Stimulated by Kim et al 2026.[1]
IF – impact factor
LTCH – long-term care hospital
NHIS – national health insurance service (South Korea)
KM – Korean medicine (referring to traditional Korean medicine)
UC – usual care
PSM – propensity score matching
DVT – deep venous thrombosis
UTI – urinary tract infection
aHR – adjusted hazard ratio– key to acronyms
This is a large retrospective cohort study from South Korea published in BMJ Open (IF 2.5). It concerns older adults in long-term care hospitals (LTCHs) for post-fracture rehabilitation.
The NHIS database provides comprehensive longitudinal data on reimbursed healthcare utilisation with near-complete population coverage (in South Korea). A subsection of this database includes patients in LTCHs and over the 10-year period of this study (from 1st January 2014) there were just over 2 million patients in this part of the database.
Of those 2 million, 231 702 were older patients with a fracture diagnosis during enrolment. After various exclusions ~74k remained, and of these 20 361 had received sustained integrative care. The later was defined as at least one session of acupuncture, moxibustion or cupping per month whilst a patient was in the LTCH.
My understanding is that the vast majority of patients in South Korea who are treated with Korean medicine (KM) receive acupuncture as a minimum, with other KM treatments added as required. The proportion of the sustained integrative care (UC plus KM) cohort who received acupuncture is not reported but I suspect it would be near to 100%.
After PSM, the KM cohort (UC plus KM) reduced by just 1 to 20 360 and this was then compared with the matched UC cohort (UC alone) of the same number.
The primary outcome was all-cause mortality occurring after the index date, the latter being the date of entry to a LTCH with a fracture diagnosis within the study period. Follow-up continued from the index date for at least 2 years and up to 10 years.
Secondary outcomes were major medical complications often associated with fractures in older adults, specifically pneumonia, DVT, pressure ulcers, and UTIs.
All-cause mortality was ~20% lower in the KM cohort (aHR 0.79). All secondary outcomes were also 20% to 30% lower: pneumonia (aHR 0.72), DVT (aHR 0.71), pressure ulcers (aHR 0.76), and UTIs (aHR 0.75).
All-cause mortality aHRs reduced with an increase in the frequency of treatments from once every 3 to 4 weeks to once every 2 to 3 weeks. The numbers were too small for the higher frequency of more than once every 2 weeks. A similar trend of decreased risk with increased treatment frequency was seen in all the secondary outcomes.
We have already seen an assessment of mortality following hip fracture from Taiwan published in Acupuncture in Medicine in 2020 and highlighted here, see Risk of mortality 2020.[2] It was the first such study with mortality outcomes, but was substantially smaller that the one highlighted above. It compared 292 patients who received at least 6 acupuncture sessions within 183 days of hip fracture with 876 matched patients who did not. Mortality within one year of the index date (date of the 6th acupuncture session following operation for hip fracture) was ~60% lower in the acupuncture group.
References
1 Kim H, Yang S, Shin S. Association of sustained integrative-care use with mortality and immobility-related complications among post fracture older adults in South Korean long-term care hospitals: a population-based, propensity score-matched, retrospective cohort study. BMJ Open. 2026;16:e121094. doi: 10.1136/bmjopen-2026-121094
2 Lin JC-F, Lin T-C, Cheng C-F, et al. Lower rates of mortality, readmission and reoperation in patients receiving acupuncture after hip fracture: a population-based analysis. Acupunct Med. 2020;38:352–60. doi: 10.1177/0964528420911664
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