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3. Income variability and incident cardiovascular disease in diabetes: a population-based cohort study.

Author

Park, Yong-Moon Mark, Baek, Jong-Ha, Lee, Hong Seok, Elfassy, Tali, Brown, Clare C, Schootman, Mario, Narcisse, Marie-Rachelle, Ko, Seung-Hyun, McElfish, Pearl A, Thomsen, Michael R, Amick, Benjamin C, Lee, Seong-Su, and Han, Kyungdo

Subjects
INCOME, HEALTH insurance premiums, CARDIOVASCULAR diseases, NATIONAL health insurance, TYPE 2 diabetes
Abstract

Background and Aims: Longitudinal change in income is crucial in explaining cardiovascular health inequalities. However, there is limited evidence for cardiovascular disease (CVD) risk associated with income dynamics over time among individuals with type 2 diabetes (T2D). Methods: Using a nationally representative sample from the Korean National Health Insurance Service database, 1 528 108 adults aged 30–64 with T2D and no history of CVD were included from 2009 to 2012 (mean follow-up of 7.3 years). Using monthly health insurance premium information, income levels were assessed annually for the baseline year and the four preceding years. Income variability was defined as the intraindividual standard deviation of the percent change in income over 5 years. The primary outcome was a composite event of incident fatal and nonfatal CVD (myocardial infarction, heart failure, and stroke) using insurance claims. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated after adjusting for potential confounders. Results: High-income variability was associated with increased CVD risk (HRhighest vs. lowest quartile 1.25, 95% CI 1.22–1.27; Ptrend <.001). Individuals who experienced an income decline (4 years ago vs. baseline) had increased CVD risk, which was particularly notable when the income decreased to the lowest level (i.e. Medical Aid beneficiaries), regardless of their initial income status. Sustained low income (i.e. lowest income quartile) over 5 years was associated with increased CVD risk (HRn = 5 years vs. n = 0 years 1.38, 95% CI 1.35–1.41; Ptrend <.0001), whereas sustained high income (i.e. highest income quartile) was associated with decreased CVD risk (HRn = 5 years vs. n = 0 years 0.71, 95% CI 0.70–0.72; Ptrend <.0001). Sensitivity analyses, exploring potential mediators, such as lifestyle-related factors and obesity, supported the main results. Conclusions: Higher income variability, income declines, and sustained low income were associated with increased CVD risk. Our findings highlight the need to better understand the mechanisms by which income dynamics impact CVD risk among individuals with T2D. Structured Graphical Abstract This study investigates the association between income dynamics over five years and incident composite cardiovascular outcomes in non-elderly individuals with type 2 diabetes. Our graphical abstract highlights significant associations between cardiovascular risk and income metrics, including income variability (standard deviation of percent change), changes in income status (rise and decline), and cumulative number of years in low- or high-income status. [ABSTRACT FROM AUTHOR]

Published
2024
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4. Longitudinal associations of sustained low or high income and income variability with incident cardiovascular disease in individuals with type 2 diabetes: a retrospective population-based cohort study

Author

Park, Yong-Moon Mark, primary, Baek, Jongha, additional, Lee, Hong Seok, additional, Elfassy, Tali, additional, Brown, Clare C., additional, Schootman, Mario, additional, Narcisse, Marie-Rachelle, additional, Ko, Seung-Hyun, additional, McElfish, Pearl A., additional, Thomsen, Michael R., additional, Amick, Benjamin C., additional, Lee, Seong-Su, additional, and Han, Kyungdo, additional

Published
2023
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15. Different effect of obesity and metabolic syndrome on prostate cancer by age group

Author

Lee, Gukjin, Han, Kyungdo, and Lee, Seong-Su

Subjects
Original Article
Abstract

Substantial evidence supports that metabolic syndrome (MetS) affects the incidence of several cancers, with different effects according to age group. We hypothesized that MetS has an age-specific effect on the occurrence of prostate cancer. We studied a National Health Insurance Service health checkup cohort. A total of 5,370,614 men in the cohort were categorized into three age groups in 2009 (20-39, 40-64, ≥65). Prostate cancer incidence was estimated on a cumulative basis from 2009 to 2018. We tried to identify the correlation of MetS components and prostate cancer by age group using this large retrospective cohort. MetS components included the body mass index (BMI), waist circumference (WC), hypertension, obesity, hyperlipidemia, cardiovascular disease, smoking, drinking, serum glucose, serum total cholesterol, serum triglyceride, serum high-density lipoprotein (HDL)-cholesterol and serum low-density lipoprotein (LDL)-cholesterol. A multivariate Cox proportional hazard model was used for the incidence of prostate cancer according to the MetS component. In the young age (20-39) group, the MetS component was not related to prostate cancer. In the middle-aged (40-64) group, the presence of MetS, WC, HDL cholesterol, and hypertension was significantly associated with an increased prevalence of prostate cancer. In the old age (≥65) group, the presence of MetS, WC, HDL cholesterol, triglycerides, and hypertension were significant factors for the incidence of prostate cancer. This tendency was marked in BMI>30 in the old age group (odds ratio: 1.32; P

Published
2022

16. Sustained Low Income, Income Changes, and Risk of All-Cause Mortality in Individuals With Type 2 Diabetes: A Nationwide Population-Based Cohort Study.

Author

Lee, Hong Seok, Park, Jimin Clara, Chung, Inkwan, Liu, Junxiu, Lee, Seong-Su, and Han, Kyungdo

Subjects
TYPE 2 diabetes, MORTALITY, HEALTH insurance premiums, PROPORTIONAL hazards models, COHORT analysis
Abstract

Objective: There is limited evidence on the association of sustained low-income status, income changes, and all-cause mortality risk in individuals with type 2 diabetes (T2D).Research Design and Methods: Using the Korean Health Insurance Service database, we studied 1,923,854 adults with T2D (aged ≥30 years) without cardiovascular disease and cancer, who were enrolled from 2009 through 2012 and followed to the end of 2020 (median 10.8 years of follow-up). We defined income levels based on the amount of health insurance premiums and categorized them into quartiles, the first being the low-income group, and assessed the income status annually in the preceding 5 years. Cox proportional hazards models were used to quantify the association of low-income status and income changes with mortality, with adjustment for sociodemographic factors, comorbidities, and diabetes duration and treatment.Results: Participants who consecutively had low income showed a higher risk of mortality (hazard ratio [HR] 1.19; 95% CI 1.16-1.22), compared with those who had never been in the low-income group. This association was much stronger for consecutive recipients of Medical Aid, reflecting very-low-income status (HR 2.26; 95% CI 2.16-2.36), compared with those who had never been Medical Aid beneficiaries. Sustained low- and very-low-income status was associated with increased risk of mortality, specifically for younger adults (aged<40 years) and males. Those who experienced declines in income between the first (preceding 5 years) and the last (baseline) time points had an increased risk of mortality, regardless of baseline income status.Conclusions: Among Korean adults with T2D, sustained low-income status and declines in income were associated with increased risk of mortality. [ABSTRACT FROM AUTHOR]

Published
2023
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24. Diabetes Fact Sheets in Korea, 2020: An Appraisal of Current Status

Author

Jung, Chan-Hee, primary, Son, Jang Won, additional, Kang, Shinae, additional, Kim, Won Jun, additional, Kim, Hun-Sung, additional, Kim, Hae Soon, additional, Seo, Mihae, additional, Shin, Hye-Jung, additional, Lee, Seong-Su, additional, Jeong, Su Jin, additional, Cho, Yongin, additional, Han, Seung Jin, additional, Jang, Hyang Mi, additional, Rho, Mira, additional, Lee, Shinbi, additional, Koo, Mihyun, additional, Yoo, Been, additional, Moon, Jung-Wha, additional, Lee, Hye Young, additional, Yun, Jae-Seung, additional, Kim, Sun Young, additional, Kim, Sung Rae, additional, Jeong, In-Kyung, additional, Mok, Ji-Oh, additional, and Yoon, Kun Ho, additional

Published
2021
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31. Analgesic effect of ropivacaine with fentanyl in comparison with ropivacaine alone for continuous femoral nerve block after knee replacement arthroplasty: a prospective, randomized, double-blinded study

Author

Kim, Gunn Hee, primary, Lee, Joon Woo, additional, Kim, Go Eun, additional, Lee, Seong Su, additional, Son, Shill Lee, additional, Kim, Byung Uk, additional, Cho, Ha Na, additional, Kwon, Mi Young, additional, Koo, Min Seok, additional, Kim, Ji Eun, additional, and Yun, Mi Jung, additional

Published
2020
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