≥ 21%) and vitiligo (2%). Two percent of CSU patients had ≥ 2 autoimmune diseases, most frequently HT plus vitiligo. Comorbid autoimmune diseases, in patients with CSU, were associated with female sex, a family history of autoimmune diseases, and higher rates of hypothyroidism and hyperthyroidism (P < 0.001). Presence of autoimmune diseases was linked to aiCSU (P = 0.02). The risks of having autoimmune diseases were 1.7, 2.9 and 3.3 times higher for CSU patients with a positive ASST, BHRA and BAT, respectively. In CSU patients, markers for autoimmune diseases, antinuclear antibodies and/or IgG anti-thyroid antibodies were associated with non-response to omalizumab treatment (P = 0.013). Conclusions In CSU, autoimmune diseases are common and linked to type IIb autoimmune CSU. Our results suggest that physicians assess and monitor all adult patients with CSU for signs and symptoms of common autoimmune diseases, especially HT and vitiligo.

만성 실질성 간질환 환자 혈청에서 Basic Fibroblast Growth Factor 및 Angiogenin 농도의 변동

백인규(In Kyu Paik),이숭환(Soong Hwan Lee),조윤주(Yun Ju Cho),이성희(Sung Hee Lee),김홍주(Hong Ju Kim),남승우(Seung Woo Nam),고희관(Hee Kwan Koh),이창범(Chang Beom Lee),박동일(Dong Il Park),조영중(Yong Jung Cho) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.6

N/A Background/Aims: Liver fibrosis by the progression of the chronic process of the liver disease induces deformed microcirculations of the hepatic lobules and this eventually resulted in portal hypertension. Angiogenic stimulant factors are physiologically activated in order to repair the tissue damage. Overexpression of angiogenic factors, however, can stimulate neovascularization as in a formation of the hypervascular tumor that liberates uncontrolled overgrowing of the tumor cells. To elucidate the dynamic changes of the serum concentration of basic fibroblast growth factor(bFGF) and angiogenin in chronic liver diseases, this study is intended to employ an ELISA out of pathologically proven patients. Methods: Sera taken out of the 44 patients with chronic persistent hepatitis(5 cases), chronic active hepatitis(6 cases), liver cirrhosis(19 cases) and hepatocellular carcinoma(14 cases) were tested for bFGF and angiogenin employing Quantikine' ELISA Kits (R & D Systems Inc. Minneapolis, MN) that pathological diagnosis was proven )ater. The statistical analysis was evaluated by students t-test. Results: Serum mean value and standar<I error of bFGF concentration(pg/ml) was 11.851.98 in 19 cases of liver cirrhosis, 9.86+2.35 in 14 cases of hepatocellular carcinoma, 9.48+4.57 in 6 cases of chronic active hepatitis, and 8.29+2.63 in 5 cases of chronic persistent hepatitis. Mean value and standard error of angiogenin concentration (ng/ml) of the sera was 238.92+50.95 in 5 cases of chronic persistent hepatitis, 184.47+12.75 in 6 cases of chronic active bepatitis, 131.36+10.99 in 19 cases of liver cirrhosis, and 211.03+19.08 in 14 cases of hepatocellular carcinoma, respectively. Serum angiogenin concentration in liver cirrhosis was significantly lower than that in chronic persistent hepatitis(p=0.0033(I), and than that in chronic active hepatitis(p=0.018673). Angiogenin concentration in hepatocellular carcinoma was very significantly elevated, when compared with the level of the liver cirrhosis investigated (p=0.000569). Conclusions: These data suppoit that persistent inflammatory insults in chronic hepatitis were compensated by the elevation of angiogenin, but complete fibrosis as in liver cirrhosis showed the depressed level of angiogenin. Again, emerging of the hepatocellular carcinoma is accompanying with the elevated stitnuli of angiogenin for the neovascularization. In contrast, bFGF in this study was statistically not significant but may be related with fibrosis and reconstruction of microvascular system accompanying with progression of chronic parenchymal liver diseases to liver cirrhosis.(Korean J Gastroenterol 1996; 28:806-814)

Growth Differentiation Factor 15 Predicts Chronic Liver Disease Severity

( Eaum Seok Lee ),( Seok Hyun Kim ),( Hyun Jin Kim ),( Kyung Hee Kim ),( Byung Seok Lee ),( Bon Jeong Ku ) 대한간학회 2017 Gut and Liver Vol.11 No.2

Background/Aims: Growth differentiation factor 15 (GDF-15) belongs to the transforming growth factor-β superfamily. GDF-15 is emerging as a biomarker for several diseases. The aim of this study was to determine the clinical performances of GDF-15 for the prediction of liver fibrosis and severity in chronic liver disease. Methods: The serum GDF-15 levels were examined via enzyme immunoassay in 145 patients with chronic liver disease and 101 healthy individuals. The patients with chronic liver disease consisted of 54 patients with chronic hepatitis, 44 patients with compensated liver cirrhosis, and 47 patients with decompensated liver cirrhosis. Results: Of the patients with chronic liver diseases, the decompensated liver cirrhosis patients had an increased serum GDF-15 (3,483 ng/L) level compared with the patients with compensated liver cirrhosis (1,861 ng/L) and chronic hepatitis (1,232 ng/L). The overall diagnostic accuracies of GDF-15, as determined by the area under the receiver operating characteristic curves, were as follows: chronic hepatitis= 0.656 (>574 ng/L, sensitivity, 53.7%; specificity, 79.2%), compensated liver cirrhosis=0.886 (>760 ng/L, sensitivity, 75.6%; specificity, 92.1%), and decompensated liver cirrhosis= 0.984 (>869 ng/L, sensitivity, 97.9%; specificity, 94.1%). Conclusions: This investigation represents the first study to demonstrate the availability of GDF-15 in chronic liver disease. GDF-15 comprised a useful biomarker for the prediction of liver fibrosis and severity in chronic liver disease. (Gut Liver 2017;11:276-282)

Effects of residential greenness on clinical outcomes of patients with chronic kidney disease: a large-scale observation study

( Jae Yoon Park ),( Jiyun Jung ),( Yong Chul Kim ),( Hyewon Lee ),( Ejin Kim ),( Yon Su Kim ),( Ho Kim ),( Jung Pyo Lee ) 대한신장학회 2021 Kidney Research and Clinical Practice Vol.40 No.2

Background: As industrialization and urbanization are accelerating, the distribution of green areas is decreasing, particularly in developing countries. Since the 2000s, the effects of surrounding greenness on self-perceived health, including physical and mental health, longevity, and obesity have been reported. However, the effects of surrounding green space on chronic kidney disease are not well understood. Therefore, we investigated the impact of residential greenness on the mortality of chronic kidney disease patients and progression from chronic kidney disease to end-stage renal disease (ESRD). Methods: Using a large-scale observational study, we recruited chronic kidney disease patients (n = 64,565; mean age, 54.0 years; 49.0% of male) who visited three Korean medical centers between January 2001 and December 2016. We investigated the hazard ratios of clinical outcomes per 0.1-point increment of exposure to greenness using various models. Results: During the mean follow-up of 6.8 ± 4.6 years, 5,512 chronic kidney disease patients developed ESRD (8.5%) and 8,543 died (13.2%). In addition, a 0.1-point increase in greenness reduced all-cause mortality risk in chronic kidney disease and ESRD patients and progression of chronic kidney disease to ESRD in a fully adjusted model. The association between mortality in ESRD patients and the normalized difference vegetation index was negatively correlated in people aged >65 years, who had normal weight, were nonsmokers, and lived in a nonmetropolitan area. Conclusion: Chronic kidney disease patients who live in areas with higher levels of greenness are at reduced risk of all-cause mortality and progression to ESRD.

EQ-5D 지수를 활용한 만성질환별 삶의 질의 성별 및 연령에 따른 변화: 2017~2019년 국민건강영양조사 자료를 이용하여

채경준,박세호,송승아,이준규,홍종민,김남준 한국농촌의학.지역보건학회 2023 농촌의학·지역보건 Vol.48 No.2

Objectives: This study analyzed the decline in quality of life according to age in the chronic disease patient group, quantified it as a quantitative index, and compared it by sex and chronic disease. Methods: In the 2017-2019 Korea National Health and Nutrition Examination Survey database, 11,473 adults aged 19 years or older, excluding cancer patients, were analyzed for age-specific changes in the EQ-5D Index by chronic disease. The decline in quality of life according to age in patients with chronic diseases was analyzed by linear regression analysis while controlling for general characteristics. Then, linear regression analysis was performed according to sex. Results: In the case of the control group, the quality of life decreased by 0.0004 for every 1-year increase in age(P<0.001). By chronic disease, asthma(β=0.0019, P<0.001), arthritis(β=0.0017, P=0.002), thyroid disease( β=0.0016, P=0.015), dyslipidemia(β=0.0011, P=0.020), and hypertension(β=0.0009, P=0.027) mostly showed a greater decrease in quality of life than the control group. In addition, when divided into two groups by sex, hypertension(β=0.0012, P=0.029), thyroid disease(β=0.0041, P=0.038), and arthritis(β=0.0022, P<0.001) showed a significant decrease in quality of life only in male. Diabetes(β=0.0056, P=0.038), dyslipidemia( β=0.0022, P=0.001) significantly decreased quality of life only in female. Conclusions: Chronic disease had a negative impact on patients perception of quality of life, and the more severe the pain and activity limitation due to the chronic disease, the more severe it was. It also showed different patterns according to sex. Therefore, it is necessary to allocate more medical resources and provide policy support to prevent chronic diseases, which are serious social problems.