• 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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• 제42권6호
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• pp.392-402
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• 2009

Objectives : The aims of this paper were to develop the composite deprivation index (CDI) for the sub-district (Eup-Myen-Dong) levels based on the theory of social exclusion and to explore the relationship between the CDI and the standardized mortality ratio (SMR). Methods : The paper calculated the age adjusted SMR and we included five dimensions of social exclusion for CDI; unemployment, poverty, housing, labor and social network. The proxy variables of the five dimensions were the proportion of unemployed males, the percent of recipients receiving National Basic Livelihood Security Act benefits, the proportion of households under the minimum housing standard, the proportion of people with a low social class and the proportion of single-parent household. All the variables were standardized using geometric transformation and then we summed up them for a single index. The paper utilized the 2004-2006 National Death Registry data, the 2003-2006 national residents' registration data, the 2005 Population Census data and the 2005-2006 means-tested benefit recipients' data. Results : The figures were 115.6, 105.8 and 105.1 for the CDI of metropolitan areas (big cities), middle size cities and rural areas, respectively. The distributional variation of the CDI was the highest in metropolitan areas (8.9 - 353.7) and the lowest was in the rural areas (26.8 - 209.7). The extent and relative differences of deprivation increased with urbanization. Compared to the Townsend and Carstairs index, the CDI better represented the characteristics of rural deprivation. The correlation with the SMR was statistically significant and the direction of the CDI effects on the SMR was in accordance with that of the previous studies. Conclusions : The study findings indicated mortality inequalities due to the difference in the CDI. Despite the attempt to improve deprivation measures, further research is warranted for the consensus development of a deprivation index.

• Journal of Preventive Medicine and Public Health
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• 제55권4호
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• pp.379-388
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• 2022

Objectives: Throughout history, societies have been impacted by inequality. Many studies have been conducted on the topic more broadly, but only a few have investigated inequalities in out-of-pocket health payments (OHP). This study measures OHP inequality trends among the Iranian households. Methods: This study used data from the Iranian Statistics Center on Iranian household income and expenditures. The analysis included a total of 995 300 households during the 36 years from 1984 to 2019. The Gini coefficient, Atkinson index, and Theil index were calculated for Iranian OHP. Results: Average Iranian household OHP increased from 33 US dollar (USD) in 1984 to 47 USD in 2019. During this 36-year span, the average±standard deviation Gini coefficient for OHP was 0.73±0.04, and the Atkinson and Theil indexes were 0.68±0.05 and 1.14±0.29, respectively. The Gini coefficients for the subcategories of OHP of outpatient diagnostic services, medical assistant accessories, hospital inpatient services, and addiction cessation were 0.70, 0.61, 0.84, and 0.64, respectively. Conclusions: In this study, we scrutinized trends of inequality in the OHP of Iranian households. Inequality in OHP decreased slightly over the past four decades. An analysis of trends among different subgroups revealed that affluent households, such as households with insurance coverage and households in higher income deciles, experienced higher inequality. Therefore, lower inequality in health care expenditures may be related to restricted access to health care services in Iran.

• 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.

• Journal of Hospice and Palliative Care
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• 제24권4호
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• pp.226-234
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• 2021

Purpose: The accessibility of medical facilities for cancer patients affects both their comfort and survival. Patients in rural areas have a higher socioeconomic burden and are more vulnerable to emergency situations than urban dwellers. This study examined the feasibility and effectiveness of a cancer care model integrating a regional cancer center (RCC) and public health center (PHC). Methods: This study analyzed the construction of a safety care network for cancer patients that integrated an RCC and PHC. Two public health institutions (an RCC in Gyeongnam and a PHC in Geochang County) collaborated on the development of the community care model. The study lasted 13 months beginning in February 2019 to February 2020. Results: The RCC developed the protocol for evaluating and measuring 27 cancer-related symptoms, conducted education for PHC nurses, and administered case counseling. The staff at the PHC registered, evaluated, and routinely monitored patients through home visits. A smartphone application and regular video conferences were incorporated to facilitate mutual communication. In total, 177 patients (mean age: 70.9 years; men: 59%) were enrolled from February 2019 to February 2020. Patients' greatest unmet need was the presence of a nearby cancer treatment hospital (83%). In total, 28 (33%) and 44 (52%) participants answered that the care model was very helpful or helpful, respectively. Conclusion: We confirmed that a combined RCC-PHC program for cancer patients in rural areas is feasible and can bring satisfaction to patients as a safety care network. This program could mitigate health inequalities caused by accessibility issues.

• 한국조경학회지
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• 제47권5호
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• pp.78-90
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• 2019

본 연구의 목적은 포용적 도시계획과 재생을 위한 공원녹지 정책의 개발 방향을 모색하는 데 있다. 국내 도시공원의 조성 현황 예산 법률 제도를 검토하고, 도시공원의 포용성 수준을 조사하여 다음과 같은 문제점과 한계를 드러냈다. 첫째, 1인당 공원 면적과 녹지율과 같은 공급자 중심의 지표를 지니는 도시공원 제도는 양적 확충에 초점이 맞춰져 있다. 둘째, 도시공원의 분포는 불균등하고, 공원녹지의 질적 수준은 취약계층 거주지일수록 낮다. 다음으로 영국 중앙정부와 런던, 에든버러, 카디프, 벨파스트, 리버풀 등 다섯 개 지방정부를 중심으로 사회경제적 불평등 완화와 포용성 확대를 위한 공원녹지 정책의 수립 배경과 내용을 분석하여 다음과 같은 특징을 밝혔다. 사회경제적 불평등 해소와 포용적 사회 건설의 필요성에 대한 정부의 인식, 물리적 재개발에서 사회경제적 재생으로 도시재생정책 방향의 변화, 공원녹지와 불평등 건강 웰빙의 상호관계에 대한 조사와 연구가 정책 수립의 배경으로 작용하였다. 그 결과, 영국 국토계획의 목표에 포용적 사회 만들기가 반영되었으며, 여러 지방정부의 공원녹지 정책에 박탈 지역과 취약계층을 중심으로 한 공원녹지 공급과 질적 개선 전략이 포함되었다. 또한 공원 결핍 분석 도구와 공원의 질적 평가 방법이 개발되었다. 이와 함께 각 사업의 지속가능성을 위해 별도의 기금 마련과 매칭 펀드 활용과 같은 다양한 재원 프로그램, 그리고 정부 조직 간 협업 기구 설립과 민간 조직의 적극적인 참여와 활성화와 같은 파트너십 구축 방안이 마련되었다. 이를 바탕으로 본 연구는 공원녹지의 불평등과 포용성에 대한 조사와 연구 수행, 공원서비스의 질적 수준 향상전략 개발, 정책 필요 지역 분석도구 개발, 도시재생을 위한 공원사업 유형 개발, 다양한 파트너십 구축과 지원제도 마련 등, 다섯 가지 정책 방향을 제시하였다.

• Journal of Preventive Medicine and Public Health
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• 제51권1호
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• pp.33-40
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• 2018

Objectives: The aim of this study was to determine the factors associated with the spatial distribution of the incidence of colorectal cancer (CRC) in the neighborhoods of Tehran, Iran using Bayesian spatial models. Methods: This ecological study was implemented in Tehran on the neighborhood level. Socioeconomic variables, risk factors, and health costs were extracted from the Equity Assessment Study conducted in Tehran. The data on CRC incidence were extracted from the Iranian population-based cancer registry. The $Besag-York-Molli{\acute{e}}$ (BYM) model was used to identify factors associated with the spatial distribution of CRC incidence. The software programs OpenBUGS version 3.2.3, ArcGIS 10.3, and GeoDa were used for the analysis. Results: The Moran index was statistically significant for all the variables studied (p<0.05). The BYM model showed that having a women head of household (median standardized incidence ratio [SIR], 1.63; 95% confidence interval [CI], 1.06 to 2.53), living in a rental house (median SIR, 0.82; 95% CI, 0.71 to 0.96), not consuming milk daily (median SIR, 0.71; 95% CI, 0.55 to 0.94) and having greater household health expenditures (median SIR, 1.34; 95% CI, 1.06 to 1.68) were associated with a statistically significant elevation in the SIR of CRC. The median (interquartile range) and mean (standard deviation) values of the SIR of CRC, with the inclusion of all the variables studied in the model, were 0.57 (1.01) and 1.05 (1.31), respectively. Conclusions: Inequality was found in the spatial distribution of CRC incidence in Tehran on the neighborhood level. Paying attention to this inequality and the factors associated with it may be useful for resource allocation and developing preventive strategies in at-risk areas.

• 한국전산구조공학회논문집
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• 제27권6호
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• pp.485-492
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• 2014

자연재해에 있어서 취약성 분석계획의 우선순위 설정활동을 위한 기초자료로서 재해 위험분석의 주요한 요소이다. 화산폭발은 화산이 인구밀도가 높은 지역에 위치하고 있는 경우 많은 사상자와 재산피해를 야기한다. 화산폭발을 막을 수 없지만, 위험도와 취약성은 미래의 위기를 예측하는 신중한 계획과 준비작업을 통해 저감될 수 있다. 사회적 불평등으로서 사회적 취약성은 다양한 사회 구성원이 재해에 대응 능력에 민감한 영향을 미친다. 본 연구에서는 인도네시아 중부 자바에 위치한 메라피 화산 인근 지역주민들의 사회적 취약성을 평가하기 위하여 사회적 취약성 지수(SoVI) 기법을 활용하였다. SoVI는 사회적 위험부담을 이해하고 정량화하기 위하여 지역사회의 복원탄력성에 영향을 미치는 사회 경제적 및 인구 통계학적 요인을 이용하여 평가된다. 본 연구에서 사회적 취약성은 이해 관계자와 지역주민과의 설문조사를 통해 평가되었다. 연구결과로 도출된 취약성 지수는 사회적 취약성의 분포와 원인에 대한 정보를 반영함을 확인하였다.

• 대한보건연구
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• 제44권4호
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• pp.51-65
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• 2018

연구목적: 장애인에게 흡연은 이차장애(secondary conditions) 발생 위험 요인을 증가시킬 수 있고 이는 일차장애와 역으로 상호작용 할 수 있어 기존의 장애를 더욱 악화시킬 수 있다. 신체적 조건이 취약한 장애인의 경우 흡연, 음주, 비만, 스트레스 등의 위험요인이 비장애인에 비하여 장애인의 삶에 결정적인 영향을 미칠 수 있기 때문에 금연을 위한 보다 적극적인 중재가 필수적이다. 연구방법: 본 연구에서는 질병관리본부에서 실시한 국민건강영양조사 제6기 1차(2013)에 참여한 만 19세 이상 흡연자중 장애유무에 따라 장애인, 비장애인으로 구분하였으며 장애인 299명, 비장애인 4,260명을 최종대상자로 선정하였다. 연구결과: 현재흡연율은 장애인의 경우 흡연자가 21.4%, 비장애인이 21.5%로 비슷한 흡연율을 보였다. 장애인의 현재흡연율에 영향을 미치는 요인은 단독가구 유무, 가구소득, 주택소유여부, 음주량, 폭음빈도, 활동제한여부였다. 결론: 흡연의 사회경제적 불평등을 줄이고 장애인에게 적극적인 정책적 개입을 위해 본 연구결과가 근거자료로서 사용될 수 있을 것이라 생각되며 흡연관련 정책 시행 시 장애인에 초점을 맞춘 새로운 접근 전략 또한 필요할 것이라 사료된다.