Risk factors for asthma-related healthcare use: longitudinal analysis using the NHI claims database in a Korean asthma cohort

• Published in: PloS one Vol. 9; no. 11; p. e112844
• Main Authors: 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
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 14.11.2014; Public Library of Science (PLoS)
• Subjects: Administration, Inhalation; Adrenal Cortex Hormones - therapeutic use; Adult; Adults; Age Factors; Aged; Asian Continental Ancestry Group; Asthma; Asthma - drug therapy; Asthma - economics; Asthma - pathology; Biology and Life Sciences; Cohort Studies; Corticoids; Corticosteroids; Databases, Factual; Delivery of Health Care; Diagnostic systems; Emergency medical services; Emergency Service, Hospital; Female; Forced Expiratory Volume; Glucocorticoids; Health care; Health insurance; Health risks; Hospitalization; Hospitals; Humans; Immunology; Insurance; Insurance claims; Internal medicine; Logistic Models; Longitudinal Studies; Male; Medicine; Medicine and Health Sciences; Middle Aged; Multivariate Analysis; National health insurance; National Health Programs; Odds Ratio; Patient admissions; Patients; Phenotype; Physicians; Regression analysis; Republic of Korea; Research and Analysis Methods; Respiratory system agents; Risk analysis; Risk Factors; Severity of Illness Index; Sex Factors; Studies; Variability; Republic of Korea
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0112844

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.