Incidence of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Nationwide Population-Based Study Using National Health Insurance Database in Korea.
BACKGROUND
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening diseases; however, it is hard to estimate their incidence due to the rarity of these diseases. We evaluated the incidence of SJS and TEN using a nationwide administrative database.


METHODS
We used a national medical insurance review system (Health Insurance Review and Assessment) database which contained the claim data of the entire nation from 2009 to 2013 to estimate the accurate incidence of SJS and TEN in Korea. The diagnostic codes of L511 (SJS) or L512 (TEN) from the International Classification of Diseases-10th revision were used to define the target study population. We also retrospectively followed up a 2011 SJS and TEN cohort for 24 months in order to assess the in-hospital mortality, related complications and total claims cost due to SJS and TEN.


RESULTS
A total of 1,167 (938 SJS and 229 TEN) cases were newly diagnosed from 2010 to 2013. The age- and sex-standardized annual incidences estimated in this study were 3.96 to 5.03 in SJS and 0.94 to 1.45 in TEN per million. There was no significant change in annual incidence throughout the study periods. When analyzed by 10-year age groups, the annual incidence was the lowest in group 20-29 years and the highest in group 70 for both SJS and TEN. Based on the 2011 cohort analysis, the in-hospital mortality were 5.7 and 15.1% for SJS and TEN, respectively. The mortality increased with age, particularly, after 40 years of age. Among the complications related with SJS or TEN, ocular sequelae was the most common (43.1 and 43.4% of SJS and TEN patients, respectively) followed by urethral sequelae (5.7 and 9.4% of SJS and TEN patients, respectively).


CONCLUSIONS
Overall, our data suggest that SJS, and TEN are infrequent but constantly arise throughout the years.
Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea.|Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.|Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Min-Suk
MS
Yang
Public Health Medical Service, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
Jin Yong
JY
Lee
Institute of Health and Environment, Seoul National University, Seoul, Korea.
Jayeun
J
Kim
Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea.|Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Gun-Woo
GW
Kim
Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea.|Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Byung-Keun
BK
Kim
Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea.|Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.|Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea.
Ju-Young
JY
Kim
Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea.|Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Heung-Woo
HW
Park
Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea.|Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.|Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea.
Sang-Heon
SH
Cho
Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea.|Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Kyung-Up
KU
Min
Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea.|Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.|Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea.
Hye-Ryun
HR
Kang
D000328:Adult; D000368:Aged; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data*; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D013262:Stevens-Johnson Syndrome / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology* / Q000401:mortality