Kim AY, et al. J Clin Neurol. 2021 Apr;17(2):257-264. https://doi.org/10.3988/jcn.2021.17.2.257

Background: Korea has a two-tiered universal health security system: the wage-based National Health Insurance (NHI) program and government-subsidized Medical Aid (MA) program. Beneficiaries of the MA program belong to the lowest economic class. This study aims to investigate the association between economic status—defined as NHI or MA enrollment—and health disparity of older people aged ≥ 65 years in South Korea. Methods: The claims records of 672,525 older age population from the 2017 Health Insurance Review and Assessment Service-Adult Patient Sample were used to estimate adjusted odds ratios (aORs) of MA vs. NHI beneficiaries for prevalence for common geriatric diseases. Logistic regression and negative binomial regression were used to investigate the association between economic status and prevalence or healthcare utilization for each disease. Results: MA beneficiaries showed significantly higher prevalence than NHI beneficiaries for seven out of nine diseases (aORs ranging from 1.18 to 1.95). The discrepancy in the prevalence between the two groups was highest among those aged 65–69 years (aORs: 1.34–2.94), and diminished as they got older (aORs: 1.05–1.67). MA beneficiaries had significantly more outpatient visits to treat six diseases (aORs: 1.07–1.28), and more hospitalization to treat seven diseases (aORs:1.08–1.73) than NHI beneficiaries. Conclusion: The higher prevalence of common geriatric diseases among MA than NHI beneficiaries confirms unfavorable health disparity in the elderly living in extreme poverty. Similar or higher healthcare utilization in treating the same conditions among MA beneficiaries suggests a low possibility of inequity for access to healthcare resources covered by the universal health security system due to poor economic status. Greater excess use of inpatient than outpatient care by MA beneficiaries implies that the condition of poor older adults might be more severe when diagnosed with the same disease.

South Korea operates a National Vaccine Injury Compensation Program (VICP) for people who experience adverse events following immunization (AEFI). To run this program rationally, it is a prerequisite to confirm whether adverse events were caused by immunization. Guillain–Barré syndrome (GBS), a severe neurological disease with limb pain and muscle weakness as cardinal symptoms, is attracting attention as an AEFI. However, algorithm or guidelines for assessing the causality between vaccination and the incidence of GBS are lacking. We aimed to develop guidelines for causality assessment of GBS as an AEFI and suggest using these guidelines in alignment with the VICP. We systematically searched for other previously published algorithms or guidelines and found a WHO-AEFI guideline used worldwide; however, it only provides general instructions and is not tailored to specific adverse events. We translated and locally adapted the structure of this guideline and then added contents related to GBS. The GBS-specific guideline consists of four steps: case ascertainment of GBS, checklist (including (1) order of incidence, (2) temporal proximity, (3) evidence for other causes and (4) published evidence), an algorithm, and final classification. We listed key information on confirming GBS and whether any other causes of GBS were present. For real world application of the guideline along with the VICP, we collaborated with a panel of neurologists, epidemiologic investigators, and committee members from the VICP. To ensure transparency and a scientific approach, regular updates and collaboration with neurologists are essential. We expect that this guideline will contribute to logical causality assessment and compensation decisions for GBS and will provide the basic structure for causality assessment of other AEFIs.

Modafinil is approved for excessive daytime sleepiness in narcolepsy, obstructive sleep apnoea (OSA), and shift work sleep disorder (SWSD), but its widespread off‐label use raises safety concerns. We evaluated the risk of adverse events (AEs) associated with both labelled and off‐label use of modafinil. A systematic search of PubMed, Embase, and Cochrane identified 54 studies that met the inclusion criteria. In labelled uses, narcolepsy patients had significantly elevated risks of diarrhoea (risk ratio [RR]: 2.16, 95% confidence interval [CI]: 1.06–4.41) and nausea compared to those with placebo (RR: 2.44, 95% CI: 1.05–5.72). OSA/hypopnea syndrome patients had higher risks of insomnia (RR: 5.82), anxiety/nervousness (RR: 3.26), and headache (RR: 1.92). SWSD patients had elevated risks of insomnia (RR: 4.09), anxiety/nervousness (RR: 3.85), and nausea (RR: 2.93). Among off‐label users, patients with attention deficit hyperactivity disorder had higher risks of insomnia (RR: 4.97) and decreased appetite (RR: 4.21). Patients with major depressive disorder showed higher risks of anxiety/nervousness (RR: 1.95). While modafinil users share common AEs, specific risks vary across patient groups. Our findings on condition‐specific AE profiles would support cautious prescribing of modafinil and careful consideration of alternative treatments.

Background: The global coronavirus disease 2019 (COVID-19) pandemic has placed patients with end-stage kidney disease (ESKD) at heightened risk owing to their vulnerability to infections. Our study focused on patients with ESKD, examining COVID-19 incidence, hospitalization, and mortality in relation to their renal replacement therapy (RRT) type and identifying factors influencing COVID-19 hospitalization. Methods: We conducted a retrospective cohort study using health insurance claims data from the Health Insurance Review and Assessment Service for patients with ESKD between July 2017 and June 2022. COVID-19 data for the general population were sourced from the Korea Disease Control and Prevention Agency. Results: Patients undergoing hemodialysis (HD) constituted 90.7% of the cohort, followed by kidney transplantation (KT) recipients and peritoneal dialysis (PD). After adjusting for every 10,000 individuals, KT recipients exhibited the highest COVID-19 incidence, followed by those undergoing HD and PD, whereas the general population showed a higher infection rate of 43.64. Patients undergoing HD had the highest hospitalization rates, followed by KT recipients and those undergoing PD. The mortality rate per 10,000 individuals was highest in HD, followed by PD, the general population, and KT. Multivariate analysis indicated that age, RRT duration, residence in a nursing hospital, and comorbidities were associated with COVID-19 hospitalization. Conclusion: Among RRT modalities, KT recipients displayed the highest COVID-19 incidence, whereas those undergoing HD exhibited the highest hospitalization and mortality rates. This study contributes to our understanding of infectious diseases in patients on RRT and aids in preparedness for future infectious disease outbreaks.

Background/Objectives: COVID-19 continues to challenge public health due to emerging variants. To mitigate this, the Korea Disease Control and Prevention Agency (KDCA) recommends annual COVID-19 vaccination, but uptake remains suboptimal. This study evaluates the public health and economic impact of annual mRNA COVID-19 vaccination for adults aged 50 and older in South Korea during the 2024–2025 season, focusing on hospitalizations and costs. Methods: We estimated hospitalizations prevented by the mRNA-1273 XBB.1.5 containing vaccine by calculating symptomatic infection incidence rates, hospitalization rates among unvaccinated individuals, vaccine effectiveness (VE) against hospitalization, and vaccination rates. Incidence rates among the unvaccinated with an annual vaccine were derived by adjusting overall infection rates based on vaccination coverage and VE against COVID-19 hospitalization rates. Hospitalization costs were obtained from a real-world dataset, integrating the KDCA’s COVID-19 confirmed cases with National Health Insurance claims data. Comparative analyses between mRNA-1273 and BNT162b2 used published meta-analysis results. Results: Assuming vaccination rates remain consistent with the 2023–2024 season, mRNA-1273 is projected to prevent 37,200 hospitalizations and save USD 77.2 million in healthcare costs during the 2024–2025 season compared to no annual vaccination. Compared to BNT162b2, it is expected to prevent an additional 13,260 hospitalizations saving USD 27.5 million. If vaccination rates increased to match influenza, hospitalizations prevented by mRNA-1273 could rise to 79,800 with USD 164.2 million in healthcare savings compared to no annual vaccination. Conclusion: Annual mRNA COVID-19 vaccination with mRNA-1273 substantially reduces hospitalizations and healthcare costs. Increasing vaccination rates are essential to maximize public health benefits.