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이상지질혈증을 진단받은 환자에서 스타틴 약물순응도에 따른 사망률과의 관련성

Other Titles
 The association of mortality with statin drug compliance in patients diagnosed with dyslipidemia 
Authors
 이영란 
College
 Graduate School of Public Health (보건대학원) 
Degree
석사
Issue Date
2019
Abstract
Objective Cardiovascular disease is a major cause of death worldwide, but it is gradually declining. However, according to the Korea National Statistical Office, the mortality rate due to heart disease is increasing. Therefore, the purpose of this study was to analyze the relationship between the total drug mortality rate, cancer mortality rate and cardiovascular mortality rate by calculating the drug compliance (PDC) for prescription of statin drugs among patients diagnosed with dyslipidemia. Methods This study used a sample cohort of the Korea National Health Insurance (KNHI), excluding the subjects who had undergone dyslipidemia, heart disease, and statin prescriptions (42,195 persons) in 2002, 2003, A total of 107,954 patients who were over 40 years old and older than 40 years of age (20,109 people) were diagnosed with the diagnosis of dyslipidemia for more than 9 years from 2004 to 2012 in 44,515 patients. The diagnosis of dyslipidemia was made by ICD-10 CODE E78, and heart disease was diagnosed as ICD-10 I00 ~ I78. Seven statins (Lovastatin, pravastatin, simvastatin, fluvastatin, atorvastatin, rosuvastatin, and pitavastatin). We defined the subgroups as the subgroups of drug compliance according to proportion of days covered (PDC), adjusted by age, sex, BMI, smoking status, alcohol consumption frequency, physical activity, income, medical insurance, family history of CVD, disability, The distribution and percentages of demographic characteristics were measured in groups by squared test, and survival analyzes were performed using a time-dependent Cox proportional hazards model for the association of cardiovascular events with the occurrence of hyperlipidemia . The study period was divided into 90 days, and statin use days were calculated for each 90 day period to calculate the proportion of days covered (PDC). PDC calculations were performed using statin (%) / 90 × 100 of the number of days prescribed and corrected for immortality time bias through time-dependent analysis. All statistical analyzes were performed using SAS software, version 9.4 (SAS Institute, Cary, North Carolina, USA). Results Of the total 107,954 patients, 96.28% (44,723 patients) survived, 3.72% (1,726 patients) died, 97.81% (60,158 patients) survived and 2.19% (1,347 patients) died and the survival rate And the death rate was 1.53% p lower than that of men. Cancer and cardiovascular mortality rates were lower in both women. In the high medication adherence group (PDC> 80%) with a Proportion of Days Covered (PDC) of more than 80%, 1,182 (2.61%) died and 44,019 (97.39%) survived, (PDC <80%), 1,141 (2.69%) died, and 41,236 (97.31%) were in the group Survival was the highest in the PDC-favorable group and the survival rate was lower in the normal group than in the poor group. (50-80%) had a 1.28-fold higher risk of death from all causes than the high-good group (PDC> 80%) of the PDC, and the poor group (PDC <50% The risk of death was 1.58 times higher, the risk of cancer death 1.33 times higher, and the risk of death from cardiovascular disease 1.27 times higher. The risk of death, cancer mortality and cardiovascular disease was low in the statin drug compliance (PDC> 80%) group, and the risk of death was low in the poor PDC group (PDC <50% Respectively. In the analysis of the correlation with cancer mortality rate, it was 1.67 times higher in the 50s compared to the 40s age group, 4.23 times in the 60s, 9.20 times in the 70s, and 15.33 times higher in the 80s. In the analysis of the relationship between cardiovascular mortality and mortality in the age group of 50, 1.12 times in the 50s, 2.61 times in the 60s, 7.98 times in the 70s, 23.20 times in the 80s and statistically significant in all age groups except the 50s. Conclusion The diagnosis of dyslipidemia and the higher the statin drug prescription rate, the lower the risk of mortality. The lower the PDC, the greater the mortality rate, the higher mortality rate due to cancer mortality and cardiovascular disease in the lower PDC group, and the lower the PDC, the higher the probability of death in men. Men need to take more medication. As age increases, the risk of death from cancer and cardiovascular disease increases rapidly. Promoting and educating people who are diagnosed with hyperlipidemia in elderly people aged 65 and over so that they can raise their awareness and take good doses of drugs and develop pre-cancer prevention programs and preventive programs for prevention of cardiovascular diseases There is a need to do. In order to prepare the elderly population for the elderly population, the quality of life of the elderly should be improved and the policy system for the healthy aging life should be prepared. The mortality rate was significantly higher in underweight and obese than in overweight and obesity group. The mortality rate was lower than that in dry group. The risk of mortality was lower in active group than in inactive group. Management of low birth weight and implementation of health policies for obesity management are necessary. If combined with exercise for dyslipidemia medication and weight management, mortality can be reduced. People who are diagnosed with dyslipidemia need to strengthen their publicity about the disease so that they can take medication more faithfully. It is also necessary to develop a health care program and prepare policies so that they can change their lifestyle habits.
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Appears in Collections:
4. Graduate School of Public Health (보건대학원) > Others (기타) > 5. Others
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/178286
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