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Systematic Review
Adjusting for Confounders in Outcome Studies Using the Korea National Health Insurance Claim Database: A Review of Methods and Applications
Seung Jin Han, Kyoung Hoon Kim
J Prev Med Public Health. 2024;57(1):1-7.   Published online November 16, 2023
DOI: https://doi.org/10.3961/jpmph.23.250
  • 1,389 View
  • 175 Download
  • 2 Crossref
AbstractAbstract AbstractSummary PDF
Objectives
Adjusting for potential confounders is crucial for producing valuable evidence in outcome studies. Although numerous studies have been published using the Korea National Health Insurance Claim Database, no study has critically reviewed the methods used to adjust for confounders. This study aimed to review these studies and suggest methods and applications to adjust for confounders.
Methods
We conducted a literature search of electronic databases, including PubMed and Embase, from January 1, 2021 to December 31, 2022. In total, 278 studies were retrieved. Eligibility criteria were published in English and outcome studies. A literature search and article screening were independently performed by 2 authors and finally, 173 of 278 studies were included.
Results
Thirty-nine studies used matching at the study design stage, and 171 adjusted for confounders using regression analysis or propensity scores at the analysis stage. Of these, 125 conducted regression analyses based on the study questions. Propensity score matching was the most common method involving propensity scores. A total of 171 studies included age and/or sex as confounders. Comorbidities and healthcare utilization, including medications and procedures, were used as confounders in 146 and 82 studies, respectively.
Conclusions
This is the first review to address the methods and applications used to adjust for confounders in recently published studies. Our results indicate that all studies adjusted for confounders with appropriate study designs and statistical methodologies; however, a thorough understanding and careful application of confounding variables are required to avoid erroneous results.
Summary
Korean summary
건강보험청구자료를 사용한 성과연구에서는 교란요인 통제가 중요하다. 최근 발표된 연구들은 연구설계와 통계 분석 과정에 적절하게 교란요인을 통제하였다. 연구의 질을 높이기 위해서는 건강보험청구자료에서 수집 가능한 교란 요인에 대한 이해와 방법론적 가이드라인이 요구된다.
Key Message
All recently published studies using Health Insurance Claims Database adjusted for confounders with appropriate study designs and statistical methodologies. The review suggests the need for careful application of confounding variables and the methodological guidance to improve the quality of outcome studies.

Citations

Citations to this article as recorded by  
  • 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
  • Trends in Regional Disparities in Cardiovascular Surgery and Mortality in Korea: A National Cross-sectional Study
    Dal-Lae Jin, Kyoung-Hoon Kim, Euy Suk Chung, Seok-Jun Yoon
    Journal of Preventive Medicine and Public Health.2024; 57(3): 260.     CrossRef
Original Article
Trends in the Quality of Primary Care and Acute Care in Korea From 2008 to 2020: A Cross-sectional Study
Yeong Geun Gwon, Seung Jin Han, Kyoung Hoon Kim
J Prev Med Public Health. 2023;56(3):248-254.   Published online April 12, 2023
DOI: https://doi.org/10.3961/jpmph.23.015
  • 1,581 View
  • 86 Download
AbstractAbstract AbstractSummary PDF
Objectives
Measuring the quality of care is paramount to inform policies for healthcare services. Nevertheless, little is known about the quality of primary care and acute care provided in Korea. This study investigated trends in the quality of primary care and acute care.
Methods
Case-fatality rates and avoidable hospitalization rates were used as performance indicators to assess the quality of primary care and acute care. Admission data for the period 2008 to 2020 were extracted from the National Health Insurance Claims Database. Case-fatality rates and avoidable hospitalization rates were standardized by age and sex to adjust for patients’ characteristics over time, and significant changes in the rates were identified by joinpoint regression.
Results
The average annual percent change in age-/sex-standardized case-fatality rates for acute myocardial infarction was -2.3% (95% confidence interval, -4.6 to 0.0). For hemorrhagic and ischemic stroke, the age-/sex-standardized case-fatality rates were 21.8% and 5.9%, respectively in 2020; these rates decreased since 2008 (27.1 and 8.7%, respectively). The average annual percent change in age-/sex-standardized avoidable hospitalization rates ranged from -9.4% to -3.0%, with statistically significant changes between 2008 and 2020. In 2020, the avoidable hospitalization rates decreased considerably compared with the 2019 rate because of the coronavirus disease 2019 pandemic.
Conclusions
The avoidable hospitalization rates and case-fatality rates decreased overall during the past decade, but they were relatively high compared with other countries. Strengthening primary care is an essential requirement to improve patient health outcomes in the rapidly aging Korean population.
Summary
Korean summary
본 연구에서는 급성심근경색증과 뇌졸중 치명률, 외래진료 민감질환의 예방 가능한 입원율을 사용하여 한국의 의료 질 수준을 분석하였다. 2008~2020년 동안 치명률과 예방 가능한 입원율은 감소하는 추세이다. 그러나, 예방 가능한 입원율은 다른 국가에 비해 상대적으로 높아 환자의 건강결과 향상을 위하여 일차의료 강화가 요구된다.
Special Article
Cohort Profile: Korean Tuberculosis and Post-Tuberculosis Cohort Constructed by Linking the Korean National Tuberculosis Surveillance System and National Health Information Database
Dawoon Jeong, Hee-Yeon Kang, Jinsun Kim, Hyewon Lee, Bit-Na Yoo, Hee-Sun Kim, Hongjo Choi
J Prev Med Public Health. 2022;55(3):253-262.   Published online April 22, 2022
DOI: https://doi.org/10.3961/jpmph.21.635
  • 3,677 View
  • 134 Download
  • 9 Web of Science
  • 10 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
We aimed to review the current data composition of the Korean Tuberculosis and Post-Tuberculosis Cohort, which was constructed by linking the Korean Tuberculosis Surveillance System (KNTSS; established and operated by the Korean Disease Control and Prevention Agency since 2000) and the National Health Information Database (NHID; established by the National Health Insurance Service in 2012). The following data were linked: KNTSS data pertaining to patients diagnosed with tuberculosis between 2011 and 2018, NHID data of patients with a history of tuberculosis and related diseases between 2006 and 2018, and data (obtained from the Statistics Korea database) on causes of death. Data from 300 117 tuberculosis patients (177 206 men and 122 911 women) were linked. The rate of treatment success for new cases was highest in 2015 (86.7%), with a gradual decrease thereafter. The treatment success rate for previously treated cases showed an increasing trend until 2014 (79.0%) and decreased thereafter. In total, 53 906 deaths were confirmed among tuberculosis patients included in the cohort. The Korean Tuberculosis and Post-Tuberculosis Cohort can be used to analyze different measurement variables in an integrated manner depending on the data source. Therefore, these cohort data can be used in future epidemiological studies and research on policy-effect analysis, treatment outcome analysis, and health-related behaviors such as treatment discontinuation.
Summary
Korean summary
TB Post 코호트(Korean Tuberculosis and Post-Tuberculosis Cohort)는 한국의 결핵 모니터링 및 관리에 대한 인구집단 수준에서의 새로운 근거를 마련하고자 구축한 우리나라 결핵 환자 코호트입니다. 국가 결핵감시체계의 일환으로 구축된 질병관리청의 결핵신고자료와 국민건강보험공단의 국민건강정보DB 자료, 통계청 사망원인 자료의 연계로 구축되었으며, 각 자료원이 보유한 정보를 활용하여 통합적인 결핵 환자 연구가 가능할 것으로 기대하고 있습니다. 결핵의 정책 효과 연구뿐만 아니라, 치료 성공, 실패, 중단 등 치료결과에 대한 영향 요인 및 환자들의 건강 관련 행태에 대한 역학 연구 등 향후 다양한 연구에 활용될 수 있을 것으로 기대됩니다.

Citations

Citations to this article as recorded by  
  • A Quasi-experimental Study on the Effect of Pre-entry Tuberculosis Screening for Immigrants on Treatment Outcomes in South Korea: A Difference-in-Differences Analysis
    Sarah Yu, Dawoon Jeong, Hee-Yeon Kang, Young Ae Kang, Gyeong In Lee, Hongjo Choi
    Journal of Epidemiology and Global Health.2024; 14(1): 154.     CrossRef
  • Relationship between metformin use and mortality in tuberculosis patients with diabetes: a nationwide cohort study
    Eunki Chung, Dawoon Jeong, Jeongha Mok, Doosoo Jeon, Hee-Yeon Kang, Heejin Kim, Heesun Kim, Hongjo Choi, Young Ae Kang
    The Korean Journal of Internal Medicine.2024; 39(2): 306.     CrossRef
  • Trends in Nationally Notifiable Infectious Diseases in Humans and Animals during COVID-19 Pandemic, South Korea
    Taehee Chang, Sung-il Cho, Dae sung Yoo, Kyung-Duk Min
    Emerging Infectious Diseases.2024;[Epub]     CrossRef
  • Beyond reducing direct medical cost: examining health outcomes in tuberculosis through a difference-in-differences analysis of South Korea’s out-of-pocket payment exception policy
    Sarah Yu, Daseul Moon, Dawoon Jeong, Young Ae Kang, Gyeong In Lee, Hongjo Choi
    Frontiers in Public Health.2024;[Epub]     CrossRef
  • Sex differences in the impact of diabetes mellitus on tuberculosis recurrence: a retrospective national cohort study
    Dararat Eksombatchai, Dawoon Jeong, Jeongha Mok, Doosoo Jeon, Hee-Yeon Kang, Hee Jin Kim, Hee-Sun Kim, Hongjo Choi, Young Ae Kang
    International Journal of Infectious Diseases.2023; 127: 1.     CrossRef
  • Nationwide Treatment Outcomes of Patients With Multidrug/Rifampin-Resistant Tuberculosis in Korea, 2011–2017: A Retrospective Cohort Study (Korean TB-POST)
    Hongjo Choi, Jeongha Mok, Young Ae Kang, Dawoon Jeong, Hee-Yeon Kang, Hee Jin Kim, Hee-Sun Kim, Doosoo Jeon
    Journal of Korean Medical Science.2023;[Epub]     CrossRef
  • Prevalence and associated factors of diabetes mellitus among patients with tuberculosis in South Korea from 2011 to 2018: a nationwide cohort study
    Dawoon Jeong, Jeongha Mok, Doosoo Jeon, Hee-Yeon Kang, Hee Jin Kim, Hee-Sun Kim, Jeong Mi Seo, Hongjo Choi, Young Ae Kang
    BMJ Open.2023; 13(3): e069642.     CrossRef
  • Impact of Anti-Tuberculosis Drug Use on Treatment Outcomes in Patients with Pulmonary Fluoroquinolone-Resistant Multidrug-Resistant Tuberculosis: A Nationwide Retrospective Cohort Study with Propensity Score Matching
    Hongjo Choi, Dawoon Jeong, Young Ae Kang, Doosoo Jeon, Hee-Yeon Kang, Hee Jin Kim, Hee-Sun Kim, Jeongha Mok
    Tuberculosis and Respiratory Diseases.2023; 86(3): 234.     CrossRef
  • Retreatment after loss to follow-up reduces mortality in patients with multidrug/rifampicin-resistant tuberculosis
    Hongjo Choi, Jeongha Mok, Young Ae Kang, Dawoon Jeong, Hee-Yeon Kang, Hee Jin Kim, Hee-Sun Kim, Doosoo Jeon
    ERJ Open Research.2023; 9(4): 00135-2023.     CrossRef
  • Association between diabetes mellitus and cause of death in patients with tuberculosis: A Korean nationwide cohort study
    Se Hyun Kwak, Dawoon Jeong, Jeongha Mok, Doosoo Jeon, Hee-Yeon Kang, Hee Jin Kim, Hee-Sun Kim, Hongjo Choi, Young Ae Kang, Frederick Quinn
    PLOS ONE.2023; 18(12): e0295556.     CrossRef
Brief Report
Citation Discovery Tools for Conducting Adaptive Meta-analyses to Update Systematic Reviews
Jong-Myon Bae, Eun Hee Kim
J Prev Med Public Health. 2016;49(2):129-133.   Published online March 14, 2016
DOI: https://doi.org/10.3961/jpmph.15.074
  • 9,438 View
  • 109 Download
  • 18 Crossref
AbstractAbstract PDF
Objectives
The systematic review (SR) is a research methodology that aims to synthesize related evidence. Updating previously conducted SRs is necessary when new evidence has been produced, but no consensus has yet emerged on the appropriate update methodology. The authors have developed a new SR update method called ‘adaptive meta-analysis’ (AMA) using the ‘cited by’, ‘similar articles’, and ‘related articles’ citation discovery tools in the PubMed and Scopus databases. This study evaluates the usefulness of these citation discovery tools for updating SRs.
Methods
Lists were constructed by applying the citation discovery tools in the two databases to the articles analyzed by a published SR. The degree of overlap between the lists and distribution of excluded results were evaluated.
Results
The articles ultimately selected for the SR update meta-analysis were found in the lists obtained from the ‘cited by’ and ‘similar’ tools in PubMed. Most of the selected articles appeared in both the ‘cited by’ lists in Scopus and PubMed. The Scopus ‘related’ tool did not identify the appropriate articles.
Conclusions
The AMA, which involves using both citation discovery tools in PubMed, and optionally, the ‘related’ tool in Scopus, was found to be useful for updating an SR.
Summary

Citations

Citations to this article as recorded by  
  • The impacts of menopausal hormone therapy on longer-term health consequences of ovarian hormone deficiency
    B.-K. Yoon
    Climacteric.2023; 26(3): 193.     CrossRef
  • Citation tracking for systematic literature searching: A scoping review
    Julian Hirt, Thomas Nordhausen, Christian Appenzeller‐Herzog, Hannah Ewald
    Research Synthesis Methods.2023; 14(3): 563.     CrossRef
  • Circulating 25-hydroxyvitamin D levels and hypertension risk after adjusting for publication bias
    Jong-Myon Bae
    Clinical Hypertension.2022;[Epub]     CrossRef
  • Coffee Consumption and Risk of Prostate Cancer in Local, Advanced, and Fatal Grades: A Meta-Epidemiological Study of Prospective Cohort Studies
    Jong-Myon Bae
    The Korean Journal of Urological Oncology.2021; 19(1): 16.     CrossRef
  • Sex as an effect modifier in the association between alcohol intake and gastric cancer risk
    Jong-Myon Bae
    World Journal of Gastrointestinal Oncology.2021; 13(5): 453.     CrossRef
  • Coffee consumption and risk of type 2 diabetes mellitus in Asians: A meta-epidemiological study of population-based cohort studies
    Jong-Myon Bae
    World Journal of Diabetes.2021; 12(6): 908.     CrossRef
  • Hormonal Replacement Therapy and Risk of Thyroid Cancer in Women: A Meta-Epidemiological Analysis of Prospective Cohort Studies
    Jong-Myon Bae
    Journal of Menopausal Medicine.2021; 27(3): 141.     CrossRef
  • History of Diabetes Mellitus and Risk of Breast Cancer in Asian Women: A Meta-Epidemiological Analysis of Population-Based Cohort Studies
    Jong-Myon Bae
    Journal of Menopausal Medicine.2020; 26(1): 29.     CrossRef
  • Body Mass Index and Risk of Gastric Cancer in Asian Adults: A Meta-Epidemiological Meta-Analysis of Population-Based Cohort Studies
    Jong-Myon Bae
    Cancer Research and Treatment.2020; 52(2): 369.     CrossRef
  • History of Coffee Consumption and Risk of Alzheimer's Disease: a Meta-epidemiological Study of Population-based Cohort Studies
    Jong-Myon Bae
    Dementia and Neurocognitive Disorders.2020; 19(3): 108.     CrossRef
  • History of Diabetes Mellitus and Risk of Prostate Cancer: A Meta-Epidemiological Study of Population-Based Cohort Studies in East Asian Men
    Jong-Myon Bae
    The Korean Journal of Urological Oncology.2019; 17(3): 119.     CrossRef
  • Prophylactic efficacy of probiotics on travelers’ diarrhea: an adaptive meta-analysis of randomized controlled trials
    Jong-Myon Bae
    Epidemiology and Health.2018; 40: e2018043.     CrossRef
  • The Role of Menopausal Hormone Therapy in Reducing All-cause Mortality in Postmenopausal Women Younger than 60 Years: An Adaptive Meta-analysis
    Jong-Myon Bae, Byung-Koo Yoon
    Journal of Menopausal Medicine.2018; 24(3): 139.     CrossRef
  • Is there evidence that Kudoa septempunctata can cause an outbreak of acute food poisoning?
    Young-Bae Chung, Jong-Myon Bae
    Epidemiology and Health.2017; 39: e2017004.     CrossRef
  • Human papillomavirus infection and risk of breast cancer: a meta-analysis of case-control studies
    Jong-Myon Bae, Eun Hee Kim
    Infectious Agents and Cancer.2016;[Epub]     CrossRef
  • Epstein-Barr Virus Infection and Risk of Breast Cancer: An Adaptive Meta-Analysis for Case-Control Studies
    Jong-Myon Bae, Eun Hee Kim
    Archives of Clinical Infectious Diseases.2016;[Epub]     CrossRef
  • Dietary intakes of citrus fruit and risk of gastric cancer incidence: an adaptive meta-analysis of cohort studies
    Jong-Myon Bae, Eun Hee Kim
    Epidemiology and Health.2016; 38: e2016034.     CrossRef
  • Breast Density and Risk of Breast Cancer in Asian Women: A Meta-analysis of Observational Studies
    Jong-Myon Bae, Eun Hee Kim
    Journal of Preventive Medicine and Public Health.2016; 49(6): 367.     CrossRef
Clinical Trial
The Current Status of Utilization and Demand on Cancer Information in the Faculties of Medical School in Korea.
Min Kyung Lim, Sook Kyung Park, Jeong Hee Yang, Young Sung Lee
Korean J Prev Med. 2003;36(1):39-46.
  • 2,094 View
  • 24 Download
AbstractAbstract PDF
OBJECTIVES
To investigate the availability and demand for overall cancer-related information, and to establish a basic plan for the construction of a cancer database and information system based on the research results from Korea. METHODS: Postal and telephone surveys were carried out, between August 2001 and November 2001, of 323 affiliated faculty professors from medical universities and colleges in Korea. The data were analyzed with descriptive statistical methods, with regard to the present status and demand for health and cancer-related information. RESULTS: Most (over 80%) subjects studied utilized the health-related information provided on Internet website from foreign countries, such as Medline, but similar comprehensive information system lacked in Korea. The construction of a cancer-related database of domestic research results was revealed to be in a great demand. Information on registration and statistics (52.8%), study results (48.5%) and study resources (37.4%) were the major ingredients required in the database. In constructing a database of the cancer-related research results, a full-text service, continuous updating of data, and the development of standardized user-friendly searching tool were regarded as the necessary components. The formulation of an information sharing system, regarding cancer-related clinical trials, was investigated as being quite feasible. CONCLUSION: This study demonstrated the great importance of cancer information systems, and much demand for an available cancer-related database based on Korean research results.
Summary

JPMPH : Journal of Preventive Medicine and Public Health