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. 2016 Nov 11;11(11):e0165933.
doi: 10.1371/journal.pone.0165933. eCollection 2016.

Incidence of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Nationwide Population-Based Study Using National Health Insurance Database in Korea

Min-Suk Yang  1   2   3 , Jin Yong Lee  4 , Jayeun Kim  5 , Gun-Woo Kim  1   3 , Byung-Keun Kim  1   3 , Ju-Young Kim  1   3   6 , Heung-Woo Park  1   3 , Sang-Heon Cho  1   3   6 , Kyung-Up Min  1   3 , Hye-Ryun Kang  1   3   6
Affiliations

Incidence of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Nationwide Population-Based Study Using National Health Insurance Database in Korea

Min-Suk Yang et al. PLoS One. .

Abstract

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening diseases; however, it is hard to estimate their incidence due to the rarity of these diseases. We evaluated the incidence of SJS and TEN using a nationwide administrative database.

Methods: We used a national medical insurance review system (Health Insurance Review and Assessment) database which contained the claim data of the entire nation from 2009 to 2013 to estimate the accurate incidence of SJS and TEN in Korea. The diagnostic codes of L511 (SJS) or L512 (TEN) from the International Classification of Diseases-10th revision were used to define the target study population. We also retrospectively followed up a 2011 SJS and TEN cohort for 24 months in order to assess the in-hospital mortality, related complications and total claims cost due to SJS and TEN.

Results: A total of 1,167 (938 SJS and 229 TEN) cases were newly diagnosed from 2010 to 2013. The age- and sex-standardized annual incidences estimated in this study were 3.96 to 5.03 in SJS and 0.94 to 1.45 in TEN per million. There was no significant change in annual incidence throughout the study periods. When analyzed by 10-year age groups, the annual incidence was the lowest in group 20-29 years and the highest in group 70 for both SJS and TEN. Based on the 2011 cohort analysis, the in-hospital mortality were 5.7 and 15.1% for SJS and TEN, respectively. The mortality increased with age, particularly, after 40 years of age. Among the complications related with SJS or TEN, ocular sequelae was the most common (43.1 and 43.4% of SJS and TEN patients, respectively) followed by urethral sequelae (5.7 and 9.4% of SJS and TEN patients, respectively).

Conclusion: Overall, our data suggest that SJS, and TEN are infrequent but constantly arise throughout the years.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. The framework of this study.
Fig 2
Fig 2. Standardized incidence rates and the percentage of death cases of SJS and TEN by age groups.
The shape of incidence curves of Stevens-Johnson syndrome (A) and toxic epidermal necrolysis (B) were similar.
Fig 3
Fig 3. Comparison of annual medical expenditure per person between the top 20 reimbursed diseases and Stevens-Johnson syndrome and toxic epidermal necrolysis in 2011 in Korea.
Although the numbers of patients were far smaller than that of the other diseases, the annual medical expenditure per person of SJS and TEN was comparable with that of the top 20 reimbursed diseases.
See this image and copyright information in PMC

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