• Journal of Preventive Medicine and Public Health
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• 제47권2호
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• pp.104-112
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• 2014

Objectives: To date, studies have not comprehensively demonstrated the relationship between stroke incidence and socioeconomic status. This study investigated stroke incidence by household income level in conjunction with age, sex, and stroke subtype in Korea. Methods: Contributions by the head of household were used as the basis for income levels. Household income levels for 21 766 036 people were classified into 6 groups. The stroke incidences were calculated by household income level, both overall within income categories and further by age group, sex, and stroke subtype. To present the inequalities among the six ranked groups in a single value, the slope index of inequality and relative index of inequality were calculated. Results: In 2005, 57 690 people were first-time stroke patients. The incidences of total stroke for males and females increased as the income level decreased. The incidences of stroke increased as the income level decreased in those 74 years old and under, whereas there was no difference by income levels in those 75 and over. Intracerebral hemorrhage for the males represented the highest inequality among stroke subtypes. Incidences of subarachnoid hemorrhage did not differ by income levels. Conclusions: The incidence of stroke increases as the income level decreases, but it differs according to sex, age, and stroke subtype. The difference in the relative incidence is large for male intracerebral hemorrhage, whereas the difference in the absolute incidence is large for male ischemic stroke.

• Asian Pacific Journal of Cancer Prevention
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• 제14권11호
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• pp.6919-6924
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• 2013

Background: Between 1998-2009 South Korea experienced significant progress in reducing the male smoking rate from 66.3% to 46.9%. As part of a significant government effort in the area of smoking cessation intervention, the Korean government implemented the national "Smoking Cessation Clinics (SCC)" program in 2004. Materials and Methods: Data covered 804,334 adult male smokers participating in SCC program at 253 public health centers between 2006-2009. We examined participant cessation rates with the SCC program, their characteristics and program intervention components using health insurance status as a socioeconomic status (SES) indicator. Multivariate logistic regression analyses were performed correcting for intra-class correlations within public health centers. Results: The overall 6-month quit rate was high (46.8%). Higher odds of smoking cessation were positively associated with higher levels of behavioral counseling sessions, but not nicotine replacement therapy (NRT). Cessation rates were lower for Medicaid participants than for regular health insurance participants. Disadvantaged younger smokers were less likely to participate in the program. Older smokers were more likely to quit regardless of SES. Stress was cited as major reason for failure. Conclusions: SES inequalities across different age groups exist in smoking cessation among Korean adult male smokers. There is a need for intervention programs specifically targeting sub-populations of SES by different age groups.

• Journal of Preventive Medicine and Public Health
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• 제38권4호
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• pp.443-448
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• 2005

Objectives : This study was done to evaluate the reliability of education and occupational class between using the health survey and the death certificate data. Methods : The 1998 National Health and Nutrition Examination Survey (NHANES) was conducted on a cross-sectional probability sample of South Korean households, and it contained unique 13-digit personal identification numbers that were linked to the data on mortality from the Korean National Statistical Office. The data from 263 deaths were used to estimate the agreement rates and the Kappa indices of the education and occupational class between using the NHANES data and the death certificate data. Results : The simple and weighted Kappa indices for education were 0.60 (95% CI=0.53-0.68) and 0.73 (95% CI=0.67-0.79) respectively, if the educational level was grouped into five categories: no-formal-education, elementary-school, middle-school, high-school and college or over. The overall agreement rate was 71.9% for these educational groups. The magnitude of reliability, as measured by the overall agreement rates and Kappa indices, tended to increase with a decrease in the educational class. The number of non-educated people with using the death certificate data was smaller than that with using the NHANES data. For the occupational class (manual workers, non-manual workers and others), the Kappa index was 0.40 (95% CI=0.30-0.51), which was relatively lower than that for the educational class. Compared with the NHANES, the number of non-manual workers for the deceased who were aged 30-64 tended to be increased (8 to 12) when using the death certificate data, whereas the number of manual workers tended to be decreased (59 to 41). Conclusions : The socioeconomic inequalities in the mortality rates that were based on the previous unlinked studies in South Korea were not due to a numerator/denominator bias. The mortality rates for the manual workers and the no-education groups might have been underestimated.

• Journal of Preventive Medicine and Public Health
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• 제55권4호
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• pp.389-397
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• 2022

Objectives: This study examined the effect of out-of-pocket (OOP) payment reduction on the potential utilization of low-value magnetic resonance imaging (MRI) across income groups. Methods: We conducted an experimental vignette survey using a proportional quota-based sample of individuals in Korea (n=1229). In two hypothetical vignettes, participants were asked whether they would be willing to use MRI if they had uncomplicated headache and non-specific low back pain, each before and after OOP payment reduction. To account for the possible role of physician inducement, half of the participants were initially presented with vignettes that included a physician recommendation for low-value care. The predicted probability, slope index of inequality (SII), and relative index of inequality (RII) were calculated using logistic regression. Results: Before OOP payment reduction, the lowest income quintile was least likely to use low-value MRI regardless of physician inducement (36.7-49.6% for low back pain; 30.5-39.3% for headache). After OOP payment reduction, almost all individuals in each income quintile were willing to use low-value MRI (89.8-98.0% for low back pain; 78.1-90.3% for headache). Absolute and relative inequalities concerning potential low-value MRI utilization decreased after OOP payments were reduced, even without physician inducement (SII: from 8.15 to 5.37%, RII: from 1.20 to 1.06 for low back pain; SII: from 6.99 to 0.83%, RII: from 1.20 to 1.01 for headache). Conclusions: OOP payment reduction for MRI has the potential to increase low-value care utilization among all income groups while decreasing inequality in low-value care utilization.

• Journal of Preventive Medicine and Public Health
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• 제55권1호
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• pp.49-59
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• 2022

Objectives: Access to maternal and neonatal care services (MNCS) is an important goal of health policy in developing countries. In this study, we proposed a 3-level hierarchical location-allocation model to maximize the coverage of MNCS providers in Iran. Methods: First, the necessary criteria for designing an MNCS network were explored. Birth data, including gestational age and birth weight, were collected from the data bank of the Iranian Maternal and Neonatal Network national registry based on 3 service levels (I, II, and III). Vehicular travel times between the points of demand and MNCS providers were considered. Alternative MNCS were mapped in some cities to reduce access difficulties. Results: It was found that 130, 121, and 86 MNCS providers were needed to respond to level I, II, and III demands, respectively, in 373 cities. Service level III was not available in 39 cities within the determined travel time, which led to an increased average travel time of 173 minutes to the nearest MNCS provider. Conclusions: This study revealed inequalities in the distribution of MNCS providers. Management of the distribution of MNCS providers can be used to enhance spatial access to health services and reduce the risk of neonatal mortality and morbidity. This method may provide a sustainable healthcare solution at the policy and decision-making level for regional, or even universal, healthcare networks.

• 한국콘텐츠학회논문지
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• 제19권7호
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• pp.546-558
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• 2019

건강불평등은 사회적 취약계층에게 부정적 영향을 미칠 수 있는 건강상의 차이를 일컫는다. 여러 학자들은 경제적, 사회적 불평등이 건강에 부정적 영향을 미치고 있으므로 건강 불평등을 축소하려는 사회적 개입이 필요하다고 주장한다. 이런 맥락에서 이 글은 여성가족부가 지난 2016년부터 시행하고 있는 학교 밖 청소년 건강검진을 한국 사회의 건강불평등 감소 정책의 일환으로 소개하고자 한다. 국가건강검진제도에서 소외됐던 학교 밖 청소년을 검진제도 내로 편입한 것은 국가차원의 건강불평등 완화 정책으로서 큰 의미를 갖는다. 지금까지 학교 밖 청소년은 한국 사회에서 소외집단이었을 뿐 아니라, 건강검진제도 내에서도 사각지대에 있었다. 이중의 상당수는 가족주의가 굳건한 한국사회에서 가족의 보호와 지원을 받지 못한 채 거리로 쫓겨난 어린 노동자임에도 불구하고 '일탈적인 10대', '가출 청소년', '비행 청소년' 등으로 불리며 차별받았다. 현행 학교 밖 청소년 건강검진은 대안학교에 다니거나 쉼터에 거주하는 등 비교적 주거파악이 쉬운 청소년 위주로 실시되고 있다. 이 제도의 실질적인 성과를 위해서는 주거가 불안정한 가출 청소년까지 검진제도 내로 포섭하는 접근성 확대 정책이 필요하다. 그리고 검진 사후관리, 예방접종과 정신건강, 검진주기 단축 등 실질적인 성과를 거두기 위한 방법과 실행이 더해져야 할 것이다.

• 한국노년학
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• 제36권3호
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• pp.611-632
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• 2016

노년기 건강문제는 의료적 관점에서뿐만 아니라, 사회경제적 지위와 같은 사회적 조건과의 상호작용 속에서 해법을 찾을 필요가 있다. 이러한 인식 하에, 본 연구에서는 사회경제적 지위가 노인의 건강불평등에 이르는 메커니즘을 파악하고자 하였다. 구체적으로는 사회경제적 지위(소득 및 교육)와 신체적 건강의 세 차원(의료적 건강/기능적 건강/주관적 건강) 간의 사이에서의 중간기제로서 건강행동, 의료시설 접근성, 사회참여, 사회적 관계망의 매개효과를 규명하는 것이다. 연구모형의 검증을 위해 2014년에 실시된 전국노인실태조사 데이터를 2차 분석하였다. 본 연구의 대상은 65세 이상 남녀 노인 10,451명으로, 매개모형 검증을 위해 Baron & Kenny(1986)가 제안하는 절차에 따라 위계적 다중회귀분석을 실시하였고 매개효과의 유의성 검증을 위해 Sobel test를 실시하였다. 분석결과, 노인의 소득수준과 교육수준의 건강에 대한 효과가 동일하지는 않았고 건강의 하위차원에 따라서도 다소 다른 결과가 도출되기는 했지만, 전반적인 결과의 방향은 노인의 사회경제적 지위는 건강격차를 야기하고 있었으며, 그 메커니즘은 건강행동, 의료시설 접근성, 사회참여, 사회적 관계망을 매개한다는 것이다. 특히 본 연구에서 교육은 소득보다도 건강에 대한 보다 강력한 효과를 나타내었다는 점, 사회참여와 같은 사회통합요인의 효과가 부각되었다는 점, 거주지역을 통제한 이후에도 잔존한 의료시설 접근성의 유의미한 매개효과 등은 본 연구의 결과 중에서도 주목할 만하다. 이러한 결과를 바탕으로 사회경제적 조건으로 인한 건강불평등의 메커니즘을 규명하고 이를 완화시킬 수 있는 대안을 모색할 수 있었다는 점에서 본 연구의 의의가 있다.

• Journal of Preventive Medicine and Public Health
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• 제41권5호
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• pp.300-306
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• 2008

Objectives : This study was performed to compare the standardized mortality ratios among different small areas and to explore the usefulness of standardized mortality ratios in South Korea. Methods : To calculate the standardized mortality ratio (SMR), we obtained the national deaths certificate data (2004-2006) and national registration population data (2003-2006), and these were provided by the National Statistical Office. The small areas (Eup.Myoun.Dong) were based on the subdivisions of counties. Among the 3,580 small areas classified by the National Statistical Office, 3,571 areas were included in this study. The basic statistics and decile distributions of the SMRs for all the regional levels were calculated, and the small area maps were also produced for some selected regions. To evaluate the precision of SMR, we calculated the 95% confidence intervals of the SMR in selected small areas. Results : The mean and the standard deviation of the SMRs among all small areas were 100.8 and 17.0, respectively. The range was 30.6-211.7 and the inter-quartile range was 20.7. Seoul metropolitan city displayed the lowest mean SMR among 16 regions in South Korea, and 34.6 percent of the small area SMRs belonged to the first decile(the lowest group). On the contrary, the mean SMR of Gyeongsangnam province was highest, and 26.1 percent of the small area SMRs belonged to the tenth decile(the highest group). In some areas, the precision of the SMR, which was calculated by the 95% confidence intervals, remained questionable, yet it was quite stable for almost areas. Conclusions : The standardized mortality ratios can be useful for allocating health resources at the small area level in Korea.

• Journal of Preventive Medicine and Public Health
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• 제42권5호
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• pp.305-314
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• 2009

Objectives : The physical activity of Korean adolescents and its distribution based on social characteristics have not yet been fully assessed. This study intends to reveal the distribution of physical activity by its subgroups and offer possible explanatory variables. Methods : The 3rd Korea Youth Risk Behavior Web-based Survey was analyzed for this study. The appropriateness of physical activity was defined by Korea s Health Plan 2010 and physical inactivity was assessed independently. Family affluence scale, parents education levels, subjective economic status, grade, and school location were considered explanatory variables. All statistical analysis was conducted using SAS ver. 9.1. Results : The proportion of participants engaging in vigorous physical activity was high in males (41.6%), at a low grade (38.5%), within the high family affluence scale group (35.5%). The distribution of participants engaging in moderate physical activity showed similar patterns, but the overall proportion was lower (9.8%). Low family affluence and students with lower subjective economic status reported a higher prevalence of physical inactivity. In multiple logistic regression analysis for physical activity, significant factors included family affluence scale (p<0.05). For physical inactivity, family affluence scale, parents education levels, and subjective economic status were included as significant factors (p<0.05). Conclusions : The results suggest that the physical activity and inactivity of adolescents may be affected by socioeconomic variables, such as family affluence scale. This implies the need to take proper measures to address these socio-economic inequalities.

• Journal of Preventive Medicine and Public Health
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• 제55권6호
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• pp.506-519
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• 2022

Objectives: This study aimed to analyze the associations of income, marital status, and health behaviors with hypertension in male and female over 40 years of age in the Korea. Methods: The data were derived from the Korean Genome and Epidemiology Study (KoGES; 4851-302) which included 211 576 participants. To analyze the relationships of income, marital status, and health behaviors with hypertension in male and female over 40 years of age, multiple logistic regression was conducted with adjustments for these variables. Results: The prevalence of hypertension increased linearly as income decreased. The odds ratio for developing hypertension in people with an income of <0.5 million Korean won (KRW) compared to ≥6.0 million KRW was 1.55 (95% confidence interval [CI], 1.25 to 1.93) in the total population, 1.58 (95% CI, 1.27 to 1.98) in male, and 1.07 (95% CI, 0.35 to 3.28) in female. The combined effect of income level and marital status on hypertension was significant. According to income level and marital status, in male, low income and divorce were most associated with hypertension (1.76 times; 95% CI, 1.01 to 3.08). However, in female, the low-income, married group was most associated with hypertension (1.83 times; 95% CI, 1.71 to 1.97). Conclusions: The results of this study show that it is necessary to approach male and female marital status separately according to income in health policies to address inequalities in the prevalence of hypertension.