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Co-prescribing Patterns of Contraindicated Drugs for the Elderly Patients in Busan.
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Nam Kyong Choi, Sun Young Jung, Byung Joo Park
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Korean J Epidemiol. 2008;30(1):128-136. Published online June 30, 2008
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DOI: https://doi.org/10.4178/kje.2008.30.1.128
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Abstract
PURPOSE
To estimate the prevalence of co-prescribing contraindicated drugs for elderly patients in Busan.
METHODS We used the Health Insurance Review Agency (HIRA) claims database. Study population consisted of elderly patients who visited clinics or hospitals in Busan metropolitan city from January 1, 2000 to December 31, 2001.
Contraindicated drugs were defined as 162 combinations of contraindicated drugs announced by the Korea Ministry of Health and Welfare in 2004. The co-prescription of contraindicated drugs was defined as prescribing two or more contraindicated drugs in combination in the same prescription. The prevalence of co-prescribing contraindicated drugswas estimated as proportion of co-prescribed patients out of the study patients. We estimated and age-adjusted prevalence and its 95% confidence interval of co-prescription of contraindicated drugs among the elderly patients in Korean population in 2001.
RESULTS The study elderly patients were 262,952 with 2,483,227 prescriptions. Among the study patients 1,208 (4.6%) were prescribed contraindicated drugs in combination.
A total of 16,255 patients were estimated as the number of co-prescribed patients among the Korean elderly in 2001.
Age-standardized prevalence of co-prescription to the Korean elderly was estimated to be 45 per 10,000 persons. The most frequently prescribed combinations were cisapride & amitriptyline, roxithromycin & ergoloid mesylate, and terfenadine & erythromycin, and the frequency were 325 (16.8%), 149 (7.7%), and 132 (6.8%),respectively.
CONCLUSIONS The contraindicated drugs were co-prescribed to the elderly patients in Korea. Many of these co-prescriptions should be avoided if unnecessary. The patients should be carefully monitored if they were inevitably prescribed the contraindicated drugs.
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Studies on the Association between Phenylpropanolamine (PPA) and Hemorrhagic Stroke in Other Countries.
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Seung Mi Lee, Byung Woo Yoon, Byung Joo Park
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Korean J Epidemiol. 2004;26(2):1-7.
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OBJECTIVES
Phenylpropanolamine (PPA) had been used widely as cold remedies or appetite suppressants. However, products containing PPA were withdrawn in sequence in the US, Japan, and Korea due to the increased risk of hemorrhagic stroke.
The purpose of this paper was to review safety issues related with the PPA use and hemorrhagic stroke in view of pharmacoepidemiology and pharmacovigilance.METHODS AND MATERIALS: Researches conducted for evaluating the association between the PPA use and hemorrhagic stroke in other countries were reviewed, which involved case reports, case series, case-control studies, and cohort studies.RESULTS In terms of pharmacologic and clinical features, PPA may increase the risk of hemorrhagic stroke through increased blood pressure, heart rate, or vasculitis. The association between the PPA use and hemorrhagic stroke among young women was suggested by case reports from spontaneous adverse events reporting systems or medical journals. The cohort study, using the large prescription database in the US and published in 1984, failed to reveal the association in the population aged below 65. The case-control study conducted as the Yale Hemorrhagic Stroke Project, published in 2000, was the first study to find the association between the PPA as appetite suppressants and hemorrhagic stroke among women ages 18-49 years by well-designed analytic epidemiological research. It led to withdrawal of all products containing PPA in the US and many other countries since 2000. However, the association between PPA and cerebral hemorrhage could not be confirmed by the case-control study conducted in Mexico due to inappropriate recruitment of control group.CONCLUSIONS During several years case reports have suggested that hemorrhagic stroke could be induced by PPA, and the Yale Hemorrhagic Stroke Project revealed the association by case-control study and provided a useful model for pharmacovigilance. Nevertheless, their finding could not be applied to other population such as elderly women and male population. And they could not provide any evidence on the association between PPA and stroke when PPA was used as cold remedy taken daily dose below 100mg.
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Lung cancer incidence, mortality and survival rate in Korean Elderly Pharmacoepidemiologic Cohort(KEPEC) in 1994-1998.
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Nam Kyong Choi, Kyung Eun Youn, Dae Seuk Heo, Yooni Kim, Seung Mi Lee, Byung Joo Park
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Korean J Epidemiol. 2002;24(2):121-130.
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This study was conducted to estimate incidence, mortality and survival rate of lung cancer in the elderly people in Korea.METHODS Study population was Korean Elderly Phamacoepidemiologic Cohort (KEPEC). The lung cancer incidence cases were detected from three different sources, medical utilization database of the Korea Medical Insurance Corporation (KMIC), the database from the National Cancer Registry, and the database from the Regional Cancer Registry. The hospital survey to confirm the final diagnosis of the potential cases was conducted. A specialist on lung cancer reviewed the abstracted data to confirm the final diagnoses. The lung cancer death cases were detected from the mortality database at National Statistical Office.
Incidence rate, survival rate and mortality rate of lung cancer and their 95% confidence intervals were estimated with SAS Window ver. 8.1.
PESULTS: There were 213 confirmed lung cancer cases in KEPEC between Jan. 1994 and Dec. 1998. Age-standardized incidence rate of lung cancer to the Korean population was estimated to be 316.9 per 100,000 person-years in male and 65.2 per 100,000 person-years in female. Age-standardized mortality rate of lung cancer to the Korean population was estimated to be 342.3 per 100,000 person-years in male and 84.8 per 100,000 person-years in female. One year survival rate was 17% in male and 11% in female. Two year survival rate was 2% in male and 4% in female.CONCLUSION Age-standardized incidence rate, age-standardized mortality rate and survival rate of lung cancer in the elderly Korean may be useful for further study and making health policy for managing lung cancer in the elderly.
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Nested Case-control Study on the Association between Alcohol and the Risk of Proximal Hip Fracture in the Elderly People in Korea.
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Byung Joo Park, Kui Oak Jung, Hye Won Koo, Jong Myon Bae
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Korean J Epidemiol. 1999;21(1):93-103.
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OBJECTIVE: To assess the association between alcohol drinking and hip fracture in the elderly people in Korea.
BACKGROUND: Hip fracture is known as one of the major health problems because of its high incidence and serious consequences in the elderly people. The association between alcohol consumption and hip fractures has not been directly evaluated yet in Korea. So we conducted a nested case-control study to investigate the relationship between alcohol consumption and hip fracture in the Korean elderly people.
DESIGN: Nested case-control study from the Korea Elderly Pharmacoepidemiology Cohort (KEPEC), in Pusan, Korea.METHODS Seventy incident cases have been selected since 1993, and 280 controls have been matched with the cases by age and gender among the KEPEC. Average alcohol intake was calculated by multiplying frequency and amount of drinking and unit capacity of each alcohol type. Odds ratios of alcohol intake on the hip fracture and their confidence intervals were computed by using multiple logistic regression with Windows version SAS 6.12.RESULTS The elderly people's drinking rate is lower than the young people in Korea. In univariate analysis, crude odds ratio was 0.26 in male and adjusted odds ratio after contolling for age, smoking status, medication history, physical activity and body mass index was 0.36 in male. So current drinking reduces the risk of hip fracture. Adjusted odds ratio after controlling for age, smoking status, medication history, physical activity and body mass index odds ratio was 0.24 in female with moderate drinking.CONCLUSION We found that alcohol consumption reduces the risk of hip fracture in the elderly Korean. However, we could not explain the plausible mechanism with our data yet.
So, we suggest the further study for elucidating the possible mechanism of the finding including the possible association between nutritional status, alcohol drinking and bone marrow density in the elderly.
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Cohort Study on the Association getween Smoking and Proximal Hip Fracture in the Elderly People in Korea.
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Byung Joo Park, Kui Oak Jung, Jong Myon Bae, Hye Won Koo, Dae Sung Kim
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Korean J Epidemiol. 1998;20(2):246-256.
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OBJECTIVE: To assess the association between cigarette smoking and hip fracture by using the Korea Pharmacoepidemiology Cohort(KPEC).
BACKGROUND: Hip fracture is known as one of the major health problems because of its high incidence and serious consequences in the elderly people. Cigarette smoking, old age, female and low body weight have been reported as risk factors for osteoporosis which is regarded as one of the risk factors for hip fracture. But the relationship between cigarette smoking and hip fracture has not been directly evaluated yet. So we conducted a prospective cohort study to investigate the relationship between cigarette smoking and hip fracture in the Korean elderly.
DESIGN: Prospective cohort study on the 8,994 elderly person aged 65 or more in Pusan, Korea between 1993 to 1996.
METHODS: The Korea Phamacoepidemiology Cohort(KPEC) has been constructed with three kinds of data sources. One is from the Korea Medical Insurance Corporation; Medical Insurance Claims Database and Enrollee's Database. Other sources are from directly constructed pharmacy database and questionnaire data. incidence density and relative risk of smoking for hip fracture were estimated by using the KPEC database. Age and gender specific incidence density was calculated by dividing the number of hip fracture cases by person-years of the follow-up the cohort. Relative risks and their confidence intervals were computed by using multiple logistic regression by Windows version SAS 6.12.RESULTS The level of incidence density in female was higher than that in male, which was increasing with age in both gender. In the multivariate analysis, we observed significant relationship between soking and hip fracture in female(PR=1.94(1.01-3.76)) in the larger amount smoking group, after adjusting for the confounders; age, alcohol drinking, medication history, physical activity and body mass index, the relative risk became slightly decreased to 1.70(0.84-3.46).CONCLUSION Accoding to this result, we suggest that effective anti-smoking campaign should be established as soon as possible for the Korean elderly women.
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Sample Size Estimation for Log-Rank Test for Phase III Clinical Trials.
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Sin Ho Jung, Jae Hee Choi, Byung Joo Park
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Korean J Epidemiol. 1997;19(1):67-72.
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At first, we review a sample size estimation method for log-rank test in survival analysis. Although it is widely used these days, it has a weakness for practical use. We propose a modification method to avoid the weakness.
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Cohort study on the asymptomatic chronic carrier rate of hepatitis B virus among male adults in Korea
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Byung Joo Park, Yoon Ok Ahn
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Korean J Epidemiol. 1989;11(2):263-273.
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In Korea, the rates of hepatitis B virus (HBV) infection and hepatocellular carcinoma (HCC) incidence, a major risk factor for which is HBV infection, are among the highest in the world. Therefore, in order to establish strategies for the prevention of HBV infection and HCC, the natural history of HBV infection should be urgently investigated; in particular, it is important to estimate the rate of asymptomatic chronic HBV infections, because individuals with such infections are considered at risk of chronic liver diseases such as HCC.
In order to identify the prevalence of chronic HBV infections among adult males, 1495 individuals without any abnormal findings during their regular physical checkup in 1986 were randomly selected from the population insured by the Korea Medical Insurance Corporation. Radioimmunoassay (RIA) tests were performed on the subjects to detect the serological markers of HBV; namely, hepatitis B surface antigen (HBsAg), antibody to the hepatitis B surface antigen (anti-HBs) and antibody to the hepatitis B core antigen (anti-HBc), and direct interviews were conducted to determine participants’ history of hepatitis B vaccination. Of these subjects, 624 healthy males who were found to be nonvaccinees were selected and followed up for 2 years. In 1988, re-tests of the three serological markers of the hepatitis B virus using RIA testing, as well as physical checkups including liver function tests, were performed. The final study population of 370 adult males consisted of those who had no abnormal findings in either physical checkups, had not been vaccinated against HBV, and received a re-test of the serological markers of HBV after the follow-up period.
The point prevalence rate of HBsAg among the 370 men enrolled was 9.6% (95% confidence interval [CI]=6.6-12.6), and after the 2-year follow-up period, the rate increased to a significantly higher level (13.0%; 95% CI=9.6-16.6). The rate of asymptomatic chronic carriers whose HBsAg tests continued to be positive during the 2-year follow-up period was 6.2% (95% CI=3.7-8.7), corresponding to 60% of the point prevalence at the time of enrollment. The age-adjusted chronic carrier rate calculated using males 20-59 years of age from the 1985 Nationwide Population and Housing Census data as a standard population was 6.2%(95% CI=6.19-6.21). The asymptomatic chronic carrier rates by age group were 6.8%in their 20s and 30s, 5.6%in their 40s, and 4.3%in their 50s; a decreasing trend according to age was found, but it was not statistically significant. The number of asymptomatic chronic carriers in Korea as of 1985 was estimated to be around 1.3 million men between their 20s and 50s. The serological profiles of the HBV markers suggested frequent loss and acquisition of the serological markers during the 2 years. While the prevalence of susceptible decreased from 14.1% at the time of enrollment to 12.7% at the end of the 2-year follow-up, the prevalence of HBsAg increased significantly. Thus, studies more precisely elucidating the mechanisms underlying these patterns in serological profiles are needed
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Distribution of the serologic markers of hepatitis B virus after the hepatitis B vaccination on healthy Korean adults
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Yoon Ok Ahn, Keun Yong Yoo, Byung Joo Park, Yong Ik Kim, Chung Yong Kim, Tae Soo Park
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Korean J Epidemiol. 1987;9(1):28-39.
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An epidemiologic study on risk factors of hepatitis B infection in Korea
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Yook Ok Ahn, Keun Yong Yoo, Byung Joo Park
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Korean J Epidemiol. 1987;9(1):57-65.
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Hepatitis B has recently become a prominent figure as one of the major communicable disease in Korea. Many reports on the HBV infection have been accumulated these years, but most of them were clinical and descriptive epidemiologic findings mainly to figure out the characters, size, and pattern of the infection in terms of hepatitis B antigenemia.
This study was planned to pursue an analytic study to detect risk factors associated with the hepatitis B infection, successively to our previous study on the risk factors of HBSantigenemia.5)
Three hundred and forty one subjects were selected randomly among those who were both HBsAg and HBsAb negative by RPHA and PHA tests at 1984 and have not received hepatitis B vaccination and have not suffered from liver disease since then.
Data about the risk factors of HBV infection have been collected by direct interview with structured questionnaire, review of health records and serologic test for HBV markers by RIA methods from July to October, 1986.
The results obtained were as follow :
1. The positive conversion rate of HBsAg was 8.5% in adult males and 3.5% in adult females and the total infection rate of HBV was 75.3% and 53.5% respectively.
2. In Korean adults HBV seems to be disseminated partly through the parenteral routes, but mainly through the oral routes, so more attention and energies should be concentrated on the interception of oral routes of HBV infection.
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An epidemiologic survey on cancer epidemic at pukcheju-gun.
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Yoon Ok Ahn, Byung Joo Park, Jong Myon Bae, Duk Hyung Lee, Dong Jin Kim, Jun Hwan Kim, Jong Won Kang, Yong Jin Jung, Dong Mo Rhie
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Korean J Epidemiol. ;15(2):185-195.
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According to a newspaper account for the epidemic occurrence of cancer patients at an area of Pukcheju-gun, epidemic survey was conducted to identify the epidemicity and possible cause of the cancer epidemic from Sep. 23, 1993 to Sep. 28, 1993.
Housefold survey for identifying prevalent
There was no female cancer cases, no temporal dusting pattern of cancer occurrence and no clustering of specific types of cancer. In the evaluation of ground water and sea water, carcinogenic substances were not detected.
According to the above evidences, it was difficult to confirm that there was an epidemic occurrence of cancer at the area. And the possibility of the association of environmental carcinogenic factors with the cancer occurrence seemed to be very low.
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