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      Effects of PM 10 on mortality in pure COPD and asthma-COPD overlap: difference in exposure duration, gender, and smoking status

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          Abstract

          We investigated the effects of particulate matter (PM) on mortality in patients diagnosed with asthma-COPD overlap (ACO) or ‘pure COPD’. Subjects from the National Health Insurance Service–National Sample Cohort of Korea, who were aged 40 years or above and had newly diagnosed COPD since 2009 were selected. Finally, 6,313 patients were enrolled and divided into ‘pure COPD’ and ACO groups. Average PM 10 exposure data were obtained using Kriging interpolation from 2001 to 2013. Hazard ratios(HR) were estimated using a time-varying Cox regression model. Exposure to PM 10 for 1, 3, and 6 months was associated with an increase in non-accidental mortality in the entire COPD group, especially the ACO group. When a stratified analysis of 3-month exposure was performed by sex, the highest HR was found in women with ACO (HR = 1.153; 95% confidence intervals [CI]: 1.121, 1.185). A stratified analysis according to smoking status showed that ACO patients had the highest HR among never smokers (HR = 1.151; 95% CI; 1.124, 1.178). Average exposure to PM 10 was associated with non-accidental mortality in patients with COPD, especially those diagnosed with ACO. In addition, the adverse effects of PM 10 exposure are more severe in women and never-smokers.

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          A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010

          The Lancet, 380(9859), 2224-2260
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            Data Resource Profile: The National Health Information Database of the National Health Insurance Service in South Korea

            Data resource basics The National Health Information Database (NHID) is a public database on health care utilization, health screening, socio-demographic variables, and mortality for the whole population of South Korea, formed by the National Health Insurance Service. The population included in the data is over 50 million, and the participation rate in the health screening programs was 74.8% in 2014. The NHID covers data between 2002 and 2014. Those insured by NHI pay insurance contributions and receive medical services from their health care providers. The NHIS, as the single insurer, pays costs based on the billing records of health care providers (Figure 1). To govern and carry out these processes in the NHI, the NHIS built a data warehouse to collect the required information on insurance eligibility, insurance contributions, medical history, and medical institutions. In 2012, the NHIS formed the NHID using information from medical treatment and health screening records and eligibility data from an existing database system. Figure 1. The governance of the National Health Insurance of South Korea. Data collected The eligibility database includes information about income-based insurance contributions, demographic variables, and date of death. The national health screening database includes information on health behaviors and bio-clinical variables. The health care utilization database includes information on records on inpatient and outpatient usage (diagnosis, length of stay, treatment costs, services received) and prescription records (drug code, days prescribed, daily dosage). The long-term care insurance database includes information about activities of daily living and service grades. The health care provider database includes data about the types of institutions, human resources, and equipment. In the NHID, de-identified join keys replacing the personal identifiers are used to interlink these databases. Data resource use Papers published covered various diseases or health conditions like infectious diseases, cancer, cardiovascular diseases, hypertension, diabetes mellitus, and injuries and risk factors such as smoking, alcohol consumption, and obesity. The impacts of health care and public health policies on health care utilization have been also explored since the data include all the necessary information reflecting patterns of health care utilization. Reasons to be cautious First, information on diagnosis and disease may not be optimal for identifying disease occurrence and prevalence since the data have been collected for medical service claims and reimbursement. However, the NHID also collects prescription data with secondary diagnosis, so the accuracy of the disease information can be improved. Second, the data linkage with other secondary national data is not widely available due to privacy issues in Korea. Governmental discussions on the statutory reform of data linkage using the NHID are under way. Collaboration and data access Access to the NHID can be obtained through the Health Insurance Data Service home page (http://nhiss.nhis.or.kr). An ethics approval from the researchers’ institutional review board is required with submission of a study proposal, which is reviewed by the NHIS review committee before providing data. Further inquiries on data use can be obtained by contacting the corresponding author. Funding and competing interests This work was supported by the NHIS in South Korea. The authors declare no competing interests.
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              The Asthma-COPD Overlap Syndrome.

              Although in textbooks asthma and chronic obstructive pulmonary disease (COPD) are viewed as distinct disorders, there is increasing awareness that many patients have features of both. This article reviews the asthma-COPD overlap syndrome.
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                Author and article information

                Contributors
                eunheeha@ewha.ac.kr
                Journal
                Sci Rep
                Sci Rep
                Scientific Reports
                Nature Publishing Group UK (London )
                2045-2322
                12 February 2020
                12 February 2020
                2020
                : 10
                : 2402
                Affiliations
                [1 ]ISNI 0000 0001 2171 7754, GRID grid.255649.9, Department of Occupational and Environmental Medicine, , Ewha Womans University College of Medicine, ; Seoul, Republic of Korea
                [2 ]ISNI 0000 0001 2171 7754, GRID grid.255649.9, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, , Ewha Womans University College of Medicine, ; Seoul, Republic of Korea
                [3 ]ISNI 0000 0001 2364 8385, GRID grid.202119.9, Department of Occupational and Environmental Medicine, , Inha University School of Medicine, ; Incheon, Republic of Korea
                Author information
                http://orcid.org/0000-0003-0843-9862
                Article
                59246
                10.1038/s41598-020-59246-2
                7016150
                32051443
                44ddd58b-0a73-44a7-b9b6-7bfcd83b3507
                © The Author(s) 2020

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 18 June 2019
                : 19 January 2020
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                Custom metadata
                © The Author(s) 2020

                Uncategorized
                environmental impact,epidemiology
                Uncategorized
                environmental impact, epidemiology

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