- Cancer Incidence in Kangwha County(1986 - 1992).
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Soh Yoon Kim, Heechoul Ohrr, Hyung Gon Kang, Suk Il Kim, Sang Wook Yi
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Korean J Prev Med. 1999;32(4):482-490.
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- OBJECTIVES
This paper presents the information on the incidence of cancer from the population-based cancer resistry in Kangwha County. Material and METHODS: This investigation is based on Kangwha cancer registry. The data included cases of cancer diagnosed from 1986 through 1992. The diagnosis of cancer was confirmed by a team of physicians and nurses with the medical records kept in the clinics and hospitals based on the diagnostic criteria recommended by WHO. Home visitings were also made to cancer patients confirmed in every 6 months for the follow up and for the collection of relevant information directly from the patients. RESULTS: A total of 992 cancer cases were registered during 1986 - 1992. The age-adjusted cancer incidence rate of all site is 201.7 in men and 110.7 in women. The most common cancer is the stomach cancer in both sexes. The age-adjusted incidence rate of the stomach cancer is 65.9 in men and 25.0 in women per 100,000 population. The lung cancer(33.8) and liver cancer(27.7) are next common cancers in men. The cervical cancer(21.8) and lung cancer(8.4) are next in women. CONCLUSION: The most common cancer is the stomach cancer in both sexes. The annual age-adjusted incidence rate of the stomach cancer is 65.9 in men and 25.0 in women per 100,000 population.
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Summary
- The Prevalence of Cancer in Kangwha County.
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Sang Wook Yi, Heechoul Ohrr, Kang Hee Lee, Suk Il Kim, Hyung Gon Kang, Sun Ha Jee
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Korean J Prev Med. 1999;32(3):333-342.
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Most descriptive studies of cancer have focused either on cancer incidence or mortality. Cancer prevalence has rarely been estimated. Cancer prevalence data can be used as a measure of the economic and social burden of cancer and are also useful for health care planning. This study attempts to estimate cancer prevalence in Kangwha county. METHODS: This investigation is based on data of Kangwha cancer registry. The data include all cases of cancer diagnosed from 1983 through 1992. We define "prevalent cases" as cancer patients who is alive as of January 1, 1993. For each five-year age group, the number of "known prevalent cases" is added to the number of "estimated prevalent cases". Prevalence is calculated by dividing these sums by the populations of Kangwha County on December 31, 1992(derived from Kangwha Statistics Annual). RESULTS: Crude prevalence of cancer among males and females are 536.7 and 601.1 per 100,000 respectively. Gastric cancer is the most common malignant neoplasm(213.2 per 100,000, crude prevalence) among males. It is followed by lung cancer(45.1 per 100,000), liver cancer(32.8 per 100,000), rectal cancer(25.4 per 100,000) and colon cancer(25.4 per 100,000). Cervical cancer is the most common cancer(201.9 per 100,000, crude prevalence) and is followed by gastric cancer(91.5 per 100,000), thyroid cancer(64.8 per 100,000), breast cancer(57.2 per 100,000) and rectal cancer(32.7 per 100,000) among females. CONCLUSIONS: We tried to estimate cancer prevalence based on the Kangwha cancer registry for the first time in Korea. The estimation of cancer prevalence based on a population-based cancer registry will be more correct and useful as the data accumulate. We will make another estimation in the near future.
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- The effect of sodium and potassium intake on blood pressure change in Korean adolescents.
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Il Suh, Chung Mo Nam, Kang Hee Lee, Sun Ha Jee, Suk Il Kim, Gyu Sang Kim, Chun Bae Kim
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Korean J Prev Med. 1998;31(3):384-394.
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- In order to investigate the effect of the urinary excretion of sodium and potassium on the change on blood pressure over 3 years, 668 adolescents aged 13 years living in Kangwha area were investigated in a longitudinal follow-up study. Two measurements were taken on each blood pressure (diastolic, systolic) and the average of the two readings was used in the analysis. Sodium and potassium intake were estimated by the determination of those electrolytes in 24hr urine. The mixed model regression analysis was used to identify the effect of urinary sodium and potassium on the change of blood pressure after controlling for BMI of each age. On simple bivariate analysis no relationship was found between urinary sodium excretion and systolic or diastolic blood pressure among both male and female, however, a significant positive association between urinary potassium excretion and systolic blood pressure among male. The results of mixed regression analysis showed that the body mass index (BMI) were more influential that urinary electrolytes among this study subjects. It suggested that risk factors observed from the adults, may not be identical with that of the growing aged population. After control of the BMI and age, significant association between sodium and diastolic BP among male, and association between potassium and systolic BP among female, were found. In summary, the results indicate that growth has been more influential than dietary factor on blood pressure for growing aged population.
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Summary
- Changes in blood pressure and determinants of blood pressure level and change in Korean adolescents.
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Il Suh, Chung Mo Nam, Sun Ha Jee, Suk Il Kim, Young Ok Kim, Sung Soon Kim, Won Heum Shim, Chun Bae Kim, Kang Hee Lee, Jong Won Ha, Hyung Gon Kang, Kyung Won Oh
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Korean J Prev Med. 1997;30(2):308-326.
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- Many studies have led to the notion that essential hypertension in adults is the result of a process that starts early in life: investigation of blood pressure(BP) in children and adolescents can therefore contribute to knowledge of the etiology of the condition. a A unique longitudinal study on BP in Korea, known as Kangwha Children's Blood Pressure(KCBP) Study was initiated in 1986 to investigate changes in BP in children. This study is a part of the KCBP study. The purposes of this study are to show changes in BP and to determine factors affecting to BP level and change in Korean adolescents during age period 12 to 16 years. A total of 710 students(335 males, 375 females) who were in the first grade at junior high school(12 years old) in 1992 in Kangwha County, Korea have been followed to measure BP and related factors(anthropometric, serologic and dietary factors) annually up to 1996. A total of 562 students(242 males, 320 females) completed all five annual examinations. The main results are as follows: 1. For males, mean systolic diastolic BP at age 12 and 16 years old were 108.7 mmHg & 118.1 mmHg(systolic), and 69.5 mmHg & 73.4 mmHg(diastolic), respectively. BP level was the highest when students were at 15 years old. For females, mean systolic and diastolic BP at age 12 and 16 years were 114.4 mmHg & 113.5 mmHg(systolic) and 75.2 mmHg & 72.1 mmHg(diastolic), respectively. BP level reached the highest point when they were 13-14 years old. 2. Anthropometric variables(height, weight and body mass index etc) increased consitantly during the study period for males. However, the rate of increase was decreased for females after age 15 years. Serum total cholesterol decreased and triglyceride increased according to age for males, but they did not show any significant trend for females. Total fat intake increased at age 16 years compared with that at age 14 years. Composition of carbohydrate, protein and fat among total energy intake was 65:15:20 at age 14 and 16 years. 3. Most of anthropometric measures, especially, height, body mass index(BMI) and triceps skinfold thickness, showed a significant correlation with BP level in both sexes. When BMI was adjusted, serum total cholesterol showed a significant negative correlation with systolic BP at age 12 years in males, but at age 14 years the direction of correlation changed to positive. In females serum total cholesterol was negatively correlated with diastolic BP at age 15 and 16 years. Triglyceride and creatine showed positive correlation with systolic and diastolic BP in males, but they did not show any correlation in females. There was no consistent findings between nutrient intake and BP level. However, protein intake correlated positively with diastolic BP level in males. 4. Blood pressure change was positively associated with changes in BMI and serum total cholesterol in both sexes. Change in creatine was associated with BP change positively in males and negatively in females. Students whose sodium intake was high showed higher systolic and diastolic BP in males, and students whose total fat intake was high maintained lower level of BP in females. The major determinants on BP change was BMI in both sexes.
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- Four-year change and tracking of serum lipids in Korean adolescents.
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Kang Hee Lee, Il Suh, Sun Ha Jee, Chung Mo Nam, Sung Soon Kim, Won Heum Shim, Jong Won Ha, Suk Il Kim, Hyung Gon Kang
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Korean J Prev Med. 1997;30(1):45-60.
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- It has been known that there is a tracking phenomenon in the level of serum lipids. However, no study has been performed to examine the change and tracking of serum lipids in Korean adolescents. The purpose of this study is to examine the changes of serum lipids in Korean adolescents from 12 to 16 years of age, and to examine whether or not there is a tracking phenomenon in serum lipids level during the period. In 1992 serum lipids(total cholesterol(TC), triglyceride(TG), LDL cholesterol(LDL-C), HDL cholesterol(HDL-C)) were measured in 318 males, 365 females who were 12 years of age in Kangwha county, Korea. These participants have been followed up to 1996 and serum lipids level were examined in 1994 and 1996. Among the participants 162 males and 147 females completed all three examinations in fasting state. To examine the effect of eliminating adolescents with incomplete data, we compared serum lipids, blood pressure and anthropometric measures at baseline between adolescents with complete follow-up and adolescents who were withdrawn. To examine the change of serum lipids we compared mean values of serum lipids according to age in males and females. Repeated analysis of variance was used to test the change according to age. We used three methods to examine the existence of tracking. First, we analyzed the trends in serum lipids over 4-year period within quartile groups formed on the basis of the first-year serum lipids level to see whether or not the relative ranking of the mean serum lipids among the quartile groups remained in the same group for 4-year period. Second, we quantified the degree of tracking by calculating Spearman's rank correlation coefficient between every tests. Third, the persistence extreme quartile method was used. This method divides the population into quartile groups according to the initial level of blood lipids and then calculates the percent of the subjects who stayed in the same group at follow-up measurement. The decreases in levels were noted during 4 years for TC, LDL-C, primarily for boys. The level of HDL-C decreased between baseline and first follow-up for both sexes and girls. Tracking, as measured by both correlation coefficients and persistence extreme quartiles, was evident for all of the lipids. The correlation coefficients of TC between baseline and 4 years later in boys and girls were 0.55 and 0.68, respectively. And the corresponding values for HDL-C were 0.58 and 0.69. More than 50% of adolescents who belonged to the highest quartile group in TC, HDL-C and LDL-C at the baseline were remained at the same group at the examination performed 2 years later for both sexes. The probability of remaining at the same group was more than 35% when examined 4 years later. The tracking phenomenon of TG was less evident compared with the other lipids. Percents of girls who stayed at the same group 2 years later and 4 years later were 42.9% and 25.7%, respectively. It was evident that serum lipid levels tracked in Korean adolescents. Researches with longer follow-up would be needed in he future to investigate the long-term change of lipids from adolescents to adults.
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Summary
- A methodological study on simplifying claims review system in medical insurance.
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Suk Il Kim, Hyung Gon Kang, Han Joong Kim, Young Moon Chae, Myongsei Sohn, Myung Keun Lee
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Korean J Prev Med. 1995;28(3):640-650.
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- After the introduction of National Medical Insurance in 1989, the medical demand has rapidly increased. The impact of increased medical demand was followed by an increase in the number of claims in need of review. We studied a new, fair method for reducing the number of claims reviewed. we analysed 90,583 outpatient claims submitted between september and october; claims were made for services given August of 1994. We finally suggested a screening system for claims review using a statistical method of discriminant analysis of the medical costs. The results were as follows. 1. In the cut-off group, age, days of medication, number of hospital or clinic visits, and total change were significantly high The cut-off rates according to the hospital-type and existence of accompanied disease were significantly different. 2. According to ICD, the cut-off rate was highest in peripheral enthesopathies and allied syndromes(20.76%), lowest in acute sinusitis(0.93%). The mean charges were significantly different according to ICD and existence of cut-off. 3. we build discriminant functions by ICD with such discriminant variables as patient age, sex, existence of accompanied disease, number of hospital or clinic visits, and 9 detailed hospital or clinic charges included in claim. 4. we applied the discriminant function for screening those claims that were expected to be cut-off. The sensitivities comprised from 40% to 70%, and specificities from 70% to 95% by ICD. Acute rhinitis had highest sensitivity(100.00%)and other local infections of skin and subcutaneous tissue had highest specificity(98.45%). The excepted number of cut-off was 17,762(19.61%). The total sensitivity was 49.62%, the total specificity was 82.57% and the error rate was 19.66%. We lacked economic analysis such as cost-benefit analysis. But, if the few method of screening claims using discriminant analysis were applied, the number of claims in need of review will reduce considerably.
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Summary
- A Comparison of Laparoscopic Cholecystectomy with Open Cholecystectomy in a Korean Hospital.
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Eun Mee Lee, Seung Hum Yu, Myong Sei Sohn, Suk Il Kim
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Korean J Prev Med. 1995;28(2):325-333.
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- Laparoscopic cholecystectomy was introduced into Korea in 1990 and has been rapidly replacing open cholecystectomy when the indications were met. In this study a medical utilization and technology was assessed on the selected hospitalized patients with cholelithiasis who underwent open or laparoscopic cholecystectomy from April 1, 1991 to March 31, 1994. The results are as follows. Despite the low reimbursement rate by the health insurance, the number of laparoscopic cases have been steadily increased. The post-operative days before health insurance coverage were significantly shortened from 8.4 days to 4.6 days. The preoperative days before health insurance coverage were significantly shorted from 8.4 days to 4.0 days. The total length-of-stays in the hospital were also significantly shortened from 15.2 days to 10.7 and 9.8 days in laparoscopic cholecystectomy. The laparoscopic cholecystectomy showed low expenses in all aspects expect the average hospital charges per day. For the hospital to have cost containment, it is more effective if length-of-stay is shorter because of high daily inpatient hospital charge. The laparoscopic cholecystectomy also showed shortened anesthesia time and operation time compared with open cholecystectomy that were statistically significant. The mean anesthesia and operation time for open cholecystectomy were 113.2 and 90.2 minutes but those of laparoscopic cholecystectomy were 105.7 and 68.6 minutes. According to this study the laparoscopic cholecystectomy has reduced the medical expenditure and we recommend this procedure over open cholecystectomy. The further discussion on the different morbidity rate between two types of procedure is essential in providing quality medical care, and to educate specialist.
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KSPM
