Bronchiectasis is a chronic respiratory disease characterised by abnormal dilatation of bronchi, which presents clinically with cough, sputum production and recurrent infection [1]. Although bronchiectasis had been regarded as an "orphan" disease [2], recent studies have shown that the prevalence of bronchiectasis is increasing and this disease causes a significant burden on public health, including increased healthcare costs, hospital admission and mortality [3][4][5].Data on the prevalence of bronchiectasis and bronchiectasis-related comorbidities are relevant, since comorbidities are important factors for predicting the risk of mortality in patients with bronchiectasis [6]. However, epidemiological data on the prevalence of bronchiectasis remain limited, especially in Asian populations. Furthermore, only a few studies have included a comprehensive evaluation of the prevalence of bronchiectasis-related comorbidities among Asians [1,7]. Thus, in the present study, the overall prevalence of bronchiectasis and associated comorbidities were investigated using a representative sample of national health insurance claims data in South Korea.To identify patients with bronchiectasis and investigate their comorbidities, data were used from the 2012-2017 Health Insurance Review and Assessment Service, National Patient Sample (HIRA-NPS), which is nationally representative and open to the public for research purposes [8]. The HIRA-NPS data are cross-sectional and composed of health insurance claim records during the year. The database includes approximately 1 400 000 individuals each year drawn by 3% stratified random sampling by age and sex from the entire population who had claims records during the year. It also provides information on healthcare costs, composed of payer's amounts and patient's out-of-pocket costs. South Korea has a government-run mandatory national health security system; 97% of the population is enrolled in the National Health Insurance and 3% in Medical Aid programmes [9].
Background Dipeptidyl peptidase-4 inhibitor (DPP-4i) and renin-angiotensin system (RAS) blockade are reported to affect the clinical course of coronavirus disease 2019 (COVID-19) in patients with diabetes mellitus (DM). Methods As of May 2020, analysis was conducted on all subjects who could confirm their history of claims related to COVID-19 in the National Health Insurance Review and Assessment Service (HIRA) database in Korea. Using this dataset, we compared the short-term prognosis of COVID-19 infection according to the use of DPP-4i and RAS blockade. Additionally, we validated the results using the National Health Insurance Service (NHIS) of Korea dataset. Results Totally, data of 67,850 subjects were accessible in the HIRA dataset. Of these, 5,080 were confirmed COVID-19. Among these, 832 subjects with DM were selected for analysis in this study. Among the subjects, 263 (31.6%) and 327 (39.3%) were DPP-4i and RAS blockade users, respectively. Thirty-four subjects (4.09%) received intensive care or died. The adjusted odds ratio for severe treatment among DPP-4i users was 0.362 (95% confidence interval [CI], 0.135 to 0.971), and that for RAS blockade users was 0.599 (95% CI, 0.251 to 1.431). These findings were consistent with the analysis based on the NHIS data using 704 final subjects. The adjusted odds ratio for severe treatment among DPP-4i users was 0.303 (95% CI, 0.135 to 0.682), and that for RAS blockade users was 0.811 (95% CI, 0.391 to 1.682). Conclusion This study suggests that DPP-4i is significantly associated with a better clinical outcome of patients with COVID-19.
Background: Dipeptidyl peptidase-4 inhibitor (DPP-4i) and renin-angiotensin system (RAS) blockade are reported to affect the clinical course of coronavirus disease 2019 (COVID-19) in patients with diabetes mellitus (DM). However, the effectiveness of these drugs in large populations is unclear. Subjects and Methods: As of May 2020, data analysis was conducted on all subjects who could confirm their history of claims related to COVID-19 in the National Health Review and Assessment Service database in Korea. Using the COVID-19 and claims data of the past 5 years, we compared the short-term prognosis of COVID-19 infection according to the use of DPP-4i and RAS blockade. Results: Totally, data of 67850 subjects were accessible. Of these, 5080 were confirmed COVID-19. Among these, 832 subjects with DM were selected for analysis in this study. Among the subjects, 263 (31.6%) and 327 (39.3%) were DPP-4i and RAS blockade users, respectively. Thirty-four subjects (4.09%) received intensive care or died. The adjusted odds ratio for severe treatment among DPP-4i users was 0.362 [95% confidence interval (CI), 0.135-0.971], and that for RAS blockade users was 0.599 (95% CI, 0.251-1.431). No synergy was observed for subjects using both drugs. Conclusion: This population-based study suggests that DPP-4i is significantly associated with a better clinical outcome of patients with COVID-19. However, the effect of RAS blockade is not significant.
Objective: Little is known about the role of estrogen in thyroid cancer development. We aimed to evaluate the association between hysterectomy or bilateral salpingo-oophorectomy (BSO) and the risk of subsequent thyroid cancer. Design: A nationwide cohort study. Methods: Data from the Korea National Health Insurance Service between 2002 and 2017 were used. A total of 78,961 and 592,330 women were included in the surgery group and no surgery group, respectively. The surgery group was categorized into two groups according to the extent of surgery: hysterectomy with ovarian conservation (hysterectomy-only) and BSO with or without hysterectomy (BSO). Results: During 8,086,396.4 person-years of follow-up, 12,959 women developed thyroid cancer. Women in the hysterectomy-only (adjusted hazard ratio = 1.7, P < 0.001) and BSO (adjusted hazard ratio = 1.4, P < 0.001) groups had increased risk of thyroid cancer compared to those in the no surgery group. In premenopausal women, hysterectomy-only (adjusted hazard ratio = 1.7, P < 0.001) or BSO (adjusted hazard ratio = 1.4, P < 0.001) increased the risk of subsequent thyroid cancer, irrespective of hormone therapy, whereas, there was no significant association between hysterectomy-only (P = 0.204) or BSO (P = 0.857) and thyroid cancer development in postmenopausal women who had undergone hormone therapy. Conclusions: Our findings do not support the hypotheses that sudden or early gradual decline in estrogen levels is a protective factor in the development of thyroid cancer, or that exogenous estrogen is a risk factor for thyroid cancer.
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