Effect of meteorological factors and air pollutants on fractures: a nationwide population-based ecological study

Objective To determine the association of meteorological factors and air pollutants (MFAPs) with fracture and to estimate the effect size/time lag.Design This is a nationwide population-based ecological study from 2008 to 2017.Setting Eight large metropolitan areas in Korea.Participants Of 8 093 820 patients with fractures reported in the Korea National Health Insurance database, 2 129 955 were analysed after the data set containing patient data (age, sex and site of fractures) were merged with MFAPs. Data on meteorological factors were obtained from the National Climate Data Center of the Korea Meteorological Administration. Additionally, data on air pollutants (atmospheric particulate matter ≤2.5 µm in diameter (PM2.5), PM10, ozone, nitrogen dioxide, sulfur dioxide and carbon monoxide) were obtained from the Air Korea database.Primary and secondary outcome measures We hypothesised that there would be an association between MFAPs and the incidence of fracture. A generalised additive model was used while factoring in the non-linear relationship between MFAPs and fractures as well as a time lag ≤7 days. Multivariate analysis was performed. Backward elimination with an Akaike information criterion was used to fit the multivariate model.Results Overall, in eight urban areas, 2 129 955 patients with fractures were finally analysed. These included 370 344, 187 370, 173 100, 140 358, 246 775, 6501, 228 346, 57 183 and 719 978 patients with hip, knee, shoulder, elbow, wrist, hand, ankle, foot and spine fractures, respectively. Various MFAPs (average temperature, daily rain, wind speed, daily snow and PM2.5) showed significant association with fractures, with positive correlations at time lags 7, 5–7, 5–7, 3–7 and 6–7 days, respectively.Conclusions Various MFAPs could affect the occurrence of fractures. The average temperature, daily rain, wind speed, daily snow and PM2.5 were most closely associated with fracture. Thus, improved public awareness on these MFAPs is required for clinical prevention and management of fractures

Burden of Disease in Coastal Areas of South Korea: An Assessment Using Health Insurance Claim Data

Background: While measuring and monitoring disease morbidity, it is essential to focus on regions experiencing inequitable health outcomes, especially coastal populations. However, no research investigating population health outcomes in coastal areas has been conducted. Therefore, we aimed to investigate the burden of disease morbidity in coastal areas of South Korea. Methods: Using an administrative division map and the ArcGIS, we identified and included 496 coastal districts. In this observational study, years lived with disability (YLDs) were estimated using incidence-based approaches to calculate the burden of disease in 2015. Incidence and prevalence cases were collected using National Health Insurance Service (NHIS) medical claim data using a specialized algorithm. Results: Age-standardized years lived with disability (ASYLDs) in the coastal areas were 24,398 per 100,000 population, which is greater than the 22,613 YLDs observed nationwide. In coastal areas, the burden of disease morbidity was higher in females than in males. Diabetes mellitus was the leading specific disease of total YLDs per 100,000 population, followed by low back pain, chronic obstructive pulmonary disease, osteoarthritis, and ischemic stroke. Conclusion: In this study, the coastal areas of South Korea carry a higher burden than the national population. Additionally, chronic diseases compose the majority of the health burden in coastal areas. Despite the limitation of data, YLD was the best tool available for evaluating the health outcomes in specific areas, and has the advantage of simplicity and timely analysis

Model-based cost-effectiveness analysis of oral antivirals against SARS-CoV-2 in Korea

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