Trends in long-term glucocorticoid use and risk of 5-year mortality: a historical cohort study in South Korea
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ORIGINAL ARTICLE
Trends in long-term glucocorticoid use and risk of 5-year mortality: a historical cohort study in South Korea Tak Kyu Oh1 In-Ae Song1 ●
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Received: 7 January 2020 / Accepted: 3 June 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose This study investigated trends in chronic glucocorticoid (GC) use in South Korea, and determined the association between chronic GC use and 5-year all-cause mortality. Methods A sample cohort was extracted from the South Korean National Health Insurance database. Patients prescribed a continuous dose of GC for ≥30 days were defined as chronic GC users. Time-dependent Cox regression was used for statistical analysis, and chronic GC exposure was considered a time-varying variable. Results The prevalence of chronic GC use gradually increased from 0.16% in 2002 to 0.54% in 2015. In the 2010 cohort (n = 822,097), chronic GC users had a significantly 1.41-fold higher 5-year all-cause mortality compared with controls [hazard ratio: 1.41, 95% confidence interval (CI): 1.28–1.55, P < 0.001]. On sensitivity analysis, chronic high-dose GC users showed 1.52-fold (HR: 1.52, 95% CI: 1.32–1.76; P < 0.001) and low-dose GC users showed 1.34-fold (HR: 1.34, 95% CI: 1.18–1.51; P < 0·001) higher 5-year all-cause mortality, compared with controls; the disease-specific 5-year mortality risk in chronic GC users was highest due to musculoskeletal disease (HR: 9.50), followed by infectious and parasitic diseases (HR: 2.43), and respiratory disease (HR: 2.18). Conclusions Numbers of chronic GC users gradually increased during 2002–2015; chronic GC use increased risks of 5-year all-cause mortality in the general adult South Korean population. This association was more evident among high-dose GC users (>5 mg/day of prednisolone). The risk of disease-specific mortality among chronic GC users was increased in those with musculoskeletal, infectious and parasitic, and respiratory diseases. Keywords Corticosteroids Mortality Epidemiology Cancer Cohort study ●
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Introduction Glucocorticoids (GCs) are a class of corticosteroids commonly prescribed to 1.2% and 1.0% of patients with chronic disease in the United States and the United Kingdom, respectively [1, 2]. GCs have immunosuppressive and potent anti-inflammatory effects [3]. They inhibit the immune response and production of prostaglandins and leukotrienes, which are two main products of
Supplementary information The online version of this article (https:// doi.org/10.1007/s12020-020-02382-6) contains supplementary material, which is available to authorized users. * In-Ae Song songofi[email protected] 1
Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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inflammation [4]. Based on their immunosuppressive and anti-inflammatory effects, GCs has been prescribed to patients with chronic obstructive pulmonary disease (COPD) or asthma [5], autoimmune disease [6], rheumatic disease [7], and allergic diseases [8]. Although treatmen
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