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


RESULTS
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.


CONCLUSIONS
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.
Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
Taehoon
T
Lee
National Evidence-based Healthcare Collaborating Agency, Seoul, Korea; Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea.
Jinhee
J
Kim
Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
Sujeong
S
Kim
National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.
Kyoungjoo
K
Kim
Department of Statistics, Dongguk University, Seoul, Korea.
Yunjin
Y
Park
National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.
Yuri
Y
Kim
Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Yoon Su
YS
Lee
Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Hyouk-Soo
HS
Kwon
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Sae-Hoon
SH
Kim
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Yoon-Seok
YS
Chang
Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
You Sook
YS
Cho
Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
An-Soo
AS
Jang
Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea.
Jung-Won
JW
Park
Department of Internal Medicine, College of Medicine, Ajou University, Suwon, Korea.
Dong-Ho
DH
Nahm
Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea.
Ho-Joo
HJ
Yoon
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Sang-Heon
SH
Cho
Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea.
Young-Joo
YJ
Cho
Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul, Korea.
Byoung Whui
BW
Choi
Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Hee-Bom
HB
Moon
Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Tae-Bum
TB
Kim
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D000368:Aged; D044466:Asian People; D001249:Asthma / Q000188:drug therapy / Q000191:economics / Q000473:pathology*; D015331:Cohort Studies; D016208:Databases, Factual; D003695:Delivery of Health Care; D004636:Emergency Service, Hospital; D005260:Female; D005541:Forced Expiratory Volume; D006761:Hospitals; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009313:National Health Programs; D016017:Odds Ratio; D010641:Phenotype; D056910:Republic of Korea; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors
D000305:Adrenal Cortex Hormones