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Ryou IS, Lee SW, Mun H, Lee JK, Chun S, Cho K. Trend of incidence rate of age-related diseases: results from the National Health Insurance Service-National Sample Cohort (NHIS-NSC) database in Korea: a cross- sectional study. BMC Geriatr 2023; 23:840. [PMID: 38087197 PMCID: PMC10714524 DOI: 10.1186/s12877-023-04578-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/07/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND This study aimed to identify and select age-related diseases (ARDs) in Korea, which is about to have a super-aged society, and to elucidate patterns in their incidence rates. METHODS The National Health Insurance Service-National Sample Cohort, comprising 1 million health insurance and medical benefit beneficiaries in Korea from 2002 to 2019, was utilized. We selected 14 diseases with high disease burden and prevalence among Koreans from the 92 diseases defined in the Global Burden of Diseases, Injuries, and Risk Factors Study as ARDs. The annual incidence rate represented the number of patients newly diagnosed with an ARD each year from 2006 to 2019, excluding those with a history of ARD diagnosis from 2002 to 2005. The incidence rate by age was categorized into 10-year units based on age as of 2019. The number of patients with ARDs in each age group was used as the numerator, and the incidence rate for each age group was calculated with the age group as the denominator. RESULTS Regarding the annual incidence rates of ARDs from 2006 to 2019, chronic obstructive pulmonary disease, congestive heart failure, and ischemic heart disease decreased annually, whereas dyslipidemia, chronic kidney disease, cataracts, hearing loss, and Parkinson's disease showed a significant increase. Hypertension, diabetes, cerebrovascular disease, osteoporosis, osteoarthritis, and age-related macular degeneration initially displayed a gradual decrease in incidence but exhibited a tendency to increase after 2015. Concerning age-specific incidence rates of ARDs, two types of curves emerged. The first type, characterized by an exponential increase with age, was exemplified by congestive heart failure. The second type, marked by an exponential increase peaking between ages 60 and 80, followed by stability or decrease, was observed in 13 ARDs, excluding congestive heart failure. However, hypertension, ischemic heart disease, cerebrovascular disease, chronic obstructive pulmonary disease, and hearing loss in men belonged to the first type. CONCLUSIONS From an epidemiological perspective, there are similar characteristics in age-specific ARDs that increase with age, reaching a peak followed by a plateau or decrease in Koreans.
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Affiliation(s)
- In Sun Ryou
- Department of Familial Medicine, Ewha Womens University Medical Center, Ewha Womens University School of Medicine, Seoul, Republic of Korea
| | - Sang Wha Lee
- Department of Familial Medicine, Ewha Womens University Medical Center, Ewha Womens University School of Medicine, Seoul, Republic of Korea
| | - Hanbit Mun
- Department of Family Medicine and Geriatrics, National Health Insurance Service Ilsan Hospital, Goyang-si, Republic of Korea
| | - Jae Kwang Lee
- Department of Research and Analysis, National Health Insurance Service Ilsan Hospital, Goyang-si, Republic of Korea
| | - SungYoun Chun
- Department of Research and Analysis, National Health Insurance Service Ilsan Hospital, Goyang-si, Republic of Korea
| | - Kyunghee Cho
- Department of Family Medicine and Geriatrics, National Health Insurance Service Ilsan Hospital, Goyang-si, Republic of Korea.
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Jee Y, Ryu M, Ryou IS, Back JH, Cho SI, Hwang SS. Mediators of the Effect of Obesity on Stroke and Heart Disease Risk: Decomposing Direct and Indirect Effects. J Epidemiol 2023; 33:514-520. [PMID: 35781427 PMCID: PMC10483103 DOI: 10.2188/jea.je20210476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 06/15/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The prevalence of overweight and obesity are well known risk factors of atherosclerotic cardiovascular disease (ASCVD). We aimed to examine the association between body mass index (BMI) and ASCVD over a 23-year follow-up in young adults. We also qualified how much of the effects of obesity on ASCVD were mediated through blood pressure, cholesterol, and glucose. METHODS Data are from the Korean Life Course Health Study, a cohort study of 226,955 Korean young adults aged 20-39. At baseline, the participants undertook routine health assessments where their BMI was measured in 1992-1994; and the metabolic mediators including systolic blood pressure (SBP), fasting serum glucose (FSG), and total cholesterol (TC) were re-measured in 2002-2004. The main outcomes of the study include incident events of ischemic heart disease (IHD), stroke, and ASCVD between 2005 and 2015. Cox proportional model was used to calculate adjusted hazard ratios (HRs) for ASCVD. RESULTS In both men and women, the direct effect of BMI on ASCVD was greater than the indirect effect. The percentage of excess HR of BMI mediated by all of the metabolic mediators, including SBP, FSG, and TC, was 45.7% for stroke and 18.7% for IHD in men and 27.5% for stroke and 17.6% for IHD in women. CONCLUSION High BMI in young adults increases the risk of metabolic mediators in their middle age, and metabolic mediators explain the adverse effects of high BMI on stroke risk than IHD risk.
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Affiliation(s)
- Yongho Jee
- Advanced Biomedical Research Institute Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - Mikyung Ryu
- Department of Sports and Health Science, College of Human-Centered Convergence, Kyonggi University, Suwon, Republic of Korea
| | - In Sun Ryou
- Department of Family Medicine, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - Joung Hwan Back
- Health Insurance Policy Research Institute, Wonju, Republic of Korea
| | - Sung-il Cho
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Seung Sik Hwang
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
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Ryou IS, Kim JY, Park HY, Oh S, Kim S, Kim HJ. Do statins benefit low-risk population for primary prevention of atherosclerotic cardiovascular disease: A retrospective cohort study. Front Med (Lausanne) 2022; 9:1024780. [PMID: 36405617 PMCID: PMC9669657 DOI: 10.3389/fmed.2022.1024780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
The reported beneficial effects of statins on cardiovascular outcome based on risk assessment are inconsistent. Therefore, we investigated statin therapy effectiveness for the primary prevention of cardiovascular disease (CVD), according to the Korean Risk Prediction Model (KRPM). Subjects aged 40–79 years with low density lipoprotein cholesterol (LDL-C) of < 190 mg/dL and without CVD history were categorized as statin users or non-users using the National Health Insurance Service-National Sample Cohort (NHIS-NSC) database, Korea, 2002–2015. The 10-year atherosclerotic CVD (ASCVD) risk was calculated using the validated KRPM and categorized as low, borderline, intermediate, or high-risk groups; the incidence of major adverse cardiovascular events (MACEs) was compared over a mean follow-up period of 5.7 years using Cox proportional hazard models. The MACE incidence risk was decreased in statin users [hazard ratio (HR) 0.90, 95% confidence interval (CI) (0.84–0.98)]. However, there was an increased risk of MACE incidence in low-risk statin users [HR 1.80, 95% CI (1.29–2.52)], and no significant relationship was identified between statin use and MACE in the borderline [HR 1.15, 95% CI (0.86–1.54)] and intermediate-risk [HR 0.94, 95% CI (0.85–1.03)] groups. The risk of MACE incidence decreased only in the high CVD risk group among statin users. Statin use is not associated with MACE reduction in low- to intermediate-risk participants. Therefore, individuals with LDL-C level of < 190 mg/dL and low ASCVD risk should consider statin therapy only when CVD risk is proved obvious using an appropriate ASCVD risk tool.
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Affiliation(s)
- In Sun Ryou
- Department of Family Medicine, Ewha Womans University Medical Center, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Ju Young Kim
- Department of Family Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea
- *Correspondence: Ju Young Kim
| | - Hwa Yeon Park
- Department of Family Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Sehun Kim
- Cardiovascular Center, Hallym University Medical Center, Seoul, South Korea
| | - Hwa Jung Kim
- Department of Preventive Medicine, Ulsan University College of Medicine, Seoul, South Korea
- Department of Clinical Epidemiology and Biostatistics, ASAN Medical Center, Seoul, South Korea
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Ryou IS, Chang J, Son JS, Ko A, Choi S, Kim K, Kim SM, Park SM. Association between CVDs and initiation and adherence to statin treatment in patients with newly diagnosed hypercholesterolaemia: a retrospective cohort study. BMJ Open 2021; 11:e045375. [PMID: 33827840 PMCID: PMC8031030 DOI: 10.1136/bmjopen-2020-045375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To evaluate the association between incident cardiovascular disease (CVD) and initiation and adherence to statin treatment for primary prevention of CVD in patients with newly diagnosed hypercholesterolaemia. DESIGN A population-based retrospective cohort study. SETTING This study used National Health Insurance Service-Health Screening Cohort (NHIS-HEALS) from Republic of Korea. PARTICIPANTS This study included 11 320 participants without previous history of CVD aged between 40 and 79 years who had elevated total cholesterol level (more than 240 mg/dL) and had initiated statin treatment within 24 months of the national health screening from 2004 to 2012 identified in the NHIS-HEALS. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome, CVD, was defined as first-ever admission or death due to ischaemic heart disease, acute myocardial infarction, revascularisation or stroke, or December 31 2013. The HRs of CVD according to statin adherence were calculated according to stratification by Systematic COronary Risk Evaluation. RESULTS Early statin initiation significantly lowered risk of CVD outcomes compared with late initiation (HR of late statin user, 1.24; 95% CI 1.02 to 2.51). Among early initiators, statin discontinuers had a significantly higher risk for CVD compared with persistent users (HR, 1.71; 95% CI 1.10 to 2.67), while statin reinitiators had an attenuated risk increase (HR 1.34, 95% CI 0.79 to 2.30). CONCLUSIONS Among statin users with newly diagnosed hypercholesterolaemia, early statin initiation is associated with lower CVD risk compared with late initiation. Furthermore, statin discontinuation is associated with increased risk of CVD, but reinitiation attenuated the risk.
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Affiliation(s)
- In Sun Ryou
- Family Medicine, Ewha Womans University School of Medicine, Seoul, Korea (the Republic of)
| | - Jooyoung Chang
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Joung Sik Son
- Family Medicine, Seoul National University Hospital, Jongno-gu, Korea (the Republic of)
| | - Ahryoung Ko
- Family Medicine, Seoul National University Hospital, Jongno-gu, Korea (the Republic of)
| | - Seulggie Choi
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Kyuwoong Kim
- Division of Cancer Control and Policy; National Cancer Survivorship Center, National Cancer Control Institute, National Cancer Center, Gyeonggi-do, Korea (the Republic of)
| | - Sung Min Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Sang Min Park
- Department of Family Medicine, Seoul National University Hospital, Jongno-gu, Korea (the Republic of)
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Park SY, Lee K, Um YJ, Paek S, Ryou IS. Association between Physical Activity and Depressive Mood among Korean Adults with Chronic Diseases. Korean J Fam Med 2018; 39:185-190. [PMID: 29788708 PMCID: PMC5975990 DOI: 10.4082/kjfm.2018.39.3.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 05/26/2017] [Accepted: 07/11/2017] [Indexed: 11/18/2022] Open
Abstract
Background This study aimed to investigate the association between physical activity and depressive mood among Korean adults with chronic diseases. Methods This study analyzed the 2014 Korean National Health and Nutrition Examination Survey data. The study was restricted to participants aged ≥20 years who had completed the survey and were not diagnosed as having depression. After exclusion, 4,676 participants were included in the final analysis. Subjects were categorized according to their level of physical activity. Physical activity was assessed using the International Physical Activity Questionnaire. Patients were categorized into two groups according to depressive traits (normal and depressed) based on the 9-item Patient Health Questionnaire scores. Results In univariate analysis, significant associations were observed between the level of physical activity and depressive mood in both chronic and healthy groups. Participants with higher levels of physical activity had lower risks of depressive mood than those with lower levels of physical activity, especially patients with chronic diseases (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.31–0.73). Similar trends were observed in multivariate logistic regression analysis (OR, 0.54; 95% CI, 0.34–0.88). Conclusion Physical activity significantly decreased the development of depressive mood among Korean adults with chronic diseases compared with their healthy counterparts. Physical activity must be emphasized in patients with chronic diseases.
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Affiliation(s)
- Seon-Young Park
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kiheon Lee
- Department of Family Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yoo Jin Um
- Department of Family Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Suekyoung Paek
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - In Sun Ryou
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
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Lee SH, Yun JM, Kim SH, Seo YG, Min H, Chung E, Bae YS, Ryou IS, Cho B. Association between bone mineral density and nonalcoholic fatty liver disease in Korean adults. J Endocrinol Invest 2016; 39:1329-1336. [PMID: 27561910 DOI: 10.1007/s40618-016-0528-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE Nonalcoholic fatty liver disease (NAFLD) is associated with various metabolic abnormalities that can increase the risk of an osteoporotic fracture. Across the few previous studies of the association between NAFLD and bone mineral density (BMD), the association was not consistent. We examined the association between BMD and NAFLD in generally healthy adults. METHODS The subjects who visited the Seoul National University Hospital for health checkup between 2005 and 2015 were included. Men aged more than 40 and postmenopausal women were included. Lumbar spine and femoral neck (FN) BMD were measured using dual-energy X-ray absorptiometry. Liver ultrasonography was conducted to evaluate the extent of fatty changes. After excluding subjects with a secondary cause of liver disease such as heavy drinking or viral hepatitis, multivariable linear regression analysis adjusted for possible cofactors was performed to investigate the association between BMD and NAFLD. RESULTS A total of 6634 subjects was included in this study (men:women = 3306:3328). Multivariate regression analysis revealed a significant negative association between FN BMD and NAFLD in men (β = -0.013, p = 0.029). However, there was a positive correlation between lumbar spine BMD and NAFLD in postmenopausal women (β = 0.022, p = 0.005). CONCLUSIONS Moderate or severe NAFLD exerted a detrimental effect on FN BMD in men. However, moderate or severe NAFLD had a positive effect on lumbar spine BMD in postmenopausal women. Potential sex-specific differences of the effect of NAFLD on BMD need to be elucidated further.
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Affiliation(s)
- S H Lee
- Department of Family Medicine, Center for Health Promotion and Optimal Aging, Health Promotion Center for Cancer survivor, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-799, Republic of Korea
| | - J M Yun
- Department of Family Medicine, Center for Health Promotion and Optimal Aging, Health Promotion Center for Cancer survivor, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-799, Republic of Korea
| | - S H Kim
- Department of Family Medicine, Center for Health Promotion and Optimal Aging, Health Promotion Center for Cancer survivor, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-799, Republic of Korea
| | - Y G Seo
- Department of Family Medicine, Center for Health Promotion and Optimal Aging, Health Promotion Center for Cancer survivor, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-799, Republic of Korea
| | - H Min
- Department of Family Medicine, Center for Health Promotion and Optimal Aging, Health Promotion Center for Cancer survivor, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-799, Republic of Korea
| | - E Chung
- Department of Family Medicine, Center for Health Promotion and Optimal Aging, Health Promotion Center for Cancer survivor, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-799, Republic of Korea
| | - Y S Bae
- Department of Family Medicine, Center for Health Promotion and Optimal Aging, Health Promotion Center for Cancer survivor, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-799, Republic of Korea
| | - I S Ryou
- Department of Family Medicine, Center for Health Promotion and Optimal Aging, Health Promotion Center for Cancer survivor, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-799, Republic of Korea
| | - B Cho
- Department of Family Medicine, Center for Health Promotion and Optimal Aging, Health Promotion Center for Cancer survivor, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-799, Republic of Korea.
- Advanced Institutes of Convergence Technology, Seoul National University, 145 Gwanggyo-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 443-270, Republic of Korea.
- Institute on Aging, Seoul National University College of Medicine, 71 Ihwajang-Gil, Jongno-gu, Seoul, 110-810, Republic of Korea.
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