Lim D, et al. J Korean Med Sci. 2014 Dec;29(12):1597-1603. http://dx.doi.org/10.3346/jkms.2014.29.12.1597

This study examined levels of blood lead and mercury, and urinary cadmium, and associated sociodemographic factors in 3-18 year-old Korean children and adolescents. We used the nationally representative Korean Environmental Health Survey in Children and Adolescents data for 2012-2014 and identified 2388 children and adolescents aged 3-18 years. The median and 95th percentile exposure biomarker levels with 95% confidence intervals (CIs) were calculated. Multivariate regression analyses were performed on log transformed exposure biomarker levels adjusted for age, sex, area, household income, and father's education level. The median exposure biomarker levels were compared with data from Germany, the US, and Canada, as well as the levels of Korean children measured at different times. The median levels of blood lead and mercury, as well as urinary cadmium were 1.23μg/dL, 1.80μg/L, and 0.40μg/L (95% CIs, 1.21-1.25, 1.77-1.83, and 0.39-0.41, respectively). The blood lead levels were significantly higher in boys and younger children (p<0.0001) and children with less educated fathers (p=0.004) after adjusting for covariates. Urinary cadmium level increased with age (p<0.0001). The median levels of blood mercury and urinary cadmium were much higher in Korean children and adolescents than those in their peers in Germany, the US, and Canada. Blood lead levels tended to decrease with increasing age and divergence between the sexes, particularly in the early teen years. Median levels of blood lead and urinary cadmium decreased since 2010. Sociodemographic factors, including age, sex, and father's education level were associated with environmental exposure to heavy metals in Korean children and adolescents. These biomonitoring data are valuable for ongoing surveillance of environmental exposure in this vulnerable population.

Cancer is the leading cause of death in Korea. This study aims to examine changes in temporal trends in major cancer mortality. Mortality data for 1993-2012 were obtained from the Korean Statistics Information Service(KOSIS) database and age-standardized to the 2000 Korean population. Joinpoint analysis was used to identify significant changes in trends over time. The annual percentage rate change (APC) was computed for each segment of the trends. The age-standardized mortality rates (ASR) for all cancer sites combined decreased by 9.1% and 1.1% in men and women, respectively, from 1983 to 2012. ASRs from cancers of esophagus, stomach, and liver decreased substantially, whereas ASRs from cancer for all other sites increased markedly. ASRs for all cancer sites combined increased until 1994 and thereafter decreased significantly in both genders except for the period of 1998-2002 (APC: -5.5% for men [p<0.05] and 0.07% for women). ASRs for esophagus and liver cancers increased until the early 1990s and thereafter declined, leading to significant decreases [p<0.05] for esophagus cancer (APC: -1.85% for men and -3.82% for women) and liver cancer (APC: -1.55% for men and -0.56% for women) in 1983-2012. ASRs for stomach cancer declined (APC: -4.06% for men and -4.07% for women) except for 1990-1994. ASRs for uterine cancer peaked in 2003 and then declined (APC: 2.85%). ASRs increased significantly until 2002 for colorectal cancer in men (APC: 7.52%) and lung cancer in both genders. The most consistently upward trend was observed for non-Hodgkin's lymphoma (APC: 3.55% for men and 5.29% for women; number of joinpoints=0). The greatest ASR increase was seen for prostate cancer for which mortality increased until 2002 at an APC of 12.56%. While mortality decreased significantly for esophagus, stomach and liver cancers in recent decades in Korea, challenges still remain for many other cancers, especially pancreatic, breast, and prostate cancers and non-Hodgkin's lymphoma. Surveillance of cancer mortality trends can lend valuable insights as to the prevention and control of cancer. Public health promotion efforts to control cancer such as lowering smoking rate and obesity could reduce the burden of cancer in many sites.

Inadequate health literacy is a risk factor for poor health outcomes and health-related quality of life (HRQoL). So far, the impact of health literacy on HRQoL has been examined for only a few chronic conditions. In this contribution, the relationship between health literacy and HRQoL in Korean adults with chronic conditions is examined using data of the cross-sectional Korea Health Panel Survey from 2021. Health literacy was measured with the 16-item European Health Literacy Survey Questionnaire (HLS-EU-Q16) and HRQoL with the European Quality of Life-5 Dimensions (EQ-5D). Multiple linear regression model was run for the EQ-5D index as the dependent variable. Multiple logistic regression models were implemented for responses to the individual EQ-5D items. 30.8%, 24.6%, and 44.6% of participants had inadequate, marginal, and adequate levels of health literacy, respectively. The EQ-5D index increases with marginal (B = 0.018, p<0.001) and adequate literacy (B = 0.017, p<0.001) compared to inadequate literacy. People with adequate or marginal literacy were more likely to report no problem with mobility (odds ration [OR] = 1.5; p<0.001), self-care (OR = 1.6; p<0.05), and usual activities (OR = 1.6 for adequate; OR = 1.4 for marginal; p<0.01) than those with inadequate literacy. Adequate health literacy was associated with an increased likelihood of having no problem with anxiety and depression (OR = 1.4; p<0.05). In conclusion, inadequate health literacy is prevalent among Korean adults with chronic diseases. Adequate health literacy is associated with better HRQoL and a protective factor for four dimensions of EQ-5D (mobility, self-care, usual activities, and anxiety/depression).

Medical care of cancer patients at the end-of-life is costly. This study aims to describe the monthly trends of EOL medical care, drug therapy, and chemotherapy costs per patient with cancer in the last year of life in the inpatients vs. outpatient setting for the 13 most prevalent cancers in Korea. Using the Health Insurance Review and Assessment Service (HIRA) database, we identified the patients who had been treated for the primary diagnoses of one of the 13 most prevalent cancers in Korea and died between January 1, 2013 and December 31, 2015. We calculated the mean monthly costs of medical care, drug therapy, and chemotherapy per patient in the last year of life by cancer site and patient setting (inpatient vs. outpatient). For most cancers, the monthly inpatient costs per patient remain stable or increased gradually from 12 months to 3 months prior to death and then increased steeply from 2 months prior to death. The mean monthly inpatient costs per patient were highest for acute myeloid leukemia (AML) throughout the last year of life; all solid tumors had similar trends of monthly inpatient costs. The mean monthly inpatient costs for AML increased from $5,465 (SD, $5,248) in 12 months prior to death to $15,033 (SD, $11,864) in the last month. The monthly outpatient costs per patient showed similar, gradually decreasing trends for most cancers. The mean outpatient costs were highest for kidney cancer; the costs sharply decreased from $954 (SD, $1,346) in 12 months prior to death to $424 (SD, $736) in the last month. The proportion of inpatients receiving chemotherapy in the last month of life was highest for AML (77%), followed by liver cancer (67%) and breast cancer (56%). The monthly inpatient medical care costs per patient with cancer increased as the patient approached death, while the monthly outpatient costs decreased. A considerable proportion of inpatient received chemotherapy in the last month of life. Efforts are needed to optimize EOL care for cancer patients.

This study analyzed the prevalence of attention deficit hyperactivity disorder (ADHD) medication use among children and adolescents in Korea between January 1, 2007 and December 31, 2011. Using the Korea National Health Insurance claims database, we identified patients between one and 17 years of age who had at least one medical claim for the diagnosis of ADHD (International Classification of Diseases, 10th revision: F90.0). The annual prevalence of ADHD diagnoses was calculated, using national census data from Statistics Korea on the population aged between one and 17 years as the denominator. The prevalence was age-standardized using the 2010 population as the standard population. The number of patients who were treated with methylphenidate and/or atomoxetine and the prevalence of total patients with ADHD that were treated with either drug were also calculated for each year. All analyses were stratified according to gender and age group (1-5 years, 6-12 years, and 13-17 years). The number of patients diagnosed with ADHD increased from 72,704 persons (0.71%) in 2007 to 85,468 persons (0.93%) in 2011. The annual age-standardized prevalence of ADHD diagnoses increased from 0.67% in 2007 to 0.94% in 2011. The prevalence of methylphenidate use among children and adolescents with ADHD decreased from 73.91% in 2007 to 70.33% in 2011, whereas that of atomoxetine use increased from 5.77% in 2009 to 13.09% in 2011. While methylphenidate remains the most commonly prescribed ADHD drug, the use of atomoxetine has increased.