Lee Taehoon, Kim Jinhee, Kim Sujeong, Kim Kyoungjoo, Park Yunjin, Kim Yuri, Lee Yoon Su, Kwon Hyouk-Soo, Kim Sae-Hoon, Chang Yoon-Seok, Cho You Sook, Jang An-Soo, Park Jung-Won, Nahm Dong-Ho, Yoon Ho-Joo, Cho Sang-Heon, Cho Young-Joo, Choi Byoung Whui, Moon Hee-Bom, Kim Tae-Bum
Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
National Evidence-based Healthcare Collaborating Agency, Seoul, Korea; Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea.
PLoS One. 2014 Nov 14;9(11):e112844. doi: 10.1371/journal.pone.0112844. eCollection 2014.
Though insurance claims data are useful for researching asthma, they have important limitations, such as a diagnostic inaccuracy and a lack of clinical information. To overcome these drawbacks, we used the novel method by merging the clinical data from our asthma cohort with the National Health Insurance (NHI) claims data.
Longitudinal analysis of asthma-related healthcare use from the NHI claims database, merged with data of 736 patients registered in a Korean asthma cohort, was conducted for three consecutive years from registration of the cohort. Asthma-related asthma healthcare referred to outpatient and emergency department visits, hospitalizations, and the use of systemic corticosteroids. Univariate and multivariate logistic regression analysis was used to evaluate risk factors for asthma-related healthcare. Over three years after enrollment, many patients changed from tertiary to primary/secondary hospitals with a lack of maintenance of inhaled corticosteroid-based controllers. An independent risk factor for emergency visits was a previous history of asthma exacerbation. In hospitalizations, old age and Asthma Control Test (ACT) score variability were independent risk factors. An independent risk factor for per person cumulative duration of systemic corticosteroids was the FEV1 (Forced expiratory volume in one second)%. The use of systemic corticosteroids was independently associated with being female, the FEV1%, and ACT score variability.
We found that old age, being female, long-standing asthma, a low FEV1%, asthma brittleness, asthma drug compliance, and a history of asthma exacerbation were independent risk factors for increased asthma-related healthcare use in Korea.
尽管保险理赔数据对哮喘研究有用，但它们有重要局限性，如诊断不准确和缺乏临床信息。为克服这些缺点，我们采用了一种新方法，即将我们哮喘队列的临床数据与国民健康保险（NHI）理赔数据合并。
对NHI理赔数据库中与哮喘相关的医疗保健使用情况进行纵向分析，并与韩国一个哮喘队列中登记的736例患者的数据合并，从队列登记开始连续三年进行分析。与哮喘相关的医疗保健是指出门诊和急诊科就诊、住院以及全身用糖皮质激素的使用。采用单因素和多因素逻辑回归分析来评估与哮喘相关医疗保健的危险因素。入组三年后，许多患者从三级医院转到一级/二级医院，且缺乏基于吸入性糖皮质激素的控制药物维持治疗。急诊就诊的一个独立危险因素是既往哮喘加重史。在住院方面，高龄和哮喘控制测试（ACT）评分变异性是独立危险因素。每人全身用糖皮质激素累积使用时间的一个独立危险因素是第一秒用力呼气量（FEV1）%。全身用糖皮质激素的使用与女性、FEV1%以及ACT评分变异性独立相关。
我们发现高龄、女性、哮喘病程长、FEV1%低、哮喘脆性、哮喘药物依从性以及哮喘加重史是韩国哮喘相关医疗保健使用增加的独立危险因素。
