Health Policy and Management (보건행정학회지)

Korean Academy of Health Policy and Management (한국보건행정학회)
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Difference of Area-based deprivation and Education on Cerebrovascular Mortality in Korea

교육수준과 지역결핍지수에 따른 뇌혈관질환 사망률 차이

  • Sim, Jeoung-Ha (Department of Nursing, Jesus University) ;
  • Ahn, Dong-Choon (Department of Veterinary Anatomy, College of Veterinary Medicine, Chonbuk National University) ;
  • Son, Mi-A (Department of Preventive Medicine, School of Medicine, Kangwon National University)
  • Received : 2011.08.15
  • Accepted : 2012.06.25
  • Published : 2012.06.30
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Abstract

This study was performed to identify the difference of the area-based deprivation and the educational level on the cerebrovascular mortality in Korea. Data used in this study was obtained from the Death Certificate Data 2000 and the 2000 Census produced by Korean National Statistics(NSO). We classified the whole country into 246 areas based on the administrative districts. Then, the Standardized Mortality Ratio (SMR) in cerebrovascular disease was calculated according to the sex, education level and 246 areas. Its Predicted SMR was calculated by the Empirical Bayes Methods to reduce the variation of the SMR values. The area-based deprivation of 246 areas were measured using the modified Carstairs index in which the 5 indicators consisted of overcrowding, the unemployment ratio of men, the percentage of households classified low social class, the percentage of non home owners, and finally those houses lacking basic amenities. The correlation between the area-based deprivation and the SMR of the whole country and the correlation between the area-based deprivation and the SMR of each metropolitan cities or provinces was analyzed by the Pearson correlation analysis method. After classifying the deprivation of 246 areas into 5 levels, we performed the random intercept Poisson regression analysis after adjusting education level and age using Empirical Bayes Method to investigate the relationship between the 5 deprivation levels and the cerebrovascular mortality. The SMR was increased in lower education level. Each 246 areas had different values in SMR, Predicted SMR and area-based deprivation. The area-based deprivation and the SMR of the whole country was not correlated in both sexes. The education level of an individual was associated the risk of cerebrovascular mortality in men. The risk of cerebrovascular mortality increased with age compared to the reference(<30). The area-based deprivation was not associated with the risk of cerebrovascular in both sexes. The findings of this study suggest that the SMR had positive and negative correlations with area-based deprivation depending on the metropolitan cities or province. It also suggests that the individual education level and age were related with mortality and finally that the area-based deprivation was not associated to the cerebrovascular mortality in Korea.

Keywords

References

  1. 강영호. 사망률에서의 사회경제적 불평등: 한국노동패널조사의 사망추적 결과. 보건행정학회지 2004; 14(4): 1-20. https://doi.org/10.4332/kjhpa.2004.14.4.001
  2. 강영호, 윤성철, 황인아, 이무송, 이상일, 조민우, 이민정. 경제위기에 따른 사망률 불평 등의 변화: 지역의 사회경제적 위치 지표의 활용. 예방의학회지 2005; 38(3): 359-365.
  3. 김혜련, 강영호. 면접조사자료와 사망등록자료 간 교육수준 및 직업계층의 신뢰도. 예방의학회지 2005; 38(4): 443-448.
  4. 손미아. 직업, 교육수준, 그리고 물질적 결핍이 사망률에 미치는 영향. 예방의학회지 2002a; 35(1): 76-82.
  5. 손미아. 사회계급과 건강행위가 유병율에 미치는 영향. 예방의학회지 2002b; 35(1): 57-64.
  6. 송윤미. 사회경제적 수준과 사망의 연관성 : 한국 남성 759,665명에서의 코호트 연구. 한국역학회 1998; 20(2): 219-225.
  7. 윤태호. 사회계급 분포와 사망비와의 연관성. 보건행정학회지 2003; 13(4): 99-114. https://doi.org/10.4332/kjhpa.2003.13.4.099
  8. 이미숙. 한국 성인의 건강불평등(사회계층과 지역 차이를 중심으로). 한국사회학 2005; 39(5): 183-209.
  9. 이자호, 김기원, 정성진, 정세희, 이경무, 박시운 등. 국내재가 뇌질환 환자의 가족구조 및 소득의 변화. 대한재활의학회 2010; 34(2), 120-127.
  10. 임승지, 김한중, 남정모, 장후선, 장영화, 김세라 등. 건강보험 청구 자료를 이용한 우리 나라 뇌졸중환자의 사회경제적비용 추계. 예방의학학회지 2009; 42(2): 252- 260.
  11. 임정수, 최대경, 임준, 홍두호, 김종균 박상현 등. 소득계층에 따른 뇌심혈관질환 사망률 차이. 보건교육․건강증진학회지 2006; 23(2): 109-119.
  12. 정백근. 정갑열, 김준연, 문옥륜, 이용환, 홍영습 등. 우리나라에서의 지역의 물질적 결핍수준과 15-64세 인구 표준화사망비의 관계. 예방의학회지 2006; 39(1): 46- 52.
  13. 정성원, 조영태. 한국적 특수성을 고려한 지역특성과 개인의 건강. 예방의학회지 2005; 38(3): 259-266.
  14. 통계청(a). 사망원인통계자료. 대전: 통계청 2000.
  15. 통계청(b). 인구센서스조사. 대전: 통계청 2000.
  16. Anno T, Matsumoto E, Watanabe E & Nakamura Y. Relationship between living arragement and stroke in Sano-Kosei General Hospital. No Shinkei Geka 2011; 39(11), 1055-1059.
  17. Aslanyan S, Weir CJ, Lees KR, Reid JL, McInnes GT. Effect of area-based deprivation on the severity, subtype, and outcome of ischemic stroke. Stroke 2003; 34(11): 2623-2628. https://doi.org/10.1161/01.STR.0000097610.12803.D7
  18. Breslow NE, Clayton DG. Approximate inference in generalized linear mixed models. J Am Stat Assoc 1993; 88(421): 9-25. https://doi.org/10.2307/2290687
  19. Carstairs V, Morris R. Deprivation and mortality: an alternative to social class? Community Med 1989; 11(3): 210-219.
  20. Cubbin C, Sundquist K, Ahlen H, Johansson, Winkleby MA, Sundquist J. Neighborhood deprivation and cardiovascular disease risk factors: protective and harmful effects. Scandinavian J Pub Health 2006; 34(3):228-237. https://doi.org/10.1080/14034940500327935
  21. Diez Roux AV, Borrell LN, Haan M, Jackson SA, Schultz R. Neighbourhood environments and mortality in an elderly cohort: results from the cardiovascular health study. J Epidemiol Community Health 2004; 58(11): 917-923. https://doi.org/10.1136/jech.2003.019596
  22. Elliot P, Wartenberg D. Spatial Epidemiology: Current approaches and future challenges. Environ Health Perspect 2004; 112(9): 998-1006. https://doi.org/10.1289/ehp.6735
  23. Hutchinson MK, Holtman MC. Analysis of count data using poisson regression. Research in Nursing & Health 2005; 28(5): 408-418. https://doi.org/10.1002/nur.20093
  24. Jakovljevic D, Sarti S, Sivenius J, Torppa J, Mahonen M, Immonen-Raiha P, et al. Socioeconomic and ischemic stroke the FINMONICA stroke register. Stroke 2001; 32: 1492-1498. https://doi.org/10.1161/01.STR.32.7.1492
  25. Janghorbani M, Stenhouse E, Millward A, Jones RB. Neighborhood deprivation and preterm birth in Plymouth, UK. J Matern Fetal Neonatal Med 2006; 19(2): 85-91. https://doi.org/10.1080/14767050500363428
  26. Jung-Choi K, Khang YH, Cho HJ. Changes in contribution of causes of death to socioeconomic mortality inequalities in Korean adults. J Prev Med Public Health. 2011 Nov;44(6):249-59. https://doi.org/10.3961/jpmph.2011.44.6.249
  27. Jungehulsing GJ, Muller-Nordhorn J, Nolte CH, Roll S, Rossnagel K, Reich A, Wagner A et al. Prevalence of stroke and stroke symptoms: a population-based survey of 28,090 participants. Neuroepidemiology 2008; 30(1): 51-57. https://doi.org/10.1159/000115750
  28. Kapral MK, Wang H, Mamdani M, Tu JV. Effect of socioeconomic status on treatment and mortality after stroke. Stroke 2002; 33: 268-275. https://doi.org/10.1161/hs0102.101169
  29. Khang YH, Lynch JW, Kaplan GA. Health inequalities in Korea: age-and sex-specific educational differences in the 10 leading causes of death. Intern J Epidemiol 2004; 33: 299-308. https://doi.org/10.1093/ije/dyg244
  30. Khang YH, Cho SI, Kim HR. Risks for cardiovascular disease, stroke, ischaemic heart disease, and diabetes mellitus associated with the metabolic syndrome using the new harmonised definition: findings from nationally representative longitudinal data from an Asian population. Atherosclerosis 2010 Dec; 213(2): 579-585. https://doi.org/10.1016/j.atherosclerosis.2010.09.009
  31. Maheswaran R, Elliott P. Stroke mortality associated with living near main roads in England and Wales: A Geographical Study. Stroke 2003(34): 2776-2780. https://doi.org/10.1161/01.STR.0000101750.77547.11
  32. Putman K, De Wit L, Schoonacker M, Baert I, Beyens H, Brinkmann N, Dejaeger E, et al. The effect of socioeconomic status on functional and motor recovery after stroke: a European multicentre study. J Neurol Neurosurg Psychiatry 2007; 78(6): 593-599. https://doi.org/10.1136/jnnp.2006.094607
  33. Son M. Commentary: why the educational effect is so strong in differentials of mortality in Korea? Int J Epidemiol 2004; 33(2): 308-310. https://doi.org/10.1093/ije/dyh017
  34. Song YM, Byeon JJ. Excess mortality from avoidable and non-avoidable causes in men of low socioeconomic status: a prospective study in Korea. J Epidemiol Community Health 2000; 54(3): 166-172. https://doi.org/10.1136/jech.54.3.166
  35. Sundquist J, Malmstrom M, Johansson SE. Cardiovascular risk factors and the neighbourhood environment: a multilevel analysis. Intern J Epidemiol 1999; 28: 841-845. https://doi.org/10.1093/ije/28.5.841
  36. Sundquist K, Malmstrom and Johansson SE. Neighborhood deprivation and incidence of coronary heart disease: a multilevel study of 2.6 million women and men in Sweden. J Epidemiol and Commun Health 2004; 58: 71-77. https://doi.org/10.1136/jech.58.1.71
  37. Taylor FC, Ascione R, Rees K, Narayan P, Angelini GD. Socioeconomic deprivation is a predictor of poor postoperative cardiovascular outcomes in patients undergoing coronary artery bypass grafting. Heart 2003; 89(9): 1062-1066. https://doi.org/10.1136/heart.89.9.1062
  38. Townsend P, Phillimore P, Beattie A. Inequalities in health in the Northern Region: An Interim report, Northern Regional Health Authority/Bristol University 1986.
  39. Weir NU, Gunkel A, Mcdowall M, Dennis MS. Study of the relation between social deprivation and outcome after stroke. Stoke 2005; 36(4): 815-819.
  40. Wong KY, Wong SY, Fraser HW, Ersoy Y, Ogston S, Wolfson D, et al. Effect of social deprivation on mortality and the duration of hospital stay after a stroke. Cerebrovasc Dis 2006; 22(4): 251-257. https://doi.org/10.1159/000094012
  41. World Health Organization, the International Classification of Disease, 10th Revision(ICD-10). 2003.
  42. Zhou G, Liu X, Xu G, Liu X, Zhang R, Zhu W. The effect of socioeconomic status on three-year mortality after first-ever ischemic stroke in Nanjing, China. BMC Public Health 2006; 6: 227 https://doi.org/10.1186/1471-2458-6-227

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