Risk of mortality 2026

Stimulated by Jun et al 2026.[1]

IF – impact factor
PWD – patients with disability
IHD – ischaemic heart disease
CVD – cardiovascular disease
NHIS – national health insurance service (South Korea)
PSM – propensity score matching
CCI – Charlston comorbidity index
aHR – adjusted hazard ratio
CI – confidence interval

– key to acronyms

This paper came out in mid-June this year, but I have been waiting for it to be page set before highlighting it here. It comes from Korea, is a large retrospective cohort study, and is published in the journal BMC Complementary Medicine and Therapies (IF 4.4).

It examines the association between acupuncture exposure and mortality in patients with disability (PWD) diagnosed with ischaemic heart disease (IHD). We have seen papers from the lead author previously. In fact I highlighted similar papers on 3 different occasions in 2025: see Acupuncture for CVD in disability;[2] Acupuncture and heart failure;[3] Acupuncture and mortality in IHD.[4] The lead author seems to have moved from Iksan to Naju, but the boss (last author) is still based at Iksan (hence the image above). In the last two studies Jennifer (Ye-Seul Lee) has joined the author list and is the first corresponding author on both papers.

We have mentioned here previously that PWD show higher CVD incidence and mortality than those without disability, regardless of the type of disability or risk factors for CV disease.[5]

The study cohort was based on NHIS claims data for PWDs from 2013 to 2020. PWDs with newly diagnosed IHD during the entry period (2014 to 2016) were divided into cohorts based on acupuncture exposure of at least 2 sessions in the first year after diagnosis or no exposure to acupuncture and then matched using PSM, which included age, sex, CCI, disability severity, comorbidities (including hypertension, diabetes mellitus, dyslipidaemia, ischemic stroke, chronic obstructive pulmonary disease, atrial fibrillation, peripheral artery disease, chronic kidney disease, and chronic liver disease), income, and area of residence. After matching the cohorts each included 38 157 patients.

This study set a landmark at one year after diagnosis, so that only patients who survived for a year were included and the exposure window was within that year, thus avoiding immortal time bias.

The primary outcome was all-cause mortality, and this was reduced by 22% in the cohort exposed to acupuncture after IHD diagnosis (aHR 0.78).

As in previous studies they assessed the level of exposure to acupuncture and showed that those in the highest exposure group (19 or more sessions) had the lowest risk of all-cause mortality (aHR 0.67).

This was emphasised by the authors but there was no obvious relationship between dose and risk, indeed the risk reduction appeared to deteriorate from acupuncture group 1 (2 to 4 sessions; aHR 0.78) to group 2 (5 to 8 sessions; aHR 0.82) and group 3 (9 to 8 sessions; aHR 0.85), before improving again in group 4 (19 or more; aHR 0.67). The 95% CIs were all overlapping apart from group 4. We have seen an odd result like this before – see Acupuncture for CVD in disability.[2]

This is often referred to as a dose response relationship, which is inappropriate for an observational study since the term response implies a causal relationship. I think it would be better to describe this as a dose risk relationship, as I have done above.

The bottom line is that if you can manage to get 19 or more sessions of acupuncture in the first year after diagnosis of IHD and you are a PWD, you are probably different in a number of ways from those who attend fewer sessions and this difference along with the acupuncture may give you a reduced risk.

References

1          Jun H, Sul J-U, Cheong MJ, et al. Association between acupuncture exposure and mortality in people with disabilities diagnosed with ischemic heart disease: a nationwide retrospective cohort study in the Republic of Korea. BMC Complement Med Ther. Published Online First: 12 June 2026. doi: 10.1186/s12906-026-05434-y

2          Jun H, Park D, Sul J-U, et al. Impact of acupuncture on mortality in patients with disabilities and newly diagnosed heart failure: a nationwide cohort study. Front Med. 2025;12:1519588. doi: 10.3389/fmed.2025.1519588

3          Jun H, Jin H, Kim H, et al. Association between acupuncture treatment exposure and mortality in patients with heart failure: a nationwide cohort study. Front Cardiovasc Med. 2025;12:1461302. doi: 10.3389/fcvm.2025.1461302

4          Jun H, Park D, Kim H, et al. Early acupuncture exposure and mortality in older adults with ischemic heart disease: A nationwide cohort study in Korea. Integr Med Res. 2026;15:101252. doi: 10.1016/j.imr.2025.101252

5          Son KY, Kim SH, Sunwoo S, et al. Association between disability and cardiovascular event and mortality: A nationwide representative longitudinal study in Korea. PloS One. 2020;15:e0236665. doi: 10.1371/journal.pone.0236665

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Declaration of interests MC