• 보건행정학회지
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• 제31권1호
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• pp.114-124
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• 2021

Background: In this study, we aimed to investigate the interaction effects of individual socioeconomic status and regional deprivation on the onset of diabetes complications and diabetes-related hospitalization among type 2 diabetes patients. Methods: Korean National Health Insurance Service National Sample Cohort data from 2002 to 2013 were used. A total of 50,954 patients newly diagnosed with type 2 diabetes from 2004 to 2012 and aged 30 years or above were included. We classified patients into six groups according to individual income level and neighborhood deprivation: 'high in advantaged,' 'high in disadvantaged,' 'middle in advantaged,' 'middle in disadvantaged,' 'low in advantaged,' and 'low in disadvantaged.' We calculated hazard ratios (HR) of onset of diabetes complication and diabetes-related hospitalization using the Cox proportional hazard model, with the reference group as diabetes patients with high income in advantaged regions. Results: In terms of the interaction effects of individual income level and regional socioeconomic level, even with the same low individual income level, the group with a high regional socioeconomic level (low in advantaged) showed low HRs for the onset of diabetes complication (HR, 1.04; 95% confidence interval [CI], 1.00-1.08) compared to the 'low in disadvantaged' group (HR, 1.10; 95% CI, 1.05-1.16). In addition, the 'high in advantaged' group showed slightly higher HRs for the onset of diabetes complication (HR, 1.06; 95% CI, 1.00-1.11) compared to the 'low in advantaged' and it appeared to be associated with slight mitigation of the risk of diabetes complication. For the low-income level, the patients in disadvantaged regions showed the highest HRs for diabetes-related hospitalization (HR, 1.29; 95% CI, 1.19-1.41) compared to the other groups. Conclusion: Although we need to perform further investigations to reveal the mechanisms that led to our results, interaction effects individual socioeconomic status and regional deprivation might be associated with on onset of diabetes complications and diabetes-related hospitalization among type 2 diabetes patients.

• Journal of Nutrition and Health
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• 제44권5호
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• pp.416-427
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• 2011

본 연구는 부모의 사회경제적 수준과 초등학교 6학년 자녀의 과체중 위험도, 식습관, 식사 질과의 관계에 대하여 알아보고자 하였으며 그 결과는 다음과 같다. 1) 어머니 교육수준이 낮은 여학생 집단이 비교 집단에 비해 과체중의 위험도가 1.91배 높았다. 하지만 남학생의 경우에는 과체중 위험도와 사회경제수준 간에 유의성이 없었다. 2) 남녀 모두 수입 및 부모의 교육수준이 낮은 집단에서 과일류 섭취량이 유의적으로 낮은 것으로 나타났으며, 여학생의 경우 이와 함께 가구 월수입 및 부모의 교육수준이 낮은 집단에서 어패류의 섭취량도 유의적으로 낮았다. 3) 1일 평균 영양소 섭취량을 비교한 결과 여학생의 경우 가구 월수입 및 부모의 교육수준이 낮은 집단에서 총 섭취량과 식물성 식품의 섭취가 유의적으로 낮았으며, 이와 함께 탄수화물, 비타민 C, 칼륨, 식이 섬유의 섭취도 유의적으로 낮게 나타났다. 4) 여학생의 경우 아버지의 교육수준이 낮은 집단에서 높은 집단 보다 탄수화물을 통하여 섭취하는 에너지의 비율은 낮았던 반면, 지방의 비율은 유의적으로 높았다. 하지만 남학생의 경우 가구 월수입 및 부모의 교육수준에 따른 열량 및 영양소 섭취량에서 유의적인 차이가 없었다. 5) 가구 월수입 및 부모의 교육수준이 낮은 집단에서 EAR 미만으로 영양소를 섭취하는 대상자 비율이 높았다. 남학생은 월수입이 낮은 집단에서 나이아신, 철분 섭취가 EAR 보다 부족한 학생비율이 높았으며, 부모의 교육수준에 따라서는 유의적인 차이가 없었다. 여학생은 사회경제적 수준이 낮은 집단에서 인의 섭취가 EAR 미만인 대상자가 비율이 유의적으로 높았고, 이와 함께 부모 교육수준이 낮은 집단에서 나이아신과 비타민 B6의 섭취량이 EAR 보다 부족한 비율이 높았다. 6) 여학생의 경우 가구 월수입에 따른 비교에서 가구 월수입이 낮은 집단에서 라면의 섭취 빈도가 높은 것으로 나타났으며, 부모의 교육수준에 따른 비교에서는 교육수준이 낮은 집단에서 남녀 모두 아침 식사 결식 횟수가 높고, 라면의 섭취 빈도가 높은 것으로 나타났다. 7) 여학생의 경우 가구 월수입 및 부모의 교육수준이 낮은 집단에서 식품섭취 다양성과 균형성이 모두 비교 집단에 비하여 낮게 나타났다. 하지만 남학생의 경우 가구 월수입 및 부모의 교육수준에 따른 유의적인 차이가 관찰되지 않았다. 본 연구를 통하여 부모의 사회경제적 수준은 여학생의 식습관과 식사의 질에 영향을 미치는 것으로 나타났다. 부모의 낮은 사회경제적 수준은 자녀의 바람직하지 않은 식습관과 낮은 식사의 질과 관련되어 있었으며, 이는 영양소 섭취량에도 영향을 미치고 있었다. 또한 어머니 교육수준은 여학생의 과체중 위험도에 영향을 미치는 것으로 나타났다. 따라서 사회경제적 수준이 낮은 집단에 대한 건강한 식습관과 체중 관리를 위한 교육 및 영양 정책이 필요하다.

• 보건행정학회지
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• 제24권2호
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• pp.172-180
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• 2014

Background: People with disabilities have higher prevalence rates and earlier onset of chronic disease than the non-disabled; therefore, their participation in health screening is important. This study evaluates the participation rate and trends in health screening of people with disabilities, and examines the association between their participation rate and disability characteristics, and socioeconomic status. Methods: Data on disability-related characteristics were collected from the National Disability Registry, and participants' corresponding health examination data were taken from the Korean National Health Insurance Corporation between 2002 and 2011. A total of 873,819 participants aged ${\geq}20$ years were analyzed in this study. Results: The rate of participation of people with disabilities in health screening has increased each year, but their participation rate is lower than that of the total population. The participation rate was lower in females than in males; the elderly group than in the younger group; those who live in city areas than rural areas; self-employed for health insurance than employees; those with an internal organ disability than those with an external physical disability; those with a severe disability than those with a mild disability; and those with a short-term disability than for those with a long-term disability. Conclusion: The factors associated with participation rate are age, sex, socioeconomic status, and disability characteristics. These findings indicate that health check-ups of people with disabilities should be promoted using an approach that takes into account the large individual differences in socioeconomic status and disability characteristics in this population.

• 보건행정학회지
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• 제7권1호
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• pp.155-182
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• 1997

Objectives : This study was designed to compare North Korea and South Korea in measures of the quality of life (physical quality of life index and human development index) and to investigate the impact of selected medical and socioeconomic factors on PQL variables. Data and Methods : The World Bank, the United Nations Development Programme, and Population Reference Bureau were the principal sources of statistical data of 121 countries. Variables included infant mortality, life expectancy at birth, literacy rate, secondary school enrollment (male and female), GNP per capita, population per doctor, daily calorie supply per capita, and a composite PQL index. The Ordinary Least Square model was employed for cross-countries analysis. Findings : Both countries under quite different political and economic systems saw big improvememts in the quality of life, reducing mortality and prolonging life expectancy during the past three decades. In recent decad, however, North Korea has experienced abrupt exacerbation in the quality of life. Significant improvements in infant mortality of the population wer attributable mainly to GNP per capita and the secondary school enrollemt of female. The principal predictors of life expectancy at birth were population per doctor, infant mortality, and literacy rate. The secondary school enrollment of female and population per doctor were significantly associated with improvements in the physical quality of life index (PQLI). Conclusion : The results of this study confirmed a point illustrated by other studies : The association between quality of life as a measure of health status and socioeconomic factors was strong and positive. The important contribution of educational attainment in general, female education level in particular to improvements in the quality of life deserves good news for building an integrated health care system in the reunified Korea, taking into account the high level of education two koreas are enjoying. Meanwhile, when a sharp drop in the quality of life has been observed in North Korea under serious economic difficulties and food shortage in recent decade, the significant contribution of economic development to improvements in the quality of life poses bad nows for reunifying Korean health care in economic terms.

• Journal of Preventive Medicine and Public Health
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• 제50권5호
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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.

• Journal of Preventive Medicine and Public Health
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• 제45권3호
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• pp.164-173
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• 2012

Objectives: Over the past several years, the incidence of hepatitis A infection has been increasing rapidly in the young-adult population in Korea. We examined the effects of area-level socioeconomic status and environmental hygiene on the incidence of hepatitis A. Methods: This study is based on the registered national population of Korea and the national health insurance data from 2004 to 2008. A total of 73 459 individuals were confirmed to have had hepatitis A. The standardized incidences of hepatitis A in 232 districts adjusted for sex and age of people were calculated for each year, and the rate ratios of the incidence rates were estimated according to area-level socioeconomic status and environmental hygiene using multiple Poisson regression models. Results: The incidence rates of hepatitis A infection were 15.6 (per 100 000) in 2004, 19.0 (per 100 000) in 2005, 27.2 (per 100 000) in 2006, 25.1 (per 100 000) in 2007, and 61.7 (per 100 000) in 2008. The analysis of the area-level effects showed that residential areas of the less deprived than other regions, areas with higher levels of education, and heavily populated areas were significantly associated with increased risk. Conclusions: There is a very strong possibility that both area-level socioeconomic status and environmental hygiene play a role in increasing the risk of hepatitis A infection in Korea. Therefore, to reduce hepatitis A infection, we need a nationwide strategy that considers these area-level characteristics.

• 치위생과학회지
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• 제17권3호
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• pp.250-256
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• 2017

The purpose of this study was to examine the influence of maternal socioeconomic status, maternal oral health behaviors, and oral health behaviors of children, on the prevalence of early childhood caries in children aged 5 years. The Korean National Health and Nutrition Examination Survey data collected between 2007 and 2014 were applied to this study, and the study sample included 824 children who received oral examinations and participated in the health behavior survey. The factor that affected the prevalence of early childhood caries were confirmed by maternal and child factors. The data were analyzed using multiple linear regression. The mothers' age, income level, and job status affected the prevalence of early childhood caries. There was a significant difference in the analysis considering the factors of motherhood and children in the prevalence of early childhood caries according to mother's age, education level, income level, and the child's oral examination. The prevalence of early childhood caries was higher in children who received oral examinations than in those who did not. When the mother's educational level was higher than college education, it was found that the index of child, i.e., there was a difference in the prevalence of early childhood caries according to the mother's educational and income levels. These results indicate that maternal socioeconomic characteristics are correlated with the oral health of children. Therefore, oral health education programs that include mothers for the prevention of early dental caries in children may improve the dental health of children. In addition, specific oral health policies are necessary to address the differences in the oral health between the income groups.

• 보건행정학회지
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• 제19권4호
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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.

• Asian Pacific Journal of Cancer Prevention
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• 제15권2호
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• pp.589-594
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• 2014

Few studies have examined reasons why those with low socioeconomic status do not adequately receive cancer screening. We therefore conducted a qualitative study to assess the barriers to cancer screening in people with low socioeconomic status, and to examine the reasons why Medical Aid Program (MAP) recipients do not participate in the National Cancer Screening Program (NCSP). A focus group methodology was used. Participants included MAP recipients (men aged 45-79 years, women aged 35-79 years) who had been invited to cancer screening at least twice based on the NCSP protocol, but had not been screened for any cancer from 2009-2012. We recruited participants living in the cities of Goyang and Paju. A total of 23 MAP recipients participated in four focus group discussions, including 12 men and 11 women. In this qualitative study, we identified six barriers to screening: lack of trust in the NCSP and cancer screening units; fear of being diagnosed with cancer; discomfort or pain from the screening procedure; lack of time, lack of knowledge about cancer screening or lack of awareness of the existence of the NCSP; physical disability or underlying disease; and logistic barriers. Interventions such as individualized counseling, letters and reminders, or other individually-targeted strategies, especially for those with lower socioeconomic status are required to increase participation and reduce disparities in cancer screening.

• 한국콘텐츠학회논문지
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• 제16권3호
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• pp.596-606
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• 2016

본 연구의 목적은 우리나라 청소년에서 천식, 알레르기 비염 및 아토피 피부염을 포함하는 알레르기 질환의 유병 영향요인을 파악하고자 하는 것이다. 본 연구는 제10차(2014년)청소년건강행태 온라인조사의 원시자료를 이용하였으며, 만 12-18세 청소년 총 72,060명을 연구대상자로 선정하였다. 알레르기 질환 유병 영향요인을 파악하기 위해 로지스틱 회귀분석 결과 모든 변수가 보정된 상태에서 천식은 성별, 연령, 체질량지수, 주관적 경제상태, 흡연 및 주관적 스트레스 인지가 알레르기 비염은 연령, 도시규모, 주관적 경제상태, 음주 및 주관적 스트레스 인지가 아토피 피부염은 성별, 연령, 주관적 경제상태, 음주 및 주관적 스트레스 인지가 알레르기 질환 유병 영향요인으로 나타났다. 따라서 앞으로 청소년의 알레르기 질환에 악영향을 미치는 흡연과 음주와 같은 생활습관들의 규제정책 강화, 포괄적인 예방교육 및 스트레스 관리가 국가적 측면에서 시행될 필요가 있다.