• Korean Journal of Health Education and Promotion
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• v.27 no.1
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• pp.61-69
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• 2010

Objectives: The aim of this study was to examine socioeconomic inequalities in oral health and to investigate the extent to which socioeconomic disparities in oral health are attenuated by oral health related consciousness and behaviors. Methods: We used data from the third 2006 Korea National Oral Health Survey(KNOHS) and a total of 3,457 subjects aged over 18 years were analyzed. The dependent variable was periodontal conditions which is devided into dichotomy, that is, health and ill-health, using the Community Periodontal Index(CPI) in KNOHS. Socioeconomic status(SES) were measured by educational attainment, income and residential area. Age, gender, oral health consciousness(self-assessed oral health status, concern about oral health and self-perceived dental treatment needs and behaviors(brushing, use of dental floss and dental visits) were adjusted in binary logistic regression analysis. Results and Conclusion: The results show that oral health consciousness and behaviors do not mediate the relationship between SES and periodontal health and there might be limitations to attenuate socioeconomic disparities in oral health only by changing of either oral health consciousness or(and) behaviors. Our findings suggest that more definite oral health policies and dental health education among adults with lower education will need in order to improve oral health.

• The Korean journal of internal medicine
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• v.39 no.4
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• pp.668-679
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• 2024

Background/Aims: This cross-sectional study aimed to investigate biologics treatment disparities in rheumatoid arthritis (RA) patients based on socioeconomic status (SES). Methods: Data from the KOrean Observational Study Network for Arthritis (KORONA) database were analyzed to assess various factors associated with SES, health behaviors, and biologics use. Logistic regression and structured equation modeling (SEM) were utilized for data analysis. Results: Among 5,077 RA patients included, 393 (7.7%) patients were identified as biologics users. Within the entire cohort, 31.8% of the participants were in the low-income and low-education groups, and 39.3% of the participants were in the high-income and high-education groups. Despite the patients with low income or low education experienced higher disease activity at diagnosis, had more comorbidities, exhibited higher medication compliance, underwent more check-ups, and had more hospital admissions than their counterparts, the odds of patients with low-income receiving biologics were 34% lower (adjusted odds ratio = 0.76, 95% confidence interval: 0.60-0.96, p = 0.021) after adjustment for demographics and comorbidities. SEM and pathway analyses confirmed the negative impact of low SES on biologics use. Conclusions: The findings suggest that SES plays a significant role in biologics use among RA patients, indicating potential healthcare inefficiencies for low SES patients. Moreover, adverse healthcare habits negatively affect biologics use in RA patients. The study highlights the importance of considering socioeconomic factors while discussing biologics use and promoting equitable access to biologics for optimal RA management.

• Journal of Preventive Medicine and Public Health
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• v.51 no.5
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• pp.219-226
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• 2018

Objectives: This study aimed to explain the health-related quality of life (HRQoL) gap between the poorest and the wealthiest quintiles in the capitals of Kermanshah and Kurdistan Provinces (Kermanshah and Sanandaj), in western Iran. Methods: This was a cross-sectional study conducted among 1772 adults. Data on socio-demographic characteristics, socioeconomic status (SES), lifestyle factors, body mass index, and HRQoL of participants were collected using a self-administered questionnaire. The slope and relative indices of inequality (SII and RII, respectively) were employed to examine socioeconomic inequality in poor HRQoL. Blinder-Oaxaca (BO) decomposition was used to quantify the contribution of explanatory variables to the gap in the prevalence of poor HRQoL between the wealthiest and the poorest groups. Results: The overall crude and age-adjusted prevalence of poor HRQoL among adults was 32.0 and 41.8%, respectively. The SII and RII indicated that poor HRQoL was mainly concentrated among individuals with lower SES. The absolute difference (%) in the prevalence of poor HRQoL between the highest and lowest SES groups was 28.4. The BO results indicated that 49.9% of the difference was explained by different distributions of age, smoking behavior, physical inactivity, chronic health conditions, and obesity between the highest and lowest SES groups, while the remaining half of the gap was explained by the response effect. Conclusions: We observed a pro-rich distribution of poor HRQoL among adults in the capitals of Kermanshah and Kurdistan Provinces. Policies and strategies aimed at preventing and reducing smoking, physical inactivity, chronic health conditions, and obesity among the poor may reduce the gap in poor HRQoL between the highest and lowest SES groups in Iran.

• Journal of Preventive Medicine and Public Health
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• v.50 no.5
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• pp.303-310
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• 2017

Objectives: The aim of this study was to evaluate socioeconomic inequalities in the prevalence of dental caries among an urban population. Methods: This study was conducted among 2000 people 15-40 years of age living in Kurdistan, Iran in 2015. Using a questionnaire, data were collected by 4 trained dental students. The dependent variable was the decayed, missing, and filled teeth (DMF) index. Using principal component analysis, the socioeconomic status (SES) of families was determined based on their household assets. Inequality was measured using the concentration index; in addition, the Oaxaca analytical method was used to determine the contribution of various determinants to the observed inequality. Results: The concentration index for poor scores on the DMF index was -0.32 (95% confidence interval [CI], -0.40 to -0.36); thus, poor DMF indices had a greater concentration in groups with a low SES (p<0.001). Decomposition analysis showed that the mean prevalence of a poor DMF index was 43.7% (95% CI, 40.4 to 46.9%) in the least privileged group and 14.4% (95% CI, 9.5 to 9.2%) in the most privileged group. It was found that 85.8% of the gap observed between these groups was due to differences in sex, parents' education, and the district of residence. A poor DMF index was less prevalent among people with higher SES than among those with lower SES (odds ratio, 0.31; 95% CI, 0.19 to 0.52). Conclusions: An alarming degree of SES inequality in oral health status was found in the studied community. Hence, it is suggested that inequalities in oral health status be reduced via adopting appropriate policies such as the delivery of oral health services to poorer groups and covering such services in insurance programs.

• Health Policy and Management
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• v.19 no.4
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• pp.66-77
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• 2009

This study aims to examine the effect of socioeconomic status (hereafter, SES) on healthcare utilization of the patients with rare and incurable diseases. Information of 2,973 patients who were self-employed insured and utilized healthcare service in 2007 was drawn from the National Health Insurance (hereafter, NHI) claim data. SES was set as four groups based on the monthly contribution. Outcome variable was the expense for outpatient and in-hospital services, which was log-transformed and square-rooted in oder to obtain normal distribution. Covariates included age, gender, residence and diagnosis. To examine the effects after controlling for covariates, we employed generalized estimating equation model, since patients with the same diagnosis are likely to have similar characteristics of demographics and healthcare utilization. Univariate statistics showed that lower SES was associated with less utilization of healthcare services. After controlling for covariates, a significantly smaller amount of money was expended for the lowest SES group compared to the highest one. Rural residence was associated with less utilization, except that residents in Seoul significantly more utilized outpatient services in tertiary hospitals. Considering that there is a subsidy program for the low income patients, such differences in healthcare utilization according to SES seems to result from the burden of out-of-pocket payments for uncovered services of the NHI.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.20 no.3
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• pp.186-193
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• 2017

Purpose: Obesity is one of the most common health problems among children and its prevalence has increased in recent decades. Socioeconomic status (SES) is a well-known risk factor for childhood obesity although the associations were different across countries. Previous studies in other countries have reported a positive association between childhood obesity and SES in developing countries, and inverse correlation has been reported in developed countries. For this reason, we wanted to investigate the relationship between SES and obesity in Korean children. Methods: Data were acquired 3,095 boys and girls who participated in the fifth Korea National Health and Nutrition Examination Survey, which was conducted from 2010 to 2012. Body mass index was calculated from measured anthropometric data using the 2007 Korean National Growth Charts. Results: Upon univariate analysis, we did not find any statistically significant differences in the parental employment status, monthly family income between children with and without obesity. Multiple logistic regression analysis showed childhood obesity was positively associated with maternal overweight (OR, 1.889; 95% CI, 1.079-3.309), maternal obesity (OR, 3.409; 95% CI, 2.228-5.215) and paternal obesity (OR, 2.135; 95% CI, 1.257-3.627). Conclusion: The present study showed that socioeconomic status might not an important risk factor for obesity in Korean children. These results warrant further studies to clarify the association between SES and obesity in Korean children.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.11
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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 the Korea Academia-Industrial cooperation Society
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• v.19 no.7
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• pp.443-452
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• 2018

The purpose of this study was to investigate the utilization behavior of medical services according to the characteristics of socioeconomic status (SES) and prevalence by using the 6th National Health and Nutrition Survey data for adults over 25 years old. Frequency and technical statistical analysis, ANOVA, ${\chi}^2$-test, and regression analysis were performed using SPSS 23.0. The results were as follows: more female than male, 65 years old and over, high school graduate, and unemployed and income quintiles were similar. The SES score considering education level, function, and income quintiles was the highest at 7-8, and most of the respondents felt moderate about their subjective health condition. The mean number of prevalence was $1.07{\pm}1.497$, the mean utilization of outpatient services was $0.50{\pm}0.045$, and the mean number of inpatient services use was $0.12{\pm}0.454$. Depending on general characteristics, there was a significant difference between subjects with prevalence and subjective health conditions. Higher age was associated with lower education, skill level, income, and SES score, and average prevalence was associated with poor subjective health conditions. More serious prevalence was associated with greater utilization of inpatient services. More chronic prevalence was associated with utilization of outpatient services. In other words, higher SES score was associated with lower overall use of medical services. Lower SES score was associated with higher use of medical services. In conclusion, we must develop appropriate health education programs that can prevent diseases in groups with low socioeconomic characteristics. There is the need to construct and implement a community-based appropriate health service system so that proper medical services can be used.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.5
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• pp.2231-2238
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• 2014

This study investigated how self-rated health and socioeconomic status are associated with behaviour of cancer survivors regarding desire for information. For this association, we compared survivors who did not seek information about cancer with those who did. We examined how sociodemographic, socioeconomic, cancerrelated, and health information factors are associated with self-rated health (SRH) by health information seeking/avoiding behavior in a survey of 502 post-treatment cancer patients. In the information seeking group, all four factors exhibited significant relationships with SRH. SRH values were significantly high for women (p<0.05), non-Hispanic White (p<0.05), and educated (p<0.01) participants, and for those who had high self-efficacy to use health information by themselves (p<0.01). Furthermore, in the information avoiding group, not only were there no significant relationships between socioeconomic status (SES) and SRH, but there were negative associations between their attitude/capacity and the SRH. In terms of communication equity, the promotion of information seeking behavior can be an effective way to reduce health disparities that are caused by social inequalities. Information avoiding behavior, however, does not exhibit a negative contribution toward the relationship between SRH and SES. Information seeking behavior was positively associated with SRH, but avoiding behavior was not negatively associated. We thus need to eliminate communication inequalities using health intervention to support information seeking behavior, while simultaneously providing support for avoiders.

• Journal of Preventive Medicine and Public Health
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• v.56 no.1
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• pp.50-58
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• 2023

Objectives: Socioeconomic inequality in metabolic syndrome (MetS) remains poorly understood in Iran. The present study examined the extent of the socioeconomic inequalities in MetS and quantified the contribution of its determinants to explain the observed inequality, with a focus on middle-aged adults in Iran. Methods: This cross-sectional study used data from the Ravansar Non-Communicable Disease cohort study. A sample of 9975 middleaged adults aged 35-65 years was analyzed. MetS was assessed based on the International Diabetes Federation definition. Principal component analysis was used to construct socioeconomic status (SES). The Wagstaff normalized concentration index (CI_n) was employed to measure the magnitude of socioeconomic inequalities in MetS. Decomposition analysis was performed to identify and calculate the contribution of the MetS inequality determinants. Results: The proportion of MetS in the sample was 41.1%. The CI_n of having MetS was 0.043 (95% confidence interval, 0.020 to 0.066), indicating that MetS was more concentrated among individuals with high SES. The main contributors to the observed inequality in MetS were SES (72.0%), residence (rural or urban, 46.9%), and physical activity (31.5%). Conclusions: Our findings indicated a pro-poor inequality in MetS among Iranian middle-aged adults. These results highlight the importance of persuading middle-aged adults to be physically active, particularly those in an urban setting. In addition to targeting physically inactive individuals and those with low levels of education, policy interventions aimed at mitigating socioeconomic inequality in MetS should increase the focus on high-SES individuals and the urban population.