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We aimed to examine the association between opioid use and the development of dementia in patients with chronic non-cancer pain in South Korea. Data were extracted from the National Health Insurance Service database in South Korea. Adult patients diagnosed with musculoskeletal diseases with chronic non-cancer pain between 2010 and 2015 were included in the analysis. Patients who were prescribed opioids regularly and continuously for ≥ 90 days were classified as opioid users. In total, 1,261,682 patients with chronic non-cancer pain were included in the final analysis, of whom 21,800 (1.7%) were opioid users. From January 1, 2016 to December 31, 2020, 35,239 (2.8%) patients with chronic non-cancer pain were newly diagnosed with dementia. In the multivariable model, opioid users showed a 15% higher risk of developing dementia than the control group. Additionally, opioid users showed a 15% and 16% higher risk of developing Alzheimer’s disease and unspecified dementia, respectively, than the control group, but did not show any significant differences for vascular dementia. Among adult patients with chronic non-cancer pain, opioid users were at a higher risk of developing dementia than the control group; the risk was significantly higher for Alzheimer’s disease but not for vascular dementia in this study. Our results suggest that in patients with CNCP, public health strategies should target opioid users for early dementia detection and intervention.

This study aimed to examine the prognostic value of C-reactive protein (CRP)/albumin (ALB) ratio among patients who were admitted to the intensive care unit (ICU) in predicting 30-day mortality rate. This retrospective cohort study was conducted by examining the medical records of adult patients who were admitted to the ICU at Seoul National University Bundang Hospital between 1 January 2012 and 31 December 2016. Data from 6,972 individuals were included in the final analysis, and 547 of these individuals (7.1%) died within 30 days after their ICU admission. The multivariable Cox regression analysis revealed that an increase of 1 for the CRP/ALB ratio was associated with an 11% increase in the risk of 30-day mortality (hazard ratio: 1.11, 95% confidence interval: 1.09–1.14, P  < 0.001). However, the area under curve of CRP/ALB ratio in receiver operating characteristic analysis was lower than that of Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II, Charlson comorbidity index, or serum albumin alone. Although an elevated CRP/ALB ratio on ICU admission was an independent risk factor for 30-day mortality rate, the predictive power of CRP/ALB ratio was lower than that of albumin alone, APACHE II, and Charlson comorbidity index.

We examined and compared the clinical characteristics of acute respiratory distress syndrome (ARDS) patients who received and did not receive extracorporeal membrane oxygenation (ECMO) support. The national health insurance database of South Korea was used to obtain real-world data. All adult patients admitted to intensive care units for ARDS treatment between 1 January 2014 and 31 December 2019 were included in this study. Of the 10,173 patients with ARDS included in the analysis, 740 (7.3%) received ECMO support for a mean duration of 1.6 days (standard deviation [SD]: 2.8 days) and were assigned to the ECMO group. The ECMO group had a significantly lower mean age at 57.0 years (SD: 15.7 years) than the non-ECMO group (71.8 Â years [SD: 15.1 Â years], P  < 0.001). In multivariable logistic regression, a 1-year increase in age was associated with a 5% lower prevalence of ECMO support. The annual case volume was classified into four groups by quartile ratio (Q1 [lowest], Q2, Q3, and Q4 [highest]), and Q2, Q3, and Q4 groups showed a higher prevalence of ECMO support than the Q1 group. ECMO support was also performed more frequently in high case volume centers than in low case volume centers for ARDS patients.

Recent information regarding the characteristics of people living with human immunodeficiency virus (HIV) (PLWH) is lacking. Therefore, we examined the incidence of HIV infection and epidemiologic characteristics of PLWH in South Korea using recent National Health Insurance Service database data. The HIV infection rate was 4.13 per 100,000 in 2017, 4.19 per 100,000 in 2018, 6.61 per 100,000 in 2019, 5.98 per 100,000 in 2020, 8.81 per 100,000 in 2021, and 4.14 per 100,000 in 2022. In 2016, the mean age of PLWH was 45.7 years (SD: 13.8 years), and it gradually increased to 49.0 years (standard deviation: 13.7 years) in 2022 over 7 years in South Korea. The proportion of male individuals among PLWH was 90.7% (19,970/22,026) in 2016, and it gradually increased to 92.3% (22,943/24,857) in 2022 over 7 years in South Korea. The proportion of anti-retroviral therapy (ART) users among PLWH in South Korea was 92.6% (20,388/22,026) in 2016, and it gradually increased to 97.9% (24,328/24,857) in 2022 over 7 years. In this population-based cohort analysis, we presented the HIV infection incidence and epidemiologic features of PLWH in South Korea. This study’s results may influence future infection prevention strategies and policies for PLWH.

Background The impact of underlying chronic respiratory diseases (CRDs) on the risk and mortality of patients with coronavirus disease 2019 (COVID-19) remains controversial. We aimed to investigate the effects of CRDs on the risk of COVID-19 and mortality among the population in South Korea. Methods The NHIS-COVID-19 database in South Korea was used for data extraction for this population-based cohort study. Chronic obstructive pulmonary disease (COPD), asthma, interstitial lung disease (ILD), lung cancer, lung disease due to external agents, obstructive sleep apnea (OSA), and tuberculosis of the lungs (TB) were considered CRDs. The primary endpoint was a diagnosis of COVID-19 between January 1st and June 4th, 2020; the secondary endpoint was hospital mortality of patients with COVID-19. Multivariable logistic regression modeling was used for statistical analysis. Results The final analysis included 122,040 individuals, 7669 (6.3%) were confirmed as COVID-19 until 4 June 2020, and 251 patients with COVID-19 (3.2%) passed away during hospitalization. Among total 122,040 individuals, 36,365 individuals were diagnosed with CRD between 2015 and 2019: COPD (4488, 3.6%), asthma (33,858, 27.2%), ILD (421, 0.3%), lung cancer (769, 0.6%), lung disease due to external agents (437, 0.4%), OSA (550, 0.4%), and TB (608, 0.5%). Among the CRDs, patients either with ILD or OSA had 1.63-fold (odds ratio [OR] 1.63, 95% confidence interval [CI] 1.17–2.26; P  = 0.004) and 1.65-fold higher (OR 1.65, 95% CI 1.23–2.16; P  < 0.001) incidence of COVID-19. In addition, among patients with COVID-19, the individuals with COPD and lung disease due to external agents had 1.56-fold (OR 1.56, 95% CI 1.06–2.2; P  = 0.024) and 3.54-fold (OR 3.54, 95% CI 1.70–7.38; P  < 0.001) higher risk of hospital mortality. Conclusions Patients with OSA and ILD might have an increased risk of COVID-19. In addition, COPD and chronic lung disease due to external agents might be associated with a higher risk of mortality among patients with COVID-19. Our results suggest that prevention and management strategies should be carefully performed.

Trauma center designation may influence surgical outcomes, but evidence from Asian trauma systems remains limited. This study examined the association between trauma center level and postoperative mortality following trauma surgery in South Korea. We conducted a nationwide cohort study using 2021 data from the Korean National Health Insurance Service. Adults (≥ 18 years) who underwent trauma surgery under general anesthesia at one of 17 designated trauma centers were included. Centers were categorized into Level A (highest), B, or C (lowest) based on a 2020 government evaluation. Primary outcomes were 90-day and 1-year all-cause mortality. Secondary outcomes included in-hospital postoperative complications. Multivariable logistic and Cox regression models were used, adjusting for demographic, clinical, and socioeconomic variables. Among 3,914 patients, 1,840 (47.0%) were treated at Level A centers, 1,749 (44.7%) at Level B, and 325 (8.3%) at Level C. Compared with Level A centers, the adjusted odds of 90-day mortality were higher in Level B (OR, 1.51; 95% CI, 1.20–1.91; P  < 0.001) and Level C centers (OR, 4.16; 95% CI, 2.85–6.05; P  < 0.001). One-year mortality was also higher in Level B (HR, 1.19; 95% CI, 1.02–1.39; P  = 0.027) and Level C (HR, 1.91; 95% CI, 1.50–2.44; P  < 0.001) centers. No significant differences in postoperative complication rates were observed. Lower-level trauma centers were associated with higher postoperative mortality after trauma surgery. These findings underscore the importance of trauma center designation and infrastructure in improving surgical outcomes and may inform national trauma system development.

Background The relationship between socioeconomic status and the risk of contracting coronavirus disease (COVID-19) remains controversial. We aimed to investigate whether socioeconomic status affected the risk of contracting COVID-19 in the South Korean population. Methods The NHIS-COVID-19 database cohort was used in this population-based study. We collected the data of COVID-19 patients who were diagnosed between January 1, 2020 and June 4, 2020 and those of the control population. The income levels of all individuals as of February 2020 were extracted, and study participants were classified into four groups based on quartiles: Q1 (the lowest) to Q4 (the highest). Data were statistically analyzed using multivariable logistic regression modeling. Results In total, 122,040 individuals—7669 and 114,371 individuals in the COVID-19 and control groups, respectively—were included in the final analysis. The multivariable logistic regression model showed that the Q1 group had a 1.19-fold higher risk of contracting COVID-19 than the Q4 group, whereas the Q2 and Q3 groups showed no significant differences. In the 20–39 years age group, compared with the Q4 group, the Q3 and Q2 groups showed 11 and 22% lower risks of contracting COVID-19, respectively. In the ≥60 years age group, compared with the Q4 group, the Q1, Q2, and Q3 groups showed a 1.39-, 1.29-, and 1.14-fold higher risks of COVID-19, respectively. Conclusions Lower socioeconomic status was associated with a higher risk of contracting COVID-19 in South Korea. This association was more evident in the older population (age ≥ 60 years), whereas both lower and higher socioeconomic statuses were associated with higher risks of contracting COVID-19 in the young adult population (in the 20–39 year age group). Strategies for the prevention of COVID-19 should focus on individuals of lower socioeconomic status and on young adults of higher and lower socioeconomic status.

We aimed to evaluate whether neonatal intensive care unit (NICU) intensivist staffing is associated with improved survival outcomes among neonates admitted to NICUs in South Korea. This nationwide retrospective cohort study included all neonates hospitalized in NICUs between January 1, 2019, and December 31, 2021. Patients were categorized into two groups based on intensivist staffing: the intensivist group, comprising neonates admitted to hospitals with full-time NICU intensivists, and the non-intensivist group, comprising those treated in hospitals without dedicated NICU intensivist coverage. A total of 79,306 neonates were included in the final analysis; among them, 44,330 (56.1%) were admitted to NICUs with registered NICU intensivists. In multivariable logistic regression analysis, the intensivist group had a significantly lower odds of 30-day mortality (odds ratio [OR]: 0.73; 95% confidence interval [CI] 0.58–0.92; P  = 0.007) compared to the non-intensivist group. Similarly, in Cox regression analysis, the intensivist group showed a lower risk of 1-year all-cause mortality (hazard ratio: 0.79; 95% CI 0.69–0.91; P  = 0.001). These findings suggest that the presence of dedicated NICU intensivists is associated with improved short- and long-term survival outcomes among neonates, supporting policies to enhance specialized staffing in neonatal intensive care settings.

Introduction There is a paucity of studies that compare suicide‐ and non‐suicide‐related deaths, with strict adjustments for people living with human immunodeficiency virus (HIV; PLWH) and those without HIV. We, therefore, aimed to determine whether the risk of suicide differs between these groups. Methods This study included all PLWH diagnosed with HIV in South Korea between 1 January 2017 and 31 December 2017. Individuals who had never been diagnosed with HIV were selected as controls using 1:10 stratified random sampling, considering age and sex. The heterogeneity of covariates between PLWH and controls was decreased by 1:5 propensity score matching. The endpoint of the study was death by suicide, with follow‐up from 1 January 2018 to 31 December 2022. Death that was not ruled as a suicide was categorized as being due to other causes. Results After propensity score matching, 22,415 PLWH (mean age 45.9 years; 91% male) and 96,790 controls (mean age 45.8 years; 90.5% male) were included in the final analysis. Within 5 years, 104 (0.5%) of PLWH and 246 (0.3%) of controls died by suicide. Cox regression analysis revealed a 1.84‐fold higher risk of suicide among PLWH compared with controls (hazard ratio [HR], 1.84; 95% confidence interval [CI], 1.46–2.31; p < 0.001). Moreover, 836 (3.7%) of 22,415 PLWH and 2882 (3.0%) of 96,790 controls died of other causes within 5 years. Cox regression analysis also revealed a 1.26‐fold increase in the risk of mortality due to other causes among PLWH (HR: 1.26; 95% CI, 1.17–1.36; p < 0.001). Conclusions This analysis of a South Korean cohort found higher rates of death due to suicide and other causes among people living with and without HIV. The risk of death by suicide was higher than that of other causes among PLWH.

PurposeAbrupt hemodynamic changes or life-threatening arrhythmias are frequently observed in individuals receiving anesthesia for cardiac arrhythmia ablation. Remimazolam is a novel ultra-short-acting benzodiazepine that has been associated with better hemodynamic stability than conventional anesthetic agents do. This study aimed to investigate whether remimazolam reduces vasoactive agent use compared with desflurane in individuals undergoing ablation for atrial fibrillation under general anesthesia.MethodsIn a retrospective cohort study, we reviewed electronic medical records of adult patients who underwent ablation for atrial fibrillation under general anesthesia between July 2021 and July 2022. We divided patients into remimazolam and desflurane groups according to the principal agent used for anesthesia. The primary endpoint was the overall incidence of vasoactive agent use. We compared the groups using propensity-score matching (PSM) analysis.ResultsA total of 177 patients were included—78 in the remimazolam group and 99 in the desflurane group. After PSM, 78 final patients were included in each group. The overall incidence of vasoactive agent use was significantly lower in the remimazolam group than in the desflurane group (41% vs 74% before PSM; 41% vs 73% after PSM; both, P < 0.001). The incidence rate, duration, and maximum dose of continuous vasopressor infusion were also significantly lower in the remimazolam group (P < 0.001). Use of remimazolam was not associated with increased complications after the ablation procedures.ConclusionsGeneral anesthesia using remimazolam vs desflurane was associated with significantly reduced vasoactive agent requirement and better hemodynamic stability without increased postoperative complications in patients undergoing ablation for atrial fibrillation.