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Operational Definitions of Colorectal Cancer in the Korean National Health Insurance Database
Hyeree Park, Yu Rim Kim, Yerin Pyun, Hyundeok Joo, Aesun Shin
J Prev Med Public Health. 2023;56(4):312-318.   Published online May 31, 2023
DOI: https://doi.org/10.3961/jpmph.23.033
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  • 148 Download
  • 4 Web of Science
  • 3 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
We reviewed the operational definitions of colorectal cancer (CRC) from studies using the Korean National Health Insurance Service (NHIS) and compared CRC incidence derived from the commonly used operational definitions in the literature with the statistics reported by the Korea Central Cancer Registry (KCCR).
Methods
We searched the MEDLINE and KoreaMed databases to identify studies containing operational definitions of CRC, published until January 15, 2021. All pertinent data concerning the study period, the utilized database, and the outcome variable were extracted. Within the NHIS-National Sample Cohort, age-standardized incidence rates (ASRs) of CRC were calculated for each operational definition found in the literature between 2005 and 2019. These rates were then compared with ASRs from the KCCR.
Results
From the 62 eligible studies, 9 operational definitions for CRC were identified. The most commonly used operational definition was “C18-C20” (n=20), followed by “C18-C20 with claim code for treatment” (n=3) and “C18-C20 with V193 (code for registered cancer patients’ payment deduction)” (n=3). The ASRs reported using these operational definitions were lower than the ASRs from KCCR, except for “C18-C20 used as the main diagnosis.” The smallest difference in ASRs was observed for “C18-C20,” followed by “C18- C20 with V193,” and “C18-C20 with claim code for hospitalization or code for treatment.”
Conclusions
In defining CRC patients utilizing the NHIS database, the ASR derived through the operational definition of “C18-C20 as the main diagnosis” was comparable to the ASR from the KCCR. Depending on the study hypothesis, operational definitions using treatment codes may be utilized.
Summary
Korean summary
- 국민건강보험공단 자료 기반 연구에서 사용된 대장암의 조작적 정의를 검토하고 각 조작적 정의에 따른 대장암의 연령표준화발생률을 중앙암등록본부에서 보고한 수치와 비교하였다. - 62개의 출판된 문헌을 검토하여 9개의 조작적 정의를 확인하였고 이 중 "C18-C20"이 가장 일반적으로 사용되었다. - "C18-C20"을 주진단으로 정의한 경우의 연령표준화발생률은 중앙암등록본부에서 보고한 연령표준화발생률과 가장 유사하였다.

Citations

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  • Worsening of health disparities across COVID-19 pandemic stages in Korea
    Hyejin Lee, Hyunwoo Nam, Jae-ryun Lee, Hyemin Jung, Jin Yong Lee
    Epidemiology and Health.2024; : e2024038.     CrossRef
  • National Trends in Rotavirus Enteritis among Infants in South Korea, 2010–2021: A Nationwide Cohort
    Hyun Jee Lee, Yujin Choi, Jaeyu Park, Yong-Sung Choi, Dong Keon Yon, Do Hyun Kim
    Children.2023; 10(9): 1436.     CrossRef
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The Association Between Metabolic Syndrome and Colorectal Cancer Risk by Obesity Status in Korean Women: A Nationwide Cohort Study
Seong-geun Moon, Boyoung Park
J Prev Med Public Health. 2022;55(5):475-484.   Published online September 21, 2022
DOI: https://doi.org/10.3961/jpmph.22.286
  • 3,155 View
  • 124 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
This study aimed to determine the association between metabolic syndrome (MetS) and the incidence of colorectal cancer (CRC) in Korean women with obesity.
Methods
Cancer-free women (n=6 142 486) aged 40-79 years, who underwent National Health Insurance Service health examinations in 2009 and 2010 were included. The incidence of CRC was followed until 2018. The hazard ratio (HR) of MetS for the incidence of colon and rectal cancer was analyzed according to body mass index (BMI) categories, adjusting for confounders such as women’s reproductive factors. In addition, the heterogeneity of associations across BMI categories was assessed.
Results
Women with MetS were at increased risk of colon and rectal cancer compared to women without MetS (HR, 1.20; 95% confidence interval [CI], 1.16 to 1.23 and HR,1.15; 95% CI, 1.11 to 1.20), respectively. The HR of MetS for colon cancer across BMI categories was 1.12 (95% CI, 1.06 to 1.19), 1.14 (95% CI, 1.08 to 1.20), and 1.16 (95% CI, 1.12 to 1.21) in women with BMIs <23.0 kg/m2, 23.0-24.9 kg/m2, and ≥25.0 kg/m2, respectively. The HR of MetS for rectal cancer across corresponding BMI categories was 1.16 (95% CI, 1.06 to 1.26), 1.14 (95% CI, 1.05 to 1.23), and 1.13 (95% CI, 1.06 to 1.20). The heterogeneity of associations across BMI categories was not significant in either colon or rectal cancer (p=0.587 for colon cancer and p=0.927 for rectal cancer).
Conclusions
Women with MetS were at increased risk of colon and rectal cancer. Clinical and public health strategies should be considered for primary CRC prevention with an emphasis on improving women’s metabolic health across all BMI groups.
Summary
Korean summary
한국 여성에서 대사증후군은 대장암 발생과 직장암 발생에 유의한 위험요인으로 보인다. 이는 체질량지수를 층화하고 여성력과 관련된 요인들을 보정하더라도 유의했다. 한국 여성의 대장암 및 직장암 예방을 위해 비만도에 관계 없이 대사증후군 요소를 관리하는 것이 필요하다.

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  • Association of metabolic obesity phenotypes with risk of overall and site-specific cancers: a systematic review and meta-analysis of cohort studies
    Yahya Mahamat-saleh, Dagfinn Aune, Heinz Freisling, Sheetal Hardikar, Rola Jaafar, Sabina Rinaldi, Marc J. Gunter, Laure Dossus
    British Journal of Cancer.2024; 131(9): 1480.     CrossRef
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    GeroScience.2024;[Epub]     CrossRef
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The Risk of Colorectal Cancer After Cholecystectomy or Appendectomy: A Population-based Cohort Study in Korea
Joonki Lee, Sunho Choe, Ji Won Park, Seung-Yong Jeong, Aesun Shin
J Prev Med Public Health. 2018;51(6):281-288.   Published online October 29, 2018
DOI: https://doi.org/10.3961/jpmph.18.105
  • 8,684 View
  • 226 Download
  • 24 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
We investigated the association between cholecystectomy or appendectomy and the subsequent risk of colorectal cancer (CRC) in the Korean population.
Methods
A retrospective cohort study was conducted with the National Health Insurance Service–National Sample Cohort of Korea; this sample was followed up from January 1, 2002, until the date of CRC incidence, loss to follow-up, or December 31, 2015. The exposure status of cholecystectomy and appendectomy was treated as a time-varying covariate. The calculated risk of CRC was stratified by follow-up period, and the association between these surgical procedures and CRC was investigated by a Cox regression model applying appropriate lag periods.
Results
A total of 707 663 individuals were identified for analysis. The study population was followed up for an average of 13.66 years, and 4324 CRC cases were identified. The hazard ratio (HR) of CRC was elevated in the first year after cholecystectomy (HR, 1.71; 95% confidence interval [CI], 1.01 to 2.89) and in the first year and 2-3 years after appendectomy (HR, 4.22; 95% CI, 2.87 to 6.20; HR, 2.34; 95% CI, 1.36 to 4.03, respectively). The HRs of CRC after applying 1 year of lag after cholecystectomy and 3 years of lag after appendectomy were 0.80 (95% CI, 0.57 to 1.13) and 0.77 (95% CI, 0.51 to 1.16), respectively.
Conclusions
The risk of CRC increased in the first year after cholecystectomy and appendectomy, implying the possibility of bias. When appropriate lag periods after surgery were applied, no association was found between cholecystectomy or appendectomy and CRC.
Summary
Korean summary
본 연구는 담낭절제술, 충수돌기절제술 후 대장암의 발생위험에 관한 연구로 국민건강보험공단 표본코호트자료를 사용한 후향적코호트 연구이다. 총 707 663명을 대상으로 연구를 진행하였으며, 담낭절제술을 시행한 환자들은 수술 후 1년 이내에서 대장암의 위험도가 유의하게 증가하였으나 이후 관련성을 보이지 않았고, 충수돌기절제술을 시행한 환자들은 수술 후 1년, 2~3년에서 유의하게 위험도가 증가하였으나, 이후에는 관련성을 보이지 않았다. 이 결과는 역인과관계의 가능성을 시사하며 이것을 고려하였을 때, 담낭절제술과 충수돌기절제술은 대장암의 발생위험과의 연관성을 보이지 않았다.

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A Survival Analysis of Gastric or Colorectal Cancer Patients Treated With Surgery: Comparison of Capital and a Non-capital City
Nam-Soo Hong, Kyeong Soo Lee, Sin Kam, Gyu Seog Choi, Oh Kyoung Kwon, Dong Hee Ryu, Sang Won Kim
J Prev Med Public Health. 2017;50(5):283-293.   Published online July 3, 2017
DOI: https://doi.org/10.3961/jpmph.17.043
  • 6,213 View
  • 223 Download
  • 3 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
The objective of the present study was to compare prognosis of patients with gastric or colorectal cancer according to places where they received surgeries. Methods: The cancer patients underwent surgeries in sampled hospitals located in Daegu were matched 1:1 to the patients who visited sampled hospitals in Seoul using propensity score method. After the occurrences of death were examined, Kaplan-Meier method was used for survival analysis and the log-rank test was performed to compare the survival curves. Results: A total of six out of 291 gastric cancer patients who had surgeries in Daegu died (2.1%) and ten deaths (3.4%) occurred from patients went Seoul hospitals. Out of 84 gastric cancer patients who had chemotherapy after surgeries in Daegu, 13 (15.5%) patients died while 18 (21.4%) deaths occurred among patients underwent surgeries in Seoul. Six deaths (6.9%) out of 87 colorectal cancer patients who had surgeries in Daegu were reported. Five patients (5.7%) died among the patients underwent surgeries in Seoul. Among the colorectal cancer patients with chemotherapy after surgeries, 13 patients (12.4%) who visited hospitals in Daegu and 14 (13.3%) patients who used medical centers in Seoul died. There were no significant differences according to places where patients used medical services. Conclusions: The result of this study is expected to be used as basic data for policy making to resolve centralization problem of cancer patients and to help patients to make rational choices in selection of medical centers.
Summary

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Diabetes Mellitus and Site-specific Colorectal Cancer Risk in Korea: A Case-control Study
Hyeongtaek Woo, Jeeyoo Lee, Jeonghee Lee, Ji Won Park, Sungchan Park, Jeongseon Kim, Jae Hwan Oh, Aesun Shin
J Prev Med Public Health. 2016;49(1):45-52.   Published online December 22, 2015
DOI: https://doi.org/10.3961/jpmph.15.029
  • 10,123 View
  • 160 Download
  • 13 Crossref
AbstractAbstract PDF
Objectives
Previous large-scale cohort studies conducted in Korea have found a positive association between diabetes mellitus (DM) and colorectal cancer (CRC) in men only, in contrast to studies of other populations that have found significant associations in both men and women.
Methods
A total of 1070 CRC cases and 2775 controls were recruited from the National Cancer Center, Korea between August 2010 and June 2013. Self-reported DM history and the duration of DM were compared between cases and controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by binary and polytomous logistic regression models.
Results
DM was associated with an elevated risk of CRC in both men (OR, 1.47; 95% CI, 1.13 to 1.90) and women (OR, 1.92; 95% CI, 1.24 to 2.98). This association remained when we controlled for age, body mass index, alcohol consumption, and physical activity level. In sub-site analyses, DM was associated with distal colon cancer risk in both men (multivariate OR, 2.04; 95% CI, 1.39 to 3.00) and women (multivariate ORs, 1.99; 95% CI, 1.05 to 3.79), while DM was only associated with rectal cancer risk in women (multivariate OR, 2.05; 95% CI, 1.10 to 3.82). No significant association was found between DM and proximal colon cancer risk in either men (multivariate OR, 1.45; 95% CI, 0.88 to 2.41) or women (multivariate OR, 1.79; 95% CI, 0.78 to 4.08).
Conclusions
Overall, DM was associated with an increased risk of CRC in Koreans. However, potential over-estimation of the ORs should be considered due to potential biases from the case-control design.
Summary

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Economic Burden of Colorectal Cancer in Korea
Ju-Young Byun, Seok-Jun Yoon, In-Hwan Oh, Young Ae Kim, Hye-Young Seo, Yo-Han Lee
J Prev Med Public Health. 2014;47(2):84-93.   Published online March 31, 2014
DOI: https://doi.org/10.3961/jpmph.2014.47.2.84
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AbstractAbstract PDF
Objectives

The incidence and survival rate of colorectal cancer in Korea are increasing because of improved screening, treatment technologies, and lifestyle changes. In this aging population, increases in economic cost result. This study was conducted to estimate the economic burden of colorectal cancer utilizing claims data from the Health Insurance Review and Assessment Service.

Methods

Economic burdens of colorectal cancer were estimated using prevalence data and patients were defined as those who received ambulatory treatment from medical institutions or who had been hospitalized due to colorectal cancer under the International Classification of Disease 10th revision codes from C18-C21. The economic burdens of colorectal cancer were calculated as direct costs and indirect costs.

Results

The prevalence rate (per 100 000 people) of those who were treated for colorectal cancer during 2010 was 165.48. The economic burdens of colorectal cancer in 2010 were 3 trillion and 100 billion Korean won (KRW), respectively. Direct costs included 1 trillion and 960 billion KRW (62.85%), respectively and indirect costs were 1 trillion and 160 billion (37.15%), respectively.

Conclusions

Colorectal cancer has a large economic burden. Efforts should be made to reduce the economic burden of the disease through primary and secondary prevention.

Summary

Citations

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Improving the Performance of Risk-adjusted Mortality Modeling for Colorectal Cancer Surgery by Combining Claims Data and Clinical Data
Won Mo Jang, Jae-Hyun Park, Jong-Hyock Park, Jae Hwan Oh, Yoon Kim
J Prev Med Public Health. 2013;46(2):74-81.   Published online March 28, 2013
DOI: https://doi.org/10.3961/jpmph.2013.46.2.74
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AbstractAbstract PDF
Objectives

The objective of this study was to evaluate the performance of risk-adjusted mortality models for colorectal cancer surgery.

Methods

We investigated patients (n=652) who had undergone colorectal cancer surgery (colectomy, colectomy of the rectum and sigmoid colon, total colectomy, total proctectomy) at five teaching hospitals during 2008. Mortality was defined as 30-day or in-hospital surgical mortality. Risk-adjusted mortality models were constructed using claims data (basic model) with the addition of TNM staging (TNM model), physiological data (physiological model), surgical data (surgical model), or all clinical data (composite model). Multiple logistic regression analysis was performed to develop the risk-adjustment models. To compare the performance of the models, both c-statistics using Hanley-McNeil pair-wise testing and the ratio of the observed to the expected mortality within quartiles of mortality risk were evaluated to assess the abilities of discrimination and calibration.

Results

The physiological model (c=0.92), surgical model (c=0.92), and composite model (c=0.93) displayed a similar improvement in discrimination, whereas the TNM model (c=0.87) displayed little improvement over the basic model (c=0.86). The discriminatory power of the models did not differ by the Hanley-McNeil test (p>0.05). Within each quartile of mortality, the composite and surgical models displayed an expected mortality ratio close to 1.

Conclusions

The addition of clinical data to claims data efficiently enhances the performance of the risk-adjusted postoperative mortality models in colorectal cancer surgery. We recommended that the performance of models should be evaluated through both discrimination and calibration.

Summary

Citations

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Quantitative Analysis of Cancer-associated Gene Methylation Connected to Risk Factors in Korean Colorectal Cancer Patients
Ho-Jin Kang, Eun-Jeong Kim, Byoung-Gwon Kim, Chang-Hun You, Sang-Yong Lee, Dong-Il Kim, Young-Seoub Hong
J Prev Med Public Health. 2012;45(4):251-258.   Published online July 31, 2012
DOI: https://doi.org/10.3961/jpmph.2012.45.4.251
Correction in: J Prev Med Public Health 2012;45(5):333
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AbstractAbstract PDF
Objectives

The purpose of this paper was to elucidate the potential methylation levels of adjacent normal and cancer tissues by comparing them with normal colorectal tissues, and to describe the correlations between the methylation and clinical parameters in Korean colorectal cancer (CRC) patients.

Methods

Hypermethylation profiles of nine genes (RASSF1, APC, p16INK4a, Twist1, E-cadherin, TIMP3, Smad4, COX2, and ABCB1) were examined with 100 sets of cancer tissues and 14 normal colorectal tissues. We determined the hypermethylation at a given level by a percent of methylation ratio value of 10 using quantitative methylation real-time polymerase chain reaction.

Results

Nine genes' hypermethylation levels in Korean CRC patient tissues were increased more higher than normal colorectal tissues. However, the amounts of p16INK4a and E-cadherin gene hypermethylation in normal and CRC tissues were not significantly different nor did TIMP3 gene hypermethylation in adjacent normal and cancer tissues differ significantly. The hypermethylation of TIMP3, E-cadherin, ABCB1, and COX2 genes among other genes were abundantly found in normal colorectal tissues. The hypermethylation of nine genes' methylation in cancer tissues was not significantly associated with any clinical parameters. In Cohen's kappa test, it was moderately observed that RASSF1 was related with E-cadherin, and Smad4 with ABCB1 and COX2.

Conclusions

This study provides evidence for different hypermethylation patterns of cancer-associated genes in normal and CRC tissues, which may serve as useful information on CRC cancer progression.

Summary

Citations

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English Abstract
Cohort Study on the Association between Alcohol Consumption and the Risk of Colorectal Cancer in the Korean Elderly.
Hoi Jeong Lim, Byung Joo Park
J Prev Med Public Health. 2008;41(1):23-29.
DOI: https://doi.org/10.3961/jpmph.2008.41.1.23
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AbstractAbstract PDF
OBJECTIVES
We examined the association between alcohol consumption and incidence of colorectal cancer in elderly Koreans. METHODS: The cohort members (n=14,304) consisted of 4,834 males and 9,470 females derived from the Korea Elderly Pharmacoepidemiologic Cohort (KEPEC), a population-based dynamic cohort. They were aged 65 years old or older and lived in Busan between 1993-1998; they were beneficiaries of the Korean Medical Insurance Corporation (KMIC). Baseline information was surveyed by a self-administered, mailed questionnaire. This study population was restricted to 14,304 participants who reported alcohol drinking habits on the questionnaire and had not been diagnosed with colorectal cancer at baseline. The adjusted hazard ratios (aHR) of status, type, frequency and daily average amount of alcohol consumption were computed with Cox's proportional hazard model, with the never-drinkers as a reference group and controlling for age and gender. RESULTS: After 4.82 person-years of mean follow-up 112 cases of colorectal cancer occurred. The incidence densities of colorectal cancer were 161 (95% CI=123-200) for never-drinkers, 219 (95% CI=125-339) for ex-drinkers, and 137 (95% CI=84-189) for current-drinkers per 100,000 person-year. The status, type, frequency, and daily average amount of alcohol consumption were not significantly related to the incidence of colorectal cancer after controlling for age and gender. CONCLSIONS: There was no significant association between alcohol consumption and colorectal cancer among elderly people after controlling for age and gender.
Summary

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Original Article
A Case-Control Study on the Relationship between Obesity and Female Colorectal Cancer.
Aesun Shin, Hachung Yoon, Keun Young Yoo
Korean J Prev Med. 2002;35(2):147-152.
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AbstractAbstract PDF
OBJECTIVES
A hospital-based case-control study was conducted to evaluate the role of obesity in the development of colorectal cancer. METHODS: Three hundred and twenty four histologically confirmed female colorectal cancer cases and 26,998 non-cancer controls were selected from patients invited to the Aichi Cancer Center, Nagoya, Japan between 1989 and 1995. Information concerning demographic factors, medical history, family medical history, reproductive factors and dietary factors were obtained from self-administered questionnaires and medical records. The effects of weight and body mass index to colorectal cancer were examined using multiple logistic regression to control for other risk factors. RESULTS: There was no significant association between female colorectal cancer and obesity. Heavier weight adjusted for height or body mass index did not increase the risk of colorectal cancer. CONCLUSIONS: These results suggest that there is no associa-tion between colorectal cancer risk and obesity in women.
Summary

JPMPH : Journal of Preventive Medicine and Public Health
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