Epidemiology and Health

Original Articles

Epidemiological data on nutritional disorders and outcomes in hospitalized Thai children: an analysis of data from the National Health Database 2015-2019: Suchaorn Saengnipanthkul, Jeeraparn Phosuwattanakul, Kaewjai Thepsuthammarat, Nalinee Chongviriyaphan; Epidemiol Health. 2022;44:e2022047. Published online May 16, 2022; DOI: https://doi.org/10.4178/epih.e2022047

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Abstract

OBJECTIVES
Malnutrition in hospitalized patients is a frequently overlooked health issue. We aimed to assess the prevalence and pattern of nutritional disorders in hospitalized Thai children from the National Health Database.

METHODS

Hospitalized children aged 1 month to 18 years diagnosed with nutritional disorders between 2015 and 2019 were retrospectively reviewed using the National Health Security Office data. Based on the International Classification of Diseases, 10th revision, Clinical Modification, nutritional disorders were classified into 3 major forms of malnutrition: undernutrition (E40-E46), overweight and obesity (E66), and micronutrient deficiencies (D50-D53, E50-E56, E58, E60-E61, and E63).

RESULTS

Out of 5,188,033 hospitalized children, malnutrition was identified in 115,254 (2.2%). Protein-energy malnutrition (PEM), overweight and obesity, and micronutrient deficiencies were prevalent in 0.21%, 0.27%, and 1.81%, respectively. Among those with micronutrient deficiencies, 95.0% had iron deficiency anemia, 2.2% had vitamin D deficiency, and 0.7% had zinc deficiency. Children aged under 5 years mostly had PEM, followed by iron deficiency anemia. Teenagers commonly had obesity and vitamin D deficiency. Patients with PEM who were admitted with common diseases had significantly longer hospital stays and higher hospital costs and mortality rates than those without PEM.

CONCLUSIONS

Hospitalized children had various nutritional disorders, particularly PEM, which was associated with higher morbidity and mortality. Nutritional screening tools should be utilized for the early detection and treatment of malnutrition. Specific International Classification of Diseases codes for nutritional care services and intervention should be available. Additionally, nutritional interventions should be reimbursed, along with nutritional education and empowerment of healthcare providers, to improve hospital care service and improve patient outcomes.

Summary

Key Message
Malnutrition is common among hospitalized Thai children, particularly protein energy malnutrition; it increases mortality, length of hospital stay, and hospital costs as well as exerts long-term effects on growth and development. Prevalence of overweight and obesity is increasing over the past 5 years, the vast majority involved patients 5 – 13 years of age.

Citations

Citations to this article as recorded by

The Low Sensitivity and Specificity of a Nutrition Screening Tool in Real Circumstances in a Tertiary Care Hospital Setting
Nithit Semsawat, Oraporn Dumrongwongsiri, Phanphen Phoonlapdacha
Children.2023; 10(4): 747. CrossRef

Model-based cost-effectiveness analysis of oral antivirals against SARS-CoV-2 in Korea: Youngji Jo, Sun Bean Kim, Munkhzul Radnaabaatar, Kyungmin Huh, Jin-Hong Yoo, Kyong Ran Peck, Hojun Park, Jaehun Jung; Epidemiol Health. 2022;44:e2022034. Published online March 12, 2022; DOI: https://doi.org/10.4178/epih.e2022034

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Abstract

OBJECTIVES
Many countries have authorized the emergency use of oral antiviral agents for patients with mild-to-moderate cases of coronavirus disease 2019 (COVID-19). We assessed the cost-effectiveness of these agents for reducing the number of severe COVID-19 cases and the burden on Korea’s medical system.

METHODS

Using an existing model, we estimated the number of people who would require hospital/intensive care unit (ICU) admission in Korea in 2022. The treatment scenarios included (1) all adult patients, (2) elderly patients only, and (3) adult patients with underlying diseases only, compared to standard care. Based on the current health system capacity, we calculated the incremental costs per severe case averted and hospital admission for each scenario.

RESULTS

We estimated that 236,510 COVID-19 patients would require hospital/ICU admission in 2022 with standard care only. Nirmatrelvir/ritonavir (87% efficacy) was predicted to reduce this number by 80%, 24%, and 17% when targeting all adults, adults with underlying diseases, and elderly patients (25, 8, and 4%, respectively, for molnupiravir, with 30% efficacy). Nirmatrelvir/ritonavir use is likely to be cost-effective, with predicted costs of US$8,878, US$8,964, and US$1,454, per severe patient averted for the target groups listed above, respectively, while molnupiravir is likely to be less cost-effective, with costs of US$28,492, US$29,575, and US$7,915, respectively.

CONCLUSIONS

In Korea, oral treatment using nirmatrelvir/ritonavir for symptomatic COVID-19 patients targeting elderly patients would be highly cost-effective and would substantially reduce the demand for hospital admission to below the capacity of the health system if targeted to all adult patients instead of standard care.

Summary

Korean summary
본 연구는 감염병 수리모형을 바탕으로 두가지 항바이러스제의 (nirmatrelvir/ritonavir와 molnupiravir) 비용 효익을 평가하였다. 본 모델에 따르면, 2022년 한국에서, 현재 의료시스템의 수용한계를 넘는 코로나 19 대유행이 발생할 때, nirmatrelvir/ritonavir 를 코로나 감염 및 증상 있는 고령층 환자들을 대상으로 투여할 경우 높은 비용 효익이 기대되고 (중증환자 1명 감소효과에$1,454 비용소요), 성인 환자 대상으로 투여할 경우, (molnupiravir이나 nirmatrelvir/ritonavir를 투여하지 않는) 일반 치료에 비해서 전체 입원 수요를 80% 줄일 것으로 기대된다.

Key Message
Given an expected high epidemic resurgence in 2022 that could exceed South Korea’s current health system capacity, oral treatment using nirmatrelvir/ritonavir for symptomatic COVID-19 patients may be a highly cost-effective solution if targeted to elderly patients ($1,454 per severe case averted) and substantially reduce the demand for hospital admission (80%, 188,478 patients) below the capacity of the health system if targeted to all adult patients compared to standard care.

Citations

Citations to this article as recorded by

Cost-Utility Model of Nirmatrelvir/Ritonavir in Brazil: Analysis of a Vaccinated Population
Ricardo R.A. Fernandes, Bruno M. Barros, Milene R. da Costa, Carlos A.S. Magliano, Bernardo R. Tura, Quenia Cristina D. Morais, Marisa Santos
Value in Health Regional Issues.2024; 40: 74. CrossRef
Cost-effectiveness of nirmatrelvir/ritonavir for high-risk adult outpatients with COVID-19 in Japan
Takahito Mizuno, Yu Kondo, Mikiyasu Sakai, Kenichi Saneyasu, Ryota Kojima, Yoshio Miyake
Journal of Infection and Chemotherapy.2024;[Epub] CrossRef
Impact of the Use of Oral Antiviral Agents on the Risk of Hospitalization in Community Coronavirus Disease 2019 Patients (COVID-19)
Terry Cheuk-Fung Yip, Grace Chung-Yan Lui, Mandy Sze-Man Lai, Vincent Wai-Sun Wong, Yee-Kit Tse, Bosco Hon-Ming Ma, Elsie Hui, Maria K W Leung, Henry Lik-Yuen Chan, David Shu-Cheong Hui, Grace Lai-Hung Wong
Clinical Infectious Diseases.2023; 76(3): e26. CrossRef
Nirmatrelvir plus ritonavir in COVID-19: a profile of its use
Hannah A. Blair
Drugs & Therapy Perspectives.2023; 39(2): 41. CrossRef
Cost-effectiveness analysis of ritonavir boosted nirmatrelvir for adult outpatients with mild to moderate COVID-19 in a European health system
Philip Wikman-Jorgensen, José María Ibarra, Carlos Devesa, Jorge Peris, Jara Llenas-García
European Journal of Internal Medicine.2023; 118: 133. CrossRef
Assessing the cost-effectiveness of annual COVID-19 booster vaccination in South Korea using a transmission dynamic model
Wongyeong Choi, Eunha Shim
Frontiers in Public Health.2023;[Epub] CrossRef
Multi-Faceted Analysis of COVID-19 Epidemic in Korea Considering Omicron Variant: Mathematical Modeling-Based Study
Youngsuk Ko, Victoria May Mendoza, Renier Mendoza, Yubin Seo, Jacob Lee, Jonggul Lee, Donghyok Kwon, Eunok Jung
Journal of Korean Medical Science.2022;[Epub] CrossRef
Adjusting non-pharmaceutical interventions based on hospital bed capacity using a multi-operator differential evolution
Victoria May P. Mendoza, Renier Mendoza, Jongmin Lee, Eunok Jung
AIMS Mathematics.2022; 7(11): 19922. CrossRef
The Possible Impact of Nationwide Vaccination on Outcomes of the COVID-19 Epidemic in North Korea: A Modelling Study
Sung-mok Jung, Jaehun Jung
Journal of Korean Medical Science.2022;[Epub] CrossRef
Medications for early treatment of COVID ‐19 in Australia
Adam Polkinghorne, James M Branley
Medical Journal of Australia.2022;[Epub] CrossRef
Comparative effectiveness of sotrovimab and molnupiravir for prevention of severe covid-19 outcomes in patients in the community: observational cohort study with the OpenSAFELY platform
Bang Zheng, Amelia C A Green, John Tazare, Helen J Curtis, Louis Fisher, Linda Nab, Anna Schultze, Viyaasan Mahalingasivam, Edward P K Parker, William J Hulme, Sebastian C J Bacon, Nicholas J DeVito, Christopher Bates, David Evans, Peter Inglesby, Henry D
BMJ.2022; : e071932. CrossRef
Treatment Options for Patients With Mild-to-Moderate Coronavirus Disease 2019 in Korea
Jaehyun Jeon, BumSik Chin
Journal of Korean Medical Science.2022;[Epub] CrossRef

Main results of the Korea National Hospital Discharge In-depth Injury Survey, 2004-2016: Sung Ok Hong, Boae Kim, Joongho Jo, Yunhyung Kwon, Yeon-Kyeng Lee, Youngtaek Kim; Epidemiol Health. 2020;42:e2020044. Published online June 20, 2020; DOI: https://doi.org/10.4178/epih.e2020044

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Abstract Summary PDF

Abstract

OBJECTIVES
The purpose of this study was to estimate the incidence of injuries and to identify their causes by classifying injuries according to various categories including age, sex, mechanism of injury, body parts injured, and place of injury.

METHODS

This study used data from the Korea National Hospital Discharge In-depth Injury Survey (KNHDIS) from 2004 to 2016. The KNHDIS is conducted annually by the Korea Centers for Disease Control and Prevention, and its survey population includes all hospitalized patients discharged from medical institutions that have 100 or more beds, such as hospitals, general hospitals, and secondary community health centers. The number of injured cases is weighted and estimated using the mid-year estimated population of each year.

RESULTS

The injury discharge rate steadily increased since 2004 (1,505 per 100,000 population in 2004, 2,007 per 100,000 population in 2016) and most injuries were unintentional (annual average of 94.7%). On average, during the 13-year study period, the injury rate for males was 1.5 times as high as for females. The 2 main causes of injury were consistently traffic accidents and falls. Notably, the rate of injuries resulting from falls rose by 1.7-fold from 463 to 792 per 100,000 people, and exceeded the rate of traffic accidents in 2016.

CONCLUSIONS

The incidence of injuries steadily increased after the survey was first conducted, whereas mortality resulting from injuries mostly remained unchanged. This suggests that effective strategies and interventions should be reinforced to reduce unintentional injuries.

Summary

Korean summary
질병관리본부가 2005년부터 구축하여 운영 중에 있는 퇴원손상심층조사의 연도별 조사자료를 분석한 결과 10만명당 손상발생규모는 2004년 1,505명에서 2016년 2,007명으로 지속적으로 증가하였다. 이러한 꾸준한 증가 추세는, 손상으로 인한 사망률은 감소하였을지라도 손상 예방을 위한 효과적인 정책과 전략, 지속적인 모니터링이 필요성을 제시한다.

Citations

Citations to this article as recorded by

The Impact of the Association between Cancer and Diabetes Mellitus on Mortality
Sung-Soo Kim, Hun-Sung Kim
Journal of Personalized Medicine.2022; 12(7): 1099. CrossRef
Comparison of Prediction Models for Mortality Related to Injuries from Road Traffic Accidents after Correcting for Undersampling
Yookyung Boo, Youngjin Choi
International Journal of Environmental Research and Public Health.2021; 18(11): 5604. CrossRef

The burden of infectious and cardiovascular diseases in India from 2004 to 2014: Kajori Banerjee, Laxmi Kant Dwivedi; Epidemiol Health. 2016;38:e2016057. Published online December 14, 2016; DOI: https://doi.org/10.4178/epih.e2016057

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Abstract PDF

Abstract

OBJECTIVES
In India, both communicable and non-communicable diseases have been argued to disproportionately affect certain socioeconomic strata of the population. Using the 60th (2004) and 71st (2014) rounds of the National Sample Survey, this study assessed the balance between infectious diseases and cardiovascular diseases (CVD) from 2004 to 2014, as well as changes in the disease burden in various socioeconomic and demographic subpopulations.

METHODS

Prevalence rates, hospitalization rates, case fatality rates, and share of in-patients deaths were estimated to compare the disease burdens at these time points. Logistic regression and multivariate decomposition were used to evaluate changes in disease burden across various socio-demographic and socioeconomic groups.

RESULTS

Evidence of stagnation in the infectious disease burden and rapid increase in the CVD burden was observed. Along with the drastic increase in case fatality rate, share of in-patients deaths became more skewed towards CVD from 2004 to 2014. Logistic regression analysis demonstrated a significant shift of the chance of succumbing to CVD from the privileged class, comprising non-Scheduled Castes and Tribes, more highly educated individuals, and households with higher monthly expenditures, towards the underprivileged population. Decomposition indicated that a change in the probability of suffering from CVD among the subcategories of age, social groups, educational status, and monthly household expenditures contributed to the increase in CVD prevalence more than compositional changes of the population from 2004 to 2014.

CONCLUSIONS

This study provides evidence of the ongoing tendency of CVD to occur in older population segments, and also confirms the theory of diffusion, according to which an increased probability of suffering from CVD has trickled down the socioeconomic gradient.

Summary

Citations

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Comparing the Effectiveness of Different Approaches to Raise Awareness About Antimicrobial Resistance in Farmers and Veterinarians of India
Garima Sharma, Florence Mutua, Ram Pratim Deka, Rajeshwari Shome, Samiran Bandyopadhyay, Bibek Ranjan Shome, Naresh Goyal Kumar, Delia Grace, Tushar Kumar Dey, Johanna Lindahl
Frontiers in Public Health.2022;[Epub] CrossRef
India’s Opportunities and Challenges in Establishing a Twin Registry: An Unexplored Human Resource for the World’s Second-Most Populous Nation
Ruby Dhar, Shweta Rana, Tryambak Pratap Srivastava, Arnab Nayek, Jai Bhagwan Sharma, Digjeet Kaur, Krishna R. Kalari, Harpreet Singh, Subhradip Karmakar
Twin Research and Human Genetics.2022; 25(3): 156. CrossRef
COVID-19 pandemic effects on the distribution of healthcare services in India: A systematic review
Nirav Nimavat, Mohammad Mehedi Hasan, Sundip Charmode, Gowthamm Mandala, Ghanshyam R Parmar, Ranvir Bhangu, Israr Khan, Shruti Singh, Amit Agrawal, Ashish Shah, Vishi Sachdeva
World Journal of Virology.2022; 11(4): 186. CrossRef
Temporal decomposition of life years lived with disability in India: a growing demographic concern
Kajori Banerjee, Srei Chanda, Laxmi Kant Dwivedi
BMC Public Health.2019;[Epub] CrossRef
Undernutrition and Overnutrition Burden for Diseases in Developing Countries: The Role of Oxidative Stress Biomarkers to Assess Disease Risk and Interventional Strategies
Francesca Mastorci, Cristina Vassalle, Kyriazoula Chatzianagnostou, Claudio Marabotti, Khawer Siddiqui, Ahmed Eba, Soueid Mhamed, Arun Bandopadhyay, Marco Nazzaro, Mirko Passera, Alessandro Pingitore
Antioxidants.2017; 6(2): 41. CrossRef

Admission route and use of invasive procedures during hospitalization for acute myocardial infarction: analysis of 2007-2011 National Health Insurance database: Hyungseon Yeom, Dae Ryong Kang, Seong Kyung Cho, Seung Won Lee, Dong-Ho Shin, Hyeon Chang Kim; Epidemiol Health. 2015;37:e2015022. Published online May 1, 2015; DOI: https://doi.org/10.4178/epih/e2015022

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Abstract Summary PDF

Abstract

OBJECTIVES
The goal of this study was to investigate trends in admission to the emergency department and the use of invasive or surgical procedures during hospitalization for acute myocardial infarction (AMI) in Korea.

METHODS

The National Health Insurance (NHI) claims database between 2007 and 2011 was used. We identified all admission claims that included codes from the tenth revision of the International Classification of Diseases beginning with I21 as the primary or secondary diagnosis. Information about the admission route, admission date, discharge date, and whether coronary artery angiography, angioplasty, or bypass surgery was performed was also obtained from the NHI database.

RESULTS

Of the 513,886 relevant admission claims over the five years encompassed by this study, 295,001 discrete episodes of admission for AMI were identified by analyzing the date and length of each admission and the interval between admissions. The number of AMI admissions gradually decreased from 66,883 in 2007 to 47,656 in 2011. The number and proportion of admissions through the emergency department also decreased from 38,118 (57.0%) in 2007 to 24,001 (50.4%) in 2011. However, during the same period, admissions in which invasive or surgical procedures were performed increased from 15,342 (22.9%) to 17,505 (36.7%).

CONCLUSIONS

The reported numbers of emergency department visits and admissions for AMI decreased from 2007 to 2011. However, only a small portion of the patients underwent invasive or surgical procedures during hospitalization, although the number of admissions involving invasive or surgical procedures has increased. These findings suggest that simply counting the number of admission claims cannot provide valid information on trends in AMI occurrence.

Summary

Korean summary
급성심근경색 환자의 급성기 의료이용행태를 조사하기 위해 2007년부터 2011년까지 급성심근경색증 진단명(ICD-10 코드 I21.x)을 포함하는 입원 청구자료 513,886건을 분석하였다. 총 295,001건의 독립된 입원 에피소드를 추출하여 분석한 결과, 5년동안 전체 입원건수와 응급실 경유 입원건수는 감소한 반면, 진단 또는 치료 목적의 침습적 시술을 동반한 입원은 증가하였다. 건강보험청구자료를 이용하여 급성심근경색증 발생 규모를 파악할 때, 진단명만으로는 정확한 추계가 어려우며 관련 시술 등의 의료이용 정보를 추가하는 것이 필요할 것이다.

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Cardiovascular risk of Janus kinase inhibitors compared with biologic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis without underlying cardiovascular diseases: a nationwide cohort study
Yun-Kyoung Song, Gaeun Lee, Jinseub Hwang, Ji-Won Kim, Jin-Won Kwon
Frontiers in Pharmacology.2023;[Epub] CrossRef
Effect of Sodium-Glucose Cotransporter Inhibitors on Major Adverse Cardiovascular Events and Hospitalization for Heart Failure in Patients With Type 2 Diabetes Mellitus and Atrial Fibrillation
Chang Hee Kwon, Ye-Jee Kim, Min-Ju Kim, Myung-Jin Cha, Min Soo Cho, Gi-Byoung Nam, Kee-Joon Choi, Jun Kim
The American Journal of Cardiology.2022; 178: 35. CrossRef
Using real-world data for supporting regulatory decision making: Comparison of cardiovascular and safety outcomes of an empagliflozin randomized clinical trial versus real-world data
Ha Young Jang, In-Wha Kim, Jung Mi Oh
Frontiers in Pharmacology.2022;[Epub] CrossRef
Epidemiology of cardiovascular disease and its risk factors in Korea
Hyeon Chang Kim
Global Health & Medicine.2021; 3(3): 134. CrossRef
Major Adverse Cardiovascular Events in Antidepressant Users Within Patients With Ischemic Heart Diseases
Jae Hyun Kim, Yun-Kyoung Song, Ha Young Jang, Ju-Young Shin, Hae-Young Lee, Yong Min Ahn, Jung Mi Oh, In-Wha Kim
Journal of Clinical Psychopharmacology.2020; 40(5): 475. CrossRef
Antidepressant Use and the Risk of Major Adverse Cardiovascular Events in Patients Without Known Cardiovascular Disease: A Retrospective Cohort Study
Ha Young Jang, Jae Hyun Kim, Yun-Kyoung Song, Ju-Young Shin, Hae-Young Lee, Yong Min Ahn, Jung Mi Oh, In-Wha Kim
Frontiers in Pharmacology.2020;[Epub] CrossRef
Changing Disease Trends in the Northern Gyeonggi-do Province of South Korea from 2002 to 2013: A Big Data Study Using National Health Information Database Cohort
Young Soo Kim, Dong-Hee Lee, Hiun Suk Chae, Kyungdo Han
Osong Public Health and Research Perspectives.2018; 9(5): 248. CrossRef
Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016
Theo Vos, Amanuel Alemu Abajobir, Kalkidan Hassen Abate, Cristiana Abbafati, Kaja M Abbas, Foad Abd-Allah, Rizwan Suliankatchi Abdulkader, Abdishakur M Abdulle, Teshome Abuka Abebo, Semaw Ferede Abera, Victor Aboyans, Laith J Abu-Raddad, Ilana N Ackerman,
The Lancet.2017; 390(10100): 1211. CrossRef

A study on epidemiologic characteristics and factors associated with excess hospitalization of the patients injured by traffic accident.: Mi Woon Kim, Joung Soon Kim, Min Kyung Lim; Korean J Epidemiol. 1998;20(2):279-287.

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Abstract PDF: Abstract
The occurrence of injuries and death caused by traffic accidents have been increasing during last few decades in Korea, which resulted in enormous personal, social and economic loss in terms of death, disability, labour days and medical costs incurred for treatment. Generally, it is well known and even became an hot sociopolitical issue that the duration of hospital stay for traffic accident patients are much longer than that of other patients with the similar condition. The objective of the study is to find out epidemiologic characreristics and management pattern of traffic accident patients in a general hospital of medium-sized, industrialized town. This study was carried out on 177 cases injured by motor vehicle accidents, who were admitted and treated in a general hospital from Feb. 1, 1997 to Sept. 30, 1997. The results obtained are as followings: The most of the patients(44%) were 20-30 years old age group although the occurrence of injuries was more frequent among older ages, 50's for male and 60's for female being 2.1 times more frequent among male. The traffic accidents occurred most frequently(14.1%) in the morning(06:00-08:00) and afternoon(14:00-16:00), and on Saturdays(20.3%); the (14.1% traffic accidents were frequent during weekends for passengers whereas it was more frequent during weekdays for pedestrian. Old and child pedestrians were most vulnerable subjects to traffic accidents. The most common site injured was head(19.9%) and the injury types were fracture of lower extremity(9.3%), skull fracture(8.6%) and rib fracture(8.6%) for both sexes; rib fractures/thoracic spine fractures(12.0%) for female and tibia/ fibula fractures(11.6%) for male. Mean days of hospital stay presumptively judged by the doctor who examined, made diagnosis and admitted the patient was 43.8 days compare to 38.4 days of actual mean days of hospitalixation. On the other hand, the optimal mean days of hospital stay for the patients determined by two doctors independently was estimated to be 26.6 days. Thus the difference between actual days of hospitalization and optimal days of hospitalization was 11.7 days, which can be regarded as excess hospitalization days. It consists 30.5% of actual hospitalization days, an enormous waste of resources. The only factor associated with this excess hospitalization was payment responsibility for the hospital cost; when the hospitalization expenses are to be paid by the person inflicted the injury there were always excess days of hospitalization regardless of insurance status.; Summary

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