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.

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.

우리나라 성인의 구강질환과 만성질환의 관련성

천혜원 ( Hye Won Cheon ),유미선 ( Mi Sun Yu ),최미혜 ( Mi Hye Choi ) 한국치위생학회 2012 한국치위생학회지 Vol.12 No.2

Objectives : The purpose of this research is to use data from the third year of the 4th National Health and Nutrition Examination Survey to study relationship between oral disease and chronic disease that generally persist from 6 months to over a year, or more specifically, circulatory disease, diabetes, and osteoporosis. Methodes : Of the data from the third year of the 4th National Health and Nutrition Examination Survey, 7,893 adults over 19 years old who completed medical examination, health survey, and nutrition survey were selected as the final research subjects. Relationship between chronic disease and oral disease was analyzed by cross tabulation (χ2-test) and logistic regression analysis using SPSSWIN ver 18.0. Results : 1. Differences in the rate of prevalence of periodontal disease and the rate of prevalence of missing teeth were statistically significant with respect to age, gender, marital status, education level, residential area, income level, and occupation. Rate of prevalence of dental caries was statistically significant with respect to age, education level, and income level. 2. After examining the relationship between existence of chronic disease as diagnosed by doctor with oral disease, rate of prevalence of periodontal disease and missing teeth, hypertension, hyperlipidemia, stroke, myocardial infarction, angina, diabetes, and osteoporosis showed statiscally significant difference. 3. Examination of rate of prevalence of chronic disease with respect to oral disease, periodontal disease and missing teeth exerted statistically significant influence on hypertension, hyperlipidemia, stroke, myocardial infarction, angina, diabetes, and osteoporosis (p<0.05), while dental caries did not have statistically significant effect. 4. Analysis of coupling effect of periodontal disease and missing teeth on chronic disease showed that they were related in all chronic diseases examined in this study (hypertension, hyperlipidemia, stroke, myocardial infarction, angina, diabetes, and osteoporosis) (p<0.05). Conclusions : Periodontal disease and missing teeth were found to increase the rate of prevalence of chronic disease.

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.

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)

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.

The Effect of Chronic Disease Management Program on the Risk of Complications in Patients With Hypertension in Korea

Lee Sang Ah,Park Hyeki,Kim Woorim,Song Sun Ok,Lim Hyunsun,Chun Sung-Youn 대한의학회 2022 Journal of Korean medical science Vol.37 No.31

Background: A chronic disease management program was implemented in April 2012 to lower out-of-pocket costs for repeat visits to the same clinic. The aim of this study was to investigate the association between participating in this program and the onset of complications among patients with hypertension using whole-nation claims data. Methods: We used National Health Insurance Service data (2011–2018) and patients with newly detected hypertension from 2012 to 2014 were selected. Chronic disease management program reduces the out-of-pocket expenses of consultation fee from 30% to 20% when patients enroll in this program by agreeing to visit the same clinic for the treatment of hypertension or diabetes. As the dependent variable, acute myocardial infarction (MI), stroke, chronic kidney disease (CKD), and heart failure (HF) were selected. For analysis, cox proportional hazards model was used. Results: Total participants were 827,577, among which 102,831(12.6%) subjects participated in the chronic disease management. Participants of the chronic disease management program were more likely to show lower hazard ratios (HRs) than those of non-participants in terms of all complications (MI: HR, 0.75; 95% confidence interval [CI], 0.68–0.82; stroke: HR, 0.75; 95% CI, 0.72–0.78; CKD: HR, 0.90; 95% CI, 0.85–0.96; HF: HR, 0.56; 95% CI, 0.52–0.61). Conclusion: The results showed that participants of the chronic disease management program were less likely to have hypertension complications compared to non-participants. Enhancing the participation rate may be related to better outcomes and reducing medical expenses among patients with chronic diseases.

Variation in the rate of well-controlled status of chronic disease by income level in Korea : 2010 to 2015

Choi, Kun Kug,Kim, Seung Hyuk,Yoo, Kyung Don,Kim, Hyo Jin,Park, Ji In,Hwang, Subin,Chin, Ho Jun,Ku, Ho Suk Williams & Wilkins Co 2018 Medicine Vol.97 No.34

<P><B>Abstract</B></P><P>Although it is known that the prevalence rates of chronic diseases depend on income level, annual changes of the control rate have not been evaluated. In this cross-sectional study, we analyzed the variation in rate of well-controlled status of chronic diseases based on the annual income level using data from national nutrition surveys conducted between 2010 and 2015.</P><P>Prevalence and controlled rate of hypertension, diabetes mellitus, and chronic kidney disease were analyzed in relation to annual income levels, using data from the Korea National Health and Nutrition Examination Survey (KNHANES), obtained from 2010 to 2015. We also analyzed the incidence of use of necessary medical care services and the reasons cited for not using these services.</P><P>The data of 28,759 persons were analyzed. The average age increased, and sex ratio remained unchanged over the study period. Although the prevalence rates of diabetes increased, that of increased glycated hemoglobin gradually decreased. A significant change has been shown recently on the prevalence rates of hypertension patients. The prevalence rates of chronic kidney disease stayed unchanged during the course of the study period. The incidence of controlled chronic disease status increased with the income level, and over time during the study, in the case of diabetes and chronic kidney disease. However, while controlled hypertension status rate increased from year to year, there was no trend of increase with increased income level. The incidence of participants not using hospital services declined with increasing income level, but the rate of economic causes being cited as reasons for not using hospital services increased over time and showed no change among income levels. Results of regression analysis of prevalence rates of chronic diseases by income level showed that lower income groups tended to have higher odds ratios for chronic diseases.</P><P>Our results suggest that the incidence rate of well-controlled chronic disease status remains low in lower income groups. These results imply that financial status may play an important role in the management of chronic diseases.</P>

Relationship of depression, chronic disease, self-rated health, and gender with health care utilization among community-living elderly

Han, Kyu-Man,Ko, Young-Hoon,Yoon, Ho-Kyoung,Han, Changsu,Ham, Byung-Joo,Kim, Yong-Ku Elsevier 2018 Journal of affective disorders Vol.241 No.-

<P><B>Abstract</B></P> <P><B>Background</B></P> <P>We investigated the interactive effects of depressive symptoms and chronic diseases on health care utilization among elderly people and explored the potential moderating effect of gender and the mediating effect of self-rated health (SRH) on the association between depressive symptoms and health care utilization.</P> <P><B>Method</B></P> <P>We analyzed data from 5223 people aged 60 years or older living in the community from the Korea Welfare Panel Study in 2015. Depressive symptoms were measured using an 11-item version of the Center for Epidemiologic Studies Depression (CES-D-11) Scale and morbidity within 28 disease categories was assessed. Health care utilization was evaluated as the number of outpatient visits (OV), number of hospitalizations (NH), and number of days spent in the hospital (DH) during past year. Hierarchical moderated regression analyses were applied to investigate the interactive effects. We also adopted the mediation analysis method by Hayes and Preacher.</P> <P><B>Results</B></P> <P>A significant interactive effect of CES-D-11 score and chronic disease on OV was found. A positive correlation between CES-D-11 score and OV was only observed in those with chronic disease. Gender had a moderating effect on the association of depression symptoms with OV, NH, and DH among elderly people with chronic disease. SRH had mediating effects on the association of CES-D-11 with OV, NH, and DH only among those with chronic disease.</P> <P><B>Limitations</B></P> <P>The severity or multimorbidity of chronic diseases, which could affect health care utilization among elderly were not considered.</P> <P><B>Conclusions</B></P> <P>We elucidated the complex aspects of the relationship between depressive symptoms and chronic disease and their interactive effects on health care utilization among elderly people, and identified important roles of gender and SRH.</P> <P><B>Highlights</B></P> <P> <UL> <LI> A nationally representative sample of 5223 community-living elderly (≥60 years). </LI> <LI> Significant interactive effect of depression and chronic disease on health care use. </LI> <LI> Gender moderated association of depression with health care use in chronically ill. </LI> <LI> Self-rated health mediated the association of depression with health care use. </LI> <LI> The mediation by self-rated health was moderated by gender and chronic disease. </LI> </UL> </P>

An Investigation into Chronic Conditions and Diseases in Minors to Determine the Socioeconomic Status, Medical Use and Expenditure According to Data from the Korea Health Panel, 2015

Jong-Hoon Moon 질병관리본부 2019 Osong Public Health and Research Persptectives Vol.10 No.6

Objectives: This study compared the socioeconomic status, medical use and expenditures for infants (1-5 years), juveniles (6-12 years), and adolescents (13-19 years) with a chronic condition or disease to determine factors affecting health spending. Methods: Data from 3,677 minors (< 20 years old, without disabilities) were extracted from the Korea Health Panel (2015) database. Results: Minors with chronic conditions or diseases were older (juveniles, and adolescents; p < 0.001), and included a higher proportion of Medicaid recipients (p = 0.004), a higher use of hospital outpatient care (p < 0.001), and higher medical expenditure (p < 0.001) compared to minors without chronic conditions or diseases. Boys were more likely to have a chronic condition or disease than girls (p = 0.036). Adolescents and juveniles were more likely than infants to have a chronic condition or disease (p = 0.001). Medicaid recipients were more likely to have a chronic condition or disease than those who were not Medicaid recipients (p = 0.008). Minors who had been hospital outpatients were more likely to have a chronic condition or disease, compared with minors who had not been an outpatient (p = 0.001). Having a chronic condition or disease, was a factor increasing medical expenditure (p = 0.001). Medical expenditure was higher in infants than in juveniles and adolescents (p = 0.001). Infants had higher rates of medical use when compared with juveniles and adolescents (p = 0.001). Conclusion: These findings suggest that systematic health care management for minors with chronic conditions or diseases, is needed.