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Trends in long-term glucocorticoid use and risk of 5-year mortality: a historical cohort study in South Korea

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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.

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Data availability

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

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Author contributions

T.K.O. and I.A.S. contributed to the study design, methodology, analyzed the data, and drafted the first paper. All authors read and approved the final version of the paper.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea

    Tak Kyu Oh & In-Ae Song

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  1. Tak Kyu Oh
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Correspondence to In-Ae Song.

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The authors declare that they have no conflict of interest.

Ethical approval

The study protocol was approved by the Institutional Review Board of Seoul National University Bundang Hospital (X-1903-531-901) and the Health Insurance Review and Assessment Service (NHIS-2019-2-140). The requirement for informed consent was waived, because the study included anonymized data from the National Health Insurance Service (NHIS).

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Oh, T.K., Song, IA. Trends in long-term glucocorticoid use and risk of 5-year mortality: a historical cohort study in South Korea. Endocrine 69, 634–641 (2020). https://doi.org/10.1007/s12020-020-02382-6

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  • DOI: https://doi.org/10.1007/s12020-020-02382-6

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