Cancer Risk in the Early Stages of Inflammatory Bowel Disease in Korean Patients: A Nationwide Population-based Study

Self Cite

Background and Aim Variation in medical care can be an obstacle to improving quality and outcome of treatment. We conducted a nationwide, population‐based study to identify regional variations in medication prescription rates in Korean patients with inflammatory bowel diseases (IBDs). Methods Using the National Health Insurance claims, we collected data on patients diagnosed with IBD (8974 cases of Crohn's disease [CD] and 17 167 cases of ulcerative colitis [UC]) between 2010 and 2016. Results Overall rates of biologics (infliximab or adalimumab) use in CD and UC were 19.6% and 6.1%, respectively, and those of immunomodulator (azathioprine or 6‐mercaptopurine) use were 66.9% and 20.4%, respectively. The average periods from diagnosis to first biologics use for CD and UC were 1.6 and 1.8 years, respectively, and those of immunomodulators were 0.6 and 1.3 years, respectively. In Seoul, Daegu, and Busan, three major cities in Korea, biologics prescription rates for CD were 20.7%, 22.9%, and 14.6%, respectively, and those for UC were 7.3%, 6.7%, and 4.5%, respectively. In the top 7 regions with the highest number of patients in Seoul, there were 3.6‐fold and 3.2‐fold variations between regions with the highest and lowest frequency of biologics use in CD and UC, respectively. In addition, there were 1.6‐fold and 2.8‐fold variations between regions with the highest and lowest frequency of immunomodulator use for CD and UC, respectively. Conclusions Regional variation exists in medication prescription rates within a single city as well as nationwide, suggesting that standardization of IBD treatment is necessary in Korea.

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Regional variations in the use of biologics and immunomodulators among Korean patients with inflammatory bowel diseases

Han

Jung

Cheon

et al. 2019

Self Cite

“…A study from Taiwan found that the risk of CRC was not increased significantly in CD and UC patients ((SIR 0.96 in CD and SIR 1.39 in UC, respectively) compared to the background population . In contrast, a study from Korea found an increased risk of developing CRC in both CD (SIR: 3.67; 95% CI: 1.58–7.22) and UC (SIR: 2.14; 95% CI: 1.31–3.30) . Overall, it is difficult to compare the rate of developing CRC in IBD between the East and the West because of the limited number of population‐based studies and relatively short follow‐up duration in East.…”

Section: Disease Course Of Ibdmentioning

confidence: 99%

The epidemiology of inflammatory bowel disease: East meets west

Mak

Zhao

et al. 2019

445

291

The incidence of inflammatory bowel diseases (IBD) in East has risen over the past decade to become a global disease. The increasing number of studies on the incidence and course of IBD in East has enabled us to explore East versus West differences in the epidemiology of IBD which could enhance our understanding of the heterogeneity of the disease and eventually assist in the discovery of novel therapeutic targets and design of preventive strategies. Comparison of population‐based data in East and West reveals that the incidence of IBD has risen rapidly in East while plateauing in West. Furthermore, the clinical presentation and course of IBD differs between East and West with more patients in East presenting with complicated disease. Considering the scarcity of population‐based data from East and the lack of studies with long durations of follow‐up, it remains to be clarified whether these differences reflect true differences in disease presentation. The effects of genetic and environmental risk factors contributing to IBD also differ between Eastern and Western populations. Considering the differential effects of genetic and environmental risk factors in East and West, future studies should seek to discover novel genetic and environmental risk factors which might specifically apply to eastern populations. In this narrative review, we compare the epidemiology of IBD between eastern and western countries by summarizing evidence from population‐based cohort studies in the last ten years. Furthermore, we look at differences in genetic susceptibility and environmental triggers of IBD between East and West.

“…Given this unique strength in capturing all disease cases of interest, many studies using the NHIS database have been conducted and published, and additional studies are being added to the available literature . Several studies involving the Korean population with IBD have also been published in recent years; however, there is a growing concern over the study methodology being applied, particularly the use of heterogeneous across‐study case definitions. Such heterogeneity of the definition of IBD may cause serious problems in the interpretation of interstudy differences, and eventually hamper the credibility of all studies being conducted.…”

Section: Introductionmentioning

confidence: 99%

“…Such heterogeneity of the definition of IBD may cause serious problems in the interpretation of interstudy differences, and eventually hamper the credibility of all studies being conducted. We found six different diagnostic codes or algorithms from seven studies published during the past 4 years (2015–2018, Table ), two of which were conducted by the same investigators . In most of these studies, a proper reference for their own operational definition was not cited, or the authors did not provide a detailed method and/or results to define patients with IBD.…”

Section: Introductionmentioning

confidence: 99%

Nationwide validation study of diagnostic algorithms for inflammatory bowel disease in Korean National Health Insurance Service database

Lee

et al. 2019

Background and Aim:We conducted a nationwide validation study of diagnostic algorithms to identify cases of inflammatory bowel disease (IBD) within the Korea National Health Insurance System (NHIS) database. Method: Using the NHIS dataset, we developed 44 algorithms combining the International Classification of Diseases (ICD)-10 codes, codes for Rare and Intractable Diseases (RID) registration and claims data for health care encounters, and pharmaceutical prescriptions for IBD-specific drugs. For each algorithm, we compared the case identification results from electronic medical records data with the gold standard (chart-based diagnosis). A multiple sampling test verified the validation results from the entire study population. Results: A random nationwide sample of 1697 patients (848 potential cases and 849 negative control cases) from 17 hospitals were included for validation. A combination of the ICD-10 code, ≥ 1 claims for health care encounters, and ≥ 1 prescription claims (reference algorithm) achieved excellent performance (sensitivity, 93.1% [95% confidence interval 91-94.7]; specificity, 98.1% [96.9-98.8]; positive predictive value, 97.5% [96.1-98.5]; negative predictive value, 94.5% [92.8-95.8]) with the lowest error rate (4.2% [3.3-5.3]).The multiple sampling test confirmed that the reference algorithm achieves the best performance regarding IBD diagnosis. Algorithms including the RID registration codes exhibited poorer performance compared with that of the reference algorithm, particularly for the diagnosis of patients affiliated with secondary hospitals. The performance of the reference algorithm showed no statistical difference depending on the hospital volume or IBD type, with P-value < 0.05. Conclusions:We strongly recommend the reference algorithm as a uniform standard operational definition for future studies using the NHIS database.bs_bs_banner Including (i) 5-aminosalicylate (oral agents for Crohn's disease, oral and/or suppository agents for ulcerative colitis) for 1 month; (ii) immunomodulators (azathioprine or 6-mercaptopurine) at least once; and (iii) biologics (infliximab or adalimumab) at least once. ¶ Including (i) oral or topical 5-aminosalicylic acids for at least 1 month; (ii) at least one prescription of topical steroid; and (iii) thiopurines (azathioprine or 6mercaptopurine) and antitumor necrosis factor-α agents (infliximab or adalimumab). IBD, inflammatory bowel disease, ICD, International Classification of Diseases; RID, rare and intractable diseases registration.