Stimulated by Lee et al 2025.[1]
SMS – Scientific Meeting Series
IF – impact factor
KM – Korean Medicine
MA – manual acupuncture
EA – electroacupuncture
PSM – propensity score matching
k – thousand (when written after a numeral)
CCI – Charleston comorbidity index
aHR – adjusted hazard ratio– key to acronyms
This is another one of the large retrospective cohort studies from Korea and the first author has been featured on the BMAS SMS program in the recent past (2023). I first met Ye-Seul (Jennifer) Lee at a meeting in Bologna in 2022. She was presenting a previous large cohort study on the safety of acupuncture in breast cancer. It was the first time I had seen someone present this type of study – see: Acupuncture and BRCL.
The current study is published in Frontiers in Pharmacology (IF 4.8), which is an unusual choice for an acupuncture-related study, and also possibly for one focussed on polypharmacy and hyper-polypharmacy. The latter two terms refer to the concurrent use of 5 or more and 10 or more drugs by a patient respectively. In this particular study the patients had all suffered a stroke (their first) and had to take the medications for at least 270 days during the exposure window, which was a period of 365 days.
The Korean Medicine in the title of the paper actually refers to MA or EA. To be included in the KM cohort, a patient needed to have at least 3 reimbursement records of MA or EA within the year following diagnosis of a stroke. That is a relatively modest number of sessions, but it may well have had an impact on the total number in the cohort. The most recent previous retrospective cohort study highlighted on here used at least 6 sessions in the year following diagnosis – in that case it was idiopathic Parkinson’s disease.[2] See the previous blog: Acupuncture IPD and mortality.
In the yearlong entry period for the study (2015), over half a million patients were listed as having had a stroke; however, the majority of these occurred before 2015. After exclusion and inclusion criteria were satisfied, including minimum requirements for drug records, just over 25k patients were left. Of those, just under 8k were subject to polypharmacy, and just over 6.8k of these had used KM. After PSM, 3127 patients were left in each matched cohort.
PSM was successful for the vast majority of covariates (sex, age, area, economic status, type of stroke, CCI, pre-stroke polypharmacy) including all underlying comorbidities apart from chronic back pain and osteoarthritis. The latter two conditions were substantially overrepresented in the KM users. Presumably if you have either of these conditions (and reside in South Korea) you are more likely to seek KM treatment.
The outcomes of interest in this cohort study were falls and all-cause mortality. Rather surprisingly, falls were increased in KM users (aHR 1.52), although this was not the case for the non-polypharmacy cohort, or the hyper-polypharmacy cohort. You will be pleased to learn that despite the 50% increase in falls in the KM users from the main cohort, the all-cause mortality was reduced (aHR 0.66).
The authors suggest that the increased falls risk with KM use may reflect an increased ability to be active and mobile and thus be consistent with a consequent observed reduction in mortality.
References
1 Lee Y-S, Jang B-H, Jeon JP, et al. Association of Korean Medicine and polypharmacy with fall risk and mortality in older adults with stroke. Front Pharmacol. 2025;16:1621819. doi: 10.3389/fphar.2025.1621819
2 Hwang Y-C, Lee J, Kang D, et al. A nationwide retrospective cohort study of the association between acupuncture exposure and clinical outcomes of idiopathic Parkinson’s disease using health insurance claim data in South Korea. Integr Med Res. 2025;14:101146. doi: 10.1016/j.imr.2025.101146
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