• 보건의료산업학회지
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• 제9권2호
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• pp.81-88
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• 2015

The purpose of this study was to compare the risk-adjusted in-hospital mortality for craniotomies between logistic regression and multilevel analysis. By using patient sample data from the Health Insurance Review & Assessment Service, in-patients with a craniotomy were selected as the survey target. The sample data were collected from a total number of 2,335 patients from 90 hospitals. The sample data were analyzed with SAS 9.3. From the results of the existing logistic regression analysis and multilevel analysis, the values from the multilevel analysis represented a better model than that of logistic regression. The intra-class correlation (ICC) was 18.0%. It was found that risk-adjusted in-hospital mortality for craniotomies may vary in every hospital. The agreement by kappa coefficient between the two methods was good for the risk-adjusted in-hospital mortality for craniotomies, but the factors influencing the outcome for that were different.

• 응용통계연구
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• 제27권1호
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• pp.89-102
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• 2014

본 연구에서는 질병관리본부에서 매년 조사하고 있는 지역사회 건강조사 자료를 이용하여 서울시 지역을 대상으로 개인의 흡연 여부에 대한 영향 요인을 확인하고 지역간 차이를 모형에 반영시키는 다수준 로지스틱 모형을 이용하여 분석하였다. 다수준 모형에서의 적합한 분석 모형의 수준을 결정하기 위해 ICC(intraclass correlation coefficient)와 프로파일링 분석, 수준별 모형의 예측정확도를 이용하였다. 제안된 모형들의 성능을 평가하기 위해 민감도, 특이도, 정확도를 구하고 ROC curve를 작성하였다. 결과적으로 지역사회 건강조사 자료와 같이 개인과 집단 변수를 동시에 고려할 수 있다면 다양한 다수준 모형의 적용이 가능하며 활용성이 높다는 것을 알 수 있었다.

• 대한건축학회논문집:계획계
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• 제35권8호
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• pp.101-109
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• 2019

Korea's transportation paradigm is shifting from a vehicle-oriented transportation plan to a pedestrian-friendly environment that emphasizes walking safety. However, the level of pedestrian traffic accidents in Korea is still high and serious. The purpose of this study is to investigate factors affecting the severity of pedestrians traffic accidents using the multilevel logistic regression model based on 2015-2017 pedestrian accidents data provided by the Traffic Accident Analysis System(TAAS). The main results of the multilevel logistic regression model showed that 89% of pedestrian traffic accidents in Seoul were explained by individual characteristics such as drivers and pedestrians, and 11% were explained by neighborhood environmental characteristics. The results are as follows : In the individual characteristics such as pedestrians and drivers, the older the pedestrians and the drivers, the higher the traffic accident severity. The severity of traffic accidents was high when the pedestrians were female and the drivers were male. In the case of accident types, traffic accidents were more serious in the cases of heavy vehicles, inclement weather, and occurring at intersections and crosswalks. The results of the neighborhood environmental characteristics are as follows. The intersection density and the crosswalk density tended to reduce the severity of traffic accidents. On the other hand, the traffic light density and the school zones were founded to related to the higher level of traffic accident severity. This study suggests that both individual and neighborhood environmental characteristics should be considered together to prevent and reduce the severity of pedestrian traffic accidents.

• 한국콘텐츠학회논문지
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• 제13권5호
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• pp.342-353
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• 2013

의료서비스 이용의 대부분을 차지하고 있는 만성퇴행성질환은 생활습관과 연관되어 있다. 의료서비스를 이용하게 되는 원인으로는 흡연, 음주, 식이, 운동 등의 개인의 올바르지 못한 건강행태가 주요 요인이며, 사회경제적인 요인인 월 평균 가구 소득, 의료보험의 종류, 거주 지역, 인구 1,000명 당 의사 수, 직업의 유무 등이 의료서비스이용 선택에 영향을 미치는 요인이 될 수 있다. 본 연구의 목적은 외래서비스 이용에 영향을 미치는 요인을 파악하고자 한다. 최근 2주간 외래서비스 이용 횟수가 2회 이상인 응답에 대한 로지스틱 회귀분석 결과, 도시지역에 거주할수록, 소득이 높을수록, 과체중 이상일수록, 문제음주자일수록 2회 이상 의료서비스를 이용할 확률이 높았다. 반면에, 민간의료보험 보유자, 직업 보유자, 2주간 몸이 불편했던 경험자, 고혈압 환자, 당뇨 환자, 고혈압과 당뇨 환자, 흡연자들은 2회 이상 의료서비스를 이용할 확률이 낮았다. 지역을 임의효과로 한 혼합모형으로 다수준 분석을 실시한 결과는 고졸 이상자와 사고 중독을 당한 사람들이 그렇지 않은 사람들보다 외래서비스 이용횟수가 더 많았다. 앤더슨 모형과 다수준 분석기법을 함께 사용하여 국내 실정에 맞는 의료서비스 이용 요인을 체계적으로 규명하고자 하는 측면에서 이 연구의 의미가 있다.

• Journal of Preventive Medicine and Public Health
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• 제48권4호
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• pp.195-202
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• 2015

Objectives: Receiving proper dental care plays a significant role in maintaining good oral health. We investigated the relationship between regional deprivation and dental care utilization. Methods: Multilevel logistic regression was used to identify the relationship between the regional deprivation level and dental care utilization purpose, adjusting for individual-level variables, in adults aged 19+ in the 2008 Korean Community Health Survey (n=220 258). Results: Among Korean adults, 12.8% used dental care to undergo examination and 21.0% visited a dentist for other reasons. In the final model, regional deprivation level was associated with significant variations in dental care utilization for examination (p<0.001). However, this relationship was not shown with dental care utilization for other reasons in the final model. Conclusions: This study's findings suggest that policy interventions should be considered to reduce regional variations in rates of dental care utilization for examination.

• Journal of Preventive Medicine and Public Health
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• 제47권5호
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• pp.258-265
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• 2014

Objectives: To examine whether the nursing practice environment at the hospital-level affects the job satisfaction and turnover intention of hospital nurses. Methods: Among the 11 731 nurses who participated in the Korea Health and Medical Workers' Union's educational program, 5654 responded to our survey. Data from 3096 nurses working in 185 general inpatient wards at 60 hospitals were analyzed using multilevel logistic regression modeling. Results: Having a standardized nursing process (odds ratio [OR], 4.21; p<0.001), adequate nurse staffing (OR, 4.21; p<0.01), and good doctor-nurse relationship (OR, 4.15; p<0.01), which are hospital-level variables based on the Korean General Inpatients Unit Nursing Work Index (KGU-NWI), were significantly related to nurses' job satisfaction. However, no hospital-level variable from the KGU-NWI was significantly related to nurses' turnover intention. Conclusions: Favorable nursing practice environments are associated with job satisfaction among nurses. In particular, having a standardized nursing process, adequate nurse staffing, and good doctor-nurse relationship were found to positively influence nurses' job satisfaction. However, the nursing practice environment was not related to nurses' turnover intention.

• Journal of Preventive Medicine and Public Health
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• 제56권6호
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• pp.504-514
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• 2023

Objectives: This study investigated the relationship between prescribing institutions and medication adherence among patients newly diagnosed with hypertension and diabetes. Methods: This study investigated patients with new prescriptions for hypertension and diabetes in Korea in 2019 with using data collected from general health screenings. A multilevel logistic regression model was applied to explore the relationship between patients' first prescribing institution and their medication adherence, defined as a medication possession ratio (MPR) over 80%. Results: The overall adherence rates were 53.7% and 56.0% among patients with hypertension and diabetes, respectively. The intra-class correlation coefficients were 13.2% for hypertension and 13.8% for diabetes (p<0.001), implying that the first prescribing institution had a significant role in medication adherence. With clinics as the reference group, all other types of hospitals showed an odds ratio (OR) less than 1.00, with the lowest for tertiary hospitals (OR, 0.30 for hypertension; 0.45 for diabetes), and the next lowest in health screening specialized clinics (OR, 0.51 for hypertension; 0.46 for diabetes). Among individual-level variables, female sex, older age, higher insurance premium level, and residing in cities were positively associated with adherence in both the hypertension and diabetes samples. Conclusions: This study showed that the prescribing institution had a significant relationship with medication adherence. When the first prescribing institution was a clinic, newly diagnosed patients were more likely to adhere to their medication. These results highlight the important role played by primary care institutions in managing mild chronic diseases.

• 한국임상수의학회지
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• 제34권2호
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• pp.140-145
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• 2017

The goal of this study was to investigate risk factors associated with porcine reproductive and respiratory syndrome (PRRS) in pig farms in the Republic of Korea using logistic regression and a multilevel model. A cross-sectional study was applied to 305 pig farms with a questionnaire-based interview by veterinarians between March 2014 and February 2015. The questionnaire comprised eight categories: proximity to neighbors, disinfection, visitors, vehicles, insecticides, wild animals, gilts, and feeding. In total, 61 questions in eight categories related to pig farm biosecurity were investigated. Farms were classified as PRRS stable or unstable based on the results of an antibody test and PCR. For univariate analysis, keeping production records with computers (OR = 0.283, 95% CI = 0.056 - 1.425), accredited farm with no use of antibiotics (OR = 0.412, 95% CI = 0.134 - 1.269), reviewing health record of semen prior to purchasing (OR = 0.492, 95% CI = 0.152 - 1.589), complete isolation of runt pigs (OR = 0.264, 95% CI = 0.084 - 0.829), compulsory registering for visitors (OR = 0.424, 95% CI = 0.111 - 1.612), keeping records of insecticide history (OR = 0.406, 95% CI = 0.089 - 1.846), routine on-farm monitoring by veterinarians (OR = 0.314, 95% CI = 0.069 - 1.423), and use of on-farm checklist for biosecurity monitoring (OR = 0.313, 95% CI = 0.063 - 1.553) were found to decrease the probability of PRRS infection. Multivariate and multilevel analysis revealed only two factors, complete isolation of runt pigs (OR = 0.165, 95% CI = 0.045 - 0.602 and OR = 0.208, 95% CI = 0.055 - 0.782) and compulsory registering for visitors (OR = 0.106, 95% CI = 0.017 - 0.655 and OR = 0.119, 95% CI = 0.017 - 0.809) were found to decrease the probability of PRRS infection. The intracluster correlation coefficient of a province for multilevel model was 0.05. The results of this study might facilitate biosecurity measures for individual farms to reduce the probability of PRRS infection.

• 보건행정학회지
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• 제32권1호
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• pp.63-72
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• 2022

Background: Depression is a common disease around the world. Many studies are showing that mental health can be improved through physical activity, and daily regular exercise can reduce the negative effects of depression or depressive symptoms. In order to promote individual physical activity, a physical activity-friendly environment must precede. Therefore, this study attempted to confirm whether the number of sports facilities for all affects individual depression. Methods: Among the respondents to the 2018 Community Health Survey, data from 181,086 people excluding missing value were used. Descriptive and chi-square tests were performed to understanding the general characteristics of individual level variables. A multilevel logistic regression was conducted to confirm the effect of individual and regional level variables on depressive symptoms. Results: As a result of confirming the effect of individual characteristics on depressive symptoms, it was confirmed that both socioeconomic and health behavior factors had an effect. Similar results were shown in a model that considered regional level variables, and in the case of the number of sports facilities per population, people who belongs to smaller areas were more likely to have depressive symptoms (odds ratio, 0.98; 95% confidence interval, 0.97-0.99). Conclusion: As a result of the analysis, it was confirmed that both individual level and regional level variables had a significant effect on depressive symptoms. This suggests that not only individual level approaches but also regional level approaches are needed to improve individual depressive symptoms In particular, it may be possible to consider to increase the number of sports facilities in areas where the prevalence of depressive symptoms is high and the number of sports facilities is insufficient.

• 한국산학기술학회논문지
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• 제17권5호
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• pp.104-115
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• 2016

연구목적: 본 연구는 의사로부터 고혈압으로 진단받은 사람들을 대상으로 개인 건강행태 및 지역 보건의료수준이 치료순응에 미치는 영향을 파악하고자 실시하였다. 고혈압 치료순응은 고혈압 약물치료율로 조작적 정의를 하였다. 정의는 의사에게 고혈압을 진단받은 30세 이상 사람 중 현재 혈압 조절약을 한 달(30일)에 20일 이상 복용하고 있는 사람의 분율로 정의하였다. 연구방법: 2010년도 지역사회건강조사대상 만 19세 이상 성인 229,229명을 대상으로 개인특성에 따른 고혈압 치료순응지표의 차이 비교는 카이제곱 검정을 사용하였으며, 개인 및 지역수준 변수를 고려한 고혈압 치료순응의 관련지표의 지역 간 변이 파악은 다수준 로지스틱회귀분석 실시하였다. 통계 프로그램은 SPSS 18.0과 HLM 7(hierarchical linear model)을 이용하였다. 연구결과: 개인 건강행태 및 지역 보건의료수준이 고혈압 치료순응에 미치는 관련성 연구에서 건강행태 및 지역의 보건의료수준에 따라, 치료순응에 미치는 영향이 크다는 것을 알 수 있었다. 결론: 본 연구에서는 지역보건의료 수준의 변수들의 교차비가 높지는 않았지만, 개인수준의 변이에 초점을 맞춘 기존연구와는 달리 지역보건의료수준의 변이를 찾을 수 있었다는데 의의가 있었으며, 추후 많은 연구에서 지역수준을 고려한 다수준 분석이 필요할 것으로 사료된다.