J Korean Med Sci.  2015 Sep;30(9):1266-1272. 10.3346/jkms.2015.30.9.1266.

Treatment Gap in the National Health-screening Program in Korea: Claim-based Follow-up of Statin Use for Sustained Hypercholesterolemia

• Ahn E
• Shin DW
• Yang HK
• Yun JM
• Chun SH
• Suh B
• Lee H
• Son KY
• Cho B

• KMID: 2344151
• DOI: http://doi.org/10.3346/jkms.2015.30.9.1266

Abstract

Participation in a screening program by itself may not improve clinical outcomes. Treatment gaps in the program may limit its full benefit. We evaluated statin prescription rates for subjects with sustained hypercholesterolemia to assess the treatment gaps in the National Health Screening Program (NHSP) in Korea. A retrospective, random cohort was established among National Health Insurance Corporation (NHIC) members. Finally, we examined 465,499 individuals who attended the NHSP from 2003 to 2010 without any history of dyslipidemia, statin prescription, or hospitalization for cardiovascular events until the end of 2002. The subsequent statin prescription rates were identified from the NHIC medical service claim database from 2003 to 2011. Descriptive data and odds ratio from multivariate logistic analyses on statin prescription rates and the corresponding correlations were evaluated. The NHSP detected 114,085 (24.5%) cases of newly diagnosed hypercholesterolemia. However, only 8.6% of these received statin prescription within 6 months of diagnosis. For cases of sustained hypercholesterolemia determined in the next screening visit by the NHSP, the statin prescription rate increased, but only to 12.2%. Statin prescriptions were more common among females, older individuals, and hypertension or diabetes patients. Furthermore, the statin prescription rates had increased over the study period. The NHSP exhibited low statin prescription rate which has been improving. For the NHSP to be effective, it would be worthwhile to decrease the gap between the diagnosis of hypercholesterolemia and the following treatment.

Keyword

Hypercholesterolemia; Cholesterol; Cardiovascular Diseases; Prevention; Statins

MeSH Terms

Adult
Chronic Disease
Drug Prescriptions/statistics & numerical data
Female
Health Services Accessibility/statistics & numerical data
Healthcare Disparities/*statistics & numerical data
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use
Hypercholesterolemia/*diagnosis/epidemiology/*prevention & control
Insurance Claim Reporting/statistics & numerical data
Male
Mass Screening/*utilization
Middle Aged
National Health Programs/*utilization
Prevalence
Republic of Korea/epidemiology
Risk Assessment
Treatment Outcome
Young Adult
Hydroxymethylglutaryl-CoA Reductase Inhibitors

Figure

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  Fig. 1 Flow chart of subjects. *Diagnosed with dyslipidemia (ICD-10 code E78) or were prescribed statins; †Inpatient care for myocardial infarction (ICD-10 codes I21, I22) or stroke (I61, I62, I63, I64); ‡Fasting serum cholesterol level ≥ 240 mg/dL.

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