• Asian Pacific Journal of Cancer Prevention
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• v.16 no.17
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• pp.7401-7407
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• 2015

Cervical cancer continues to be a serious public health problem in the developing world, including China. Because of its large population with geographical and socioeconomic inequities, China has a high burden of cervical cancer and important disparities among different regions. In this review, we first present an overview of the cervical cancer incidence and mortality over time, and focus on diversity and disparity in access to care for various subpopulations across geographical regions and socioeconomic strata in China. Then, we describe population-based cervical cancer screening in China, and in particular implementation of the National Cervical Cancer Screening Program in Rural Areas (NACCSPRA) and the challenges that this program faces. These include low screening coverage, shortage of qualified health care personnel and limited funds. To improve prevention of cervical cancer and obtain better cancer outcomes, the Chinese government needs to urgently consider the following key factors: reducing disparities in health care access, collecting accurate and broadly representative data in cancer registries, expanding target population size and increasing allocation of government funding for training of personnel, improving health education for women, enhancing quality control of screening services and improving a system to increase follow up for women with positive results.

• Nutrition Research and Practice
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• v.14 no.6
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• pp.679-690
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• 2020

BACKGROUND/OBJECTIVES: Concerns about regional disparities in heathy eating and nutritional status among South Korean adults are increasing. This study aims to identify the magnitude of regional disparities in diet and nutritional status among Korean adults who completed the 2017 Korea National Health and Nutrition Examination Survey (KNHANES). SUBJECTS/METHODS: The participants were a nationally representative sample of Korean adults aged 19 years and older from the 2017 KNHANES (n = 6,126). We employed the svy commands in STATA to accommodate the complex survey design. The relative concentration index (RCI), absolute concentration index (ACI) and index of disparity were used to measure regional nutritional inequalities. RESULTS: Overweight and obese adults were more prevalent among the poor than among the rich in urban areas (RCI = -0.041; P < 0.05), while overweight and obese adults were more prevalent among the rich than among the poor in rural areas of South Korea (RCI = 0.084; P < 0.05). Economic inequality in fruit and vegetable intake ≥ 500 g per day was greater in rural areas than in urban areas in both relative size (RCI = 0.228 vs. 0.091, difference in equality = 0.137; P < 0.05) and absolute size (ACI = 0.055 vs. 0.023, difference in equality = 0.032; P < 0.05). CONCLUSIONS: This study provides useful information identifying opposite directions in the relative concentration curves between urban and rural areas. Adult overweight/obesity was more prevalent among the poor in urban areas, while adult overweight/obesity was more prevalent among the rich in rural areas. Public health nutrition systems should be implemented to identify nutritional inequalities that should be targeted across regions in South Korea.

• Nutrition Research and Practice
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• v.14 no.5
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• pp.519-531
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• 2020

BACKGROUND/OBJECTIVES: Regional disparities in dietary factors might be related to regional disparities in cardiometabolic health. Therefore, this study investigated the associations of cardiometabolic risk factors and dietary factors with regional types in Korean adults. SUBJECTS/METHODS: Based on data from the 2007-2017 Korea National Health and Nutrition Examination Survey, the study included 39,781 adults aged ≥ 19 years who completed the dietary survey and a health examination. Healthy and unhealthy dietary factors (fat, sodium, fruit, and vegetable intakes) were evaluated using 1-day 24-h dietary recall method, as well as the use of nutrition labels with a questionnaire. RESULTS: Of the participants, 48.7%, 36.0%, and 15.2% lived in metropolitan, urban, and rural areas, respectively. Adults living in urban and rural had higher odds ratios (ORs) for obesity (OR for urban, 1.07; 95% confidence interval (CI), 1.01-1.14; OR for rural, 1.14; 95% CI, 1.05-1.24) than adults living in metropolitan areas; these associations were significantly observed in middle-aged adults. Compared to metropolitan residents, rural residents had lower ORs for hypertension in middle-aged (OR, 0.86; 95% CI, 0.76-0.96) and metabolic syndrome in older adults (OR, 0.78; 95% CI, 0.67-0.91). Regarding urban residents, a lower OR for diabetes in middle-aged adults (OR, 0.85; 95% CI, 0.74-0.97) and a higher OR for hypertension in older adults (OR, 1.19; 95% CI, 1.02-1.39) were observed. Overall rural residents had higher ORs of excessive carbohydrate, low fruit, and high salted-vegetable intakes than metropolitan residents. Low fruit intake was positively associated with obesity, metabolic syndrome, and hypertension, after adjustment for regional type and other confounders in total participants. CONCLUSIONS: These findings indicate that cardiometabolic risk and unhealthy dietary factors differ among regional types and age groups within Korea. Nutritional policy and interventions should consider regional types for prevention and management of cardiometabolic risk factors.

• Health Policy and Management
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• v.33 no.2
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• pp.118-128
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• 2023

Background: Personal socio-economic abilities are crucial as it affects health inequalities. These multidimensional inequalities across the regions have been structured and fixed. This study aimed to analyze health vulnerabilities by regional cluster and identify regional health disparities of self-rated health, using nationally representative cross-sectional data. Methods: This study used personal and regional data. Data from the Community Health Survey 2021 were analyzed. K-means cluster analysis was applied to 250 si-gun-gu using administrative regional data. The clusters were based on three areas: physical environment, health-related behaviors and biological factors, and the psychosocial environment through the conceptual framework for action on the social determinants of health. And binary logistic regression analyses were conducted to examine the differences in self-rated health status by the regional clusters, controlling human biology, environment, lifestyle, and healthcare organization factors. Results: The most vulnerable group was group 3, the moderate vulnerable group was group 1, and the least vulnerable group was group 2. The group 2 was more likely to have high self-rated health status than the moderate vulnerable group (odds ratio [OR], 1.023; p<0.001). And the group 3 showed low self-rated health status than the moderate vulnerable group (OR, 0.775; p<0.001). However, the moderate vulnerable group had significantly higher self-rated health status than the most vulnerable group (group 2: OR, 1.023; p<0.001; group 3: OR, 0.775; p<0.001). Conclusion: These results demonstrate that community members' health status is influenced by regional determinants of health and individual levels. And these contribute to understanding the importance of specific and differentiated interventions like locally tailored support programs considering both individual and regional health determinants.

• Safety and Health at Work
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• v.8 no.4
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• pp.402-406
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• 2017

Transit workers constitute a blue-collar occupational group that have elevated smoking rates relative to other sectors of employed adults in the United States. This study analyzed cross-sectional tobacco survey data from 935 workers (60% African American; 37% female) employed at an urban public transit agency in California. Prevalence of current and former smoking was 20.3% and 20.6%, respectively. Younger workers were less likely than older workers to be current or former smokers. Having a complete home smoking ban was associated with decreased likelihood of being a smoker [odds ratio (OR) = 0.04, 95% confidence interval (CI) = 0.01-0.17], as were neutral views about whether it is easy for a smoker to take a smoking break during their shift (OR = 0.50, 95% CI 0.28-0.88). Current smoking among the sample is > 50% higher than the adult statewide prevalence. Potential points of intervention identified in this study include perceived ease of worksite smoking breaks and establishing home smoking bans. Tailored cessation efforts focusing on older transit workers more likely to smoke are needed to reduce tobacco-related disparities in this workforce.

• Health Policy and Management
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• v.33 no.3
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• pp.325-337
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• 2023

Background: While there are many studies estimating the effects of private health insurance on various types of health care utilization, few have examined how such effects change in conjunction with important policy reforms in national health insurance (NHI). This study examined how the effect of private health insurance (supplemental and fixed cash benefit) on high-cost outpatient imaging test utilization changed following the expansion of magnetic resonance imaging (MRI) coverage in 2018, which is a key example of the NHI benefit expansion policy in recent years. Methods: Data from the 2017 and 2019 Korea Health Panel Survey, which contained information about healthcare utilization before and after the expansion of MRI coverage in 2018, were used. The incremental effect of private health insurance on high-cost outpatient imaging test utilization for each period were quantified and compared, with special attention given to the type of private health insurance. Results: While people with supplemental private health insurance were more likely to use high-cost outpatient imaging tests than those without, both before and after the expansion of MRI coverage, the incremental effect increased from 1.6% points in 2017 to 2.5% points in 2019. Conclusion: Benefit expansion in NHI does not necessarily reduce disparities in the use of health care between private health insurance subscribers and non-subscribers. The results of our study also suggest that the path through which private health insurance affects healthcare utilization may not be limited to the price mechanism alone but can be more complex.

• Korean Journal of Community Nutrition
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• v.11 no.6
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• pp.808-813
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• 2006

Until now, South Korea does not have either fortification or enrichment program as intervention tools although the addition of micronutrients to foods is for the most part not regulated. The aim of this study was to determine which scenario would most effectively reduce the proportion of the population with low iron intake while not putting other population groups at risk of excessive intakes. In order to investigate potential dietary consequences of iron fortification we analyzed 2 day dietary record data (n=3,955) from the 2001 National Nutrition Surveys. The Proportion of the population consuming dietary iron less than the estimated average requirement (EAR) ranged from $12.4{\sim}87.5%$ depending upon gender and age group. Iron fortification at the level of 100% of Recommended Intake (RI) per 100g to breads and instant o. dried noodles was estimated to result in a 15% decrease of proportion of those with iron less than EAR, while putting 1.4 % of the population greater than the Upper Limit (UL). Iron fortification appeared to be the most effective for the $15{\sim}19$ year old age group, showing 39% reduction of iron intake insufficiency. The results suggest that carefully designed fortification or enrichment to staple foods may contribute to increase dietary iron intakes of Koreans, especially for the young population with a high prevalence of iron inadequacy. As the estimation in this study was based solely upon dietary intake data, iron intake from supplements should be considered in further studies.

• The Journal of Korean Academic Society of Nursing Education
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• v.22 no.2
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• pp.220-227
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• 2016

Purpose: This study aimed to understand current global health education and suggest its future direction for Korean undergraduate nursing students. Methods: After reviewing literature to identify key concepts applicable to global health nursing curricula, the authors analyzed global health curricula from 98 nursing colleges by using a framework that was developed for this study. Results: Among the 201 nursing colleges, 98 (48.8%) schools offered one or more global health-related courses. The titles of these courses were divided into two categories: Multiculturalism and international nursing. Multicultural courses were offered mainly for freshmen (40.5%) or sophomore students (40.5%), whereas international nursing courses were offered mainly for senior students (35.9%). These courses trained nursing students to be culturally competent in providing nursing care for immigrants or foreign travelers living in South Korea. Conclusions: It is evident that interest in global health education is growing in South Korea. However, the scope and content of global health education needs to be broadened beyond multiculturalism and international nursing so that it can prepare nursing students to promote global health equity, reduce global health disparities, and work competently with globally-focused organizations.

• Journal of Preventive Medicine and Public Health
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• v.40 no.5
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• pp.345-350
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• 2007

Objectives: To determine the disparity in the rate people undergo health examinations according to socioeconomic position (SEP) and the changes in this disparity with time. Methods: Seoul citizens' health profile data from 1997 to 2005 were analyzed. The study subjects were 40 years old and over, and the total number of subjects was 6,601 in 1997, 8,994 in 2001, and 8,819 in 2005. Those aged 60 years and over were eliminated from the analysis of subjects' occupation. We used education, family income and occupation as indicators of SEP. The age-standardized health examination attendance rate for each year was calculated according to the education, family income and occupation. The odds ratios (ORs) from multiple logistic regressions were adjusted for age. Results: The disparity in the rate of attendance according to the SEP decreased from 1997 to 2005 but still existed. Even though the disparities among the subgroups according to education, family income and occupation were not that high, the disparity between the group with the highest SEP and the other groups was considerable. Conclusions: Our findings suggest that unequal access to health examination services according to socioeconomic position still exists. This disparity has decreased recently but the disparity according to level of education was the greatest.

• Health Policy and Management
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• v.25 no.4
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• pp.285-294
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• 2015

Background: Suicide is one of important health problems in Korea. Previous studies showed factors associated with suicide in individual levels. However, suicide was influenced by society that individuals belong to, so it was required to analyze suicide in local levels. The purpose of this study was to analyze the regional disparities of suicide mortality by gender and the association between local characteristics and suicide mortality. Methods: This study included 229 city county district administrative districts in Korea. Age- and sex-standardized suicide mortality and age-standardized suicide mortality (male/female) were used as dependent variables. City county district types, socio-demographics (number of divorces per 1,000 population, number of marriages per 1,000 population, and single households), financial variable (financial independence), welfare variable (welfare budget), and health behavior/status (perceived health status scores and EuroQol-5 dimension [EQ-5D]) were used to represent the local characteristics. We used hot-spot analysis to identify the spatial patterns of suicide mortality and negative binomial regression analysis to examine factors affecting suicide mortality. Results: There were differences in distribution of suicide mortality and hot-spot regions of suicide mortality by gender. Negative binomial regression analysis provided that city county district types (city), number of divorces per 1,000 population, financial independence, and EQ-5D had significant influences on the age- and sex-standardized suicide mortality per 100,000. Factor influencing suicide mortality was the number of divorces per 1,000 population in both male and female. Conclusion: Study results provided evidences that suicide mortality among regions was differed by gender. Health policy makers will need to consider gender and local characteristics when making policies for suicides.