• Asian Pacific Journal of Cancer Prevention
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• 제16권17호
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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.

• Asian Pacific Journal of Cancer Prevention
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• 제17권1호
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• pp.347-352
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• 2016

Background: This study used receiver operating characteristic curve to analyze Surveillance, Epidemiology and End Results (SEER) adenosquamous carcinoma data to identify predictive models and potential disparities in outcome. Materials and Methods: This study analyzed socio-economic, staging and treatment factors available in the SEER database for adenosquamous carcinoma. For the risk modeling, each factor was fitted by a generalized linear model to predict the cause specific survival. An area under the receiver operating characteristic curve (ROC) was computed. Similar strata were combined to construct the most parsimonious models. Results: A total of 20,712 patients diagnosed from 1973 to 2009 were included in this study. The mean follow up time (S.D.) was 54.2 (78.4) months. Some 2/3 of the patients were female. The mean (S.D.) age was 63 (13.8) years. SEER stage was the most predictive factor of outcome (ROC area of 0.71). 13.9% of the patients were un-staged and had risk of cause specific death of 61.3% that was higher than the 45.3% risk for the regional disease and lower than the 70.3% for metastatic disease. Sex, site, radiotherapy, and surgery had ROC areas of about 0.55-0.65. Rural residence and race contributed to socioeconomic disparity for treatment outcome. Radiotherapy was underused even with localized and regional stages when the intent was curative. This under use was most pronounced in older patients. Conclusions: Anatomic stage was predictive and useful in treatment selection. Under-staging may have contributed to poor outcome.

• Journal of Preventive Medicine and Public Health
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• 제55권4호
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• pp.371-378
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• 2022

Objectives: No studies have examined the association between preterm birth rates and socioeconomic factors in Japan using nationwide statistical data. We analyzed the association between preterm birth rates and household occupation using Vital Statistics data. Methods: Aggregated Vital Statistics data from Japan from 2007 to 2019 were obtained from the Ministry of Health, Labour and Welfare. From the data, the number of births according to year, age group, gestational period, number of pregnancies, and household occupation were used in this study. Crude preterm birth rates and preterm birth rates adjusted by maternal age according to household occupation were calculated for each year. Poisson regression analysis was conducted to evaluate the association between household occupation and preterm births. Results: Unemployed households had the highest preterm birth rate, and households with an occupation classification of "full-time worker 2" (an employee at a large company, civil servant, or board member) had the lowest preterm birth rate throughout each period. Poisson regression analysis revealed that unemployed households were statistically significantly associated with a high preterm birth risk. In contrast, the preterm birth rate adjusted by maternal age remained stable throughout each period regardless of household occupation, and preterm birth rates were found not to have increased in recent years in Japan. Conclusions: Unemployed households had higher preterm birth rates than other household occupations. Further studies investigating the characteristics of unemployed households are needed to identify the reasons for this disparity.

• 보건의료산업학회지
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• 제6권4호
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• pp.13-25
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• 2012

There is growing evidence that substance use such as tobacco or alcohol consumption influences health disparity among adolescents. Previous research papers have shown an inconsistency in the relationship between socio-economic status (SES) and substance use in adolescents. However, little is known about socio-economic differences in unhealthy behaviors among Korean adolescents. The purpose of the present study is to explore associations between SES and substance use in Korean adolescents. The analysis was performed using data from the 2009 Korean Youth Risk Behavior Web-based Survey (YRBS), which included a nationally representative sample of middle and high school students. Drinking/heavy drinking and smoking/daily smoking behavior indices were used for dependent variables, and perceived economic status, family affluence score, parents' education were used for independent variables. Chi-square test were used to compare tobacco and alcohol consumption among 3 SES groups. Logistic regression models were used to identify statistically significant socio-economic factors after adjusting other covariates. Higher perceived economic status and higher family affluence were associated with higher rates of smoking, daily smoking, drinking, and heavy drinking, while lower level of parents' education was related to higher use of tobacco and alcohol. Socio-economic status significantly influences health behaviors in adolescents, and it may consequently affect health disparity in their adulthood. Therefore, there is a need of continuous monitoring and follow-up research of health disparity among adolescents.

• 지역연구
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• 제36권3호
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• pp.3-16
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• 2020

도시 내 공간적 불평등은 꾸준한 관심을 받고 있는 연구주제다. 그러나 공간적 불평등이 주민에게 미치는 세부적인 영향과 공간적 불평등이 지속되고 재생산되는 방식에 대한 실증연구는 제한적이다. 본 연구는 공간적 수준에서의 박탈을 나타내는 개념인 지역박탈이 주민의 계층상승 가능성에 대한 인식에 미치는 영향을 확인하고자 하였다. 2015년 서울서베이 자료를 순서형 로지스틱 다층모형을 활용하여 분석한 결과, 지역박탈 수준이 높은 지역에 거주하는 주민일수록 자신의 계층상승 가능성을 부정적으로 인식하는 것으로 나타났다. 본 연구결과는 지역박탈이 주민의 계층상승에 대한 믿음을 저해함으로써 삶의 만족도와 기회 실현을 저해하는 것은 물론 지역 격차가 지속되는 데에 영향을 미칠 수 있음을 시사한다. 이와 같은 분석결과는 공간적 불평등을 해소하기 위한 도시정책에 함의를 제공할 수 있을 것으로 기대된다.

• 치위생과학회지
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• 제14권2호
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• pp.207-213
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• 2014

본 연구는 국민건강영양조사 5기(2010~2012년) 원시자료를 이용하여 사회경제적 수준에 따른 주관적 구강건강 상태의 차이와 관련성을 분석하기 위하여 실시되었다. 주관적 구강건강 수준을 '좋다'와 '나쁘다'로 분류하여 사회경제적 수준이 건강불평등에 미치는 요인을 분해하여 다음과 같은 결과를 얻었다. 주관적 구강건강 상태는 남자에 비해 여자가 구강건강을 좋지 않다고 인식하는 것으로 나타났으며, 연령 증가 시 본인의 구강건강을 나쁘게 인식하는 것으로 분석되었다. 또한 교육수준이 낮을수록, 가구소득이 낮을수록 주관적 구강건강상태를 나쁘다고 자가 평가하는 경향을 보였다. 로지스틱회귀분석을 활용하여 주관적 구강건강 상태에 대한 영향 요인을 분석한 결과 사회계층에 따른 건강상의 차이는 남자에 비해서 여자에서 자신의 구강건강수준을 더 건강하게 인지할 확률이 높아지고 있으며 교육수준이 높을수록 건강하게 인지할 가능성이 높았다. 소득수준에 따른 주관적 건강수준에 대한 인식의 격차는 소득증가에 따라 더 심화되는 것으로 나타났다. 이상의 연구결과를 살펴보면 구강건강에 사회계층별 불평등은 존재하는 것으로 나타났다. 전체 국민의 구강건강을 증진하는 사업은 물론 사회 양극화에 따른 사회계층별 구강건강의 격차를 해소하기 위해 상대적으로 격차가 큰 취약계층에 적절한 정책적 지원이 고려되어야 할 것으로 사료된다.

• Asian Pacific Journal of Cancer Prevention
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• 제14권4호
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• pp.2259-2263
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• 2013

Background: Public use National Health and Nutrition Examination Survey (NHANES III) and NHANES III linked mortality data were here applied to investigate the association between health insurance coverage and all cause and all cancer mortality in adults. Patients and Methods: NHANES III household adult, laboratory and mortality data were merged. Only patients examined in the mobile examination center (MEC) were included in this study. The sampling weight employed was WTPFEX6, SDPPSU6 being used for the probability sampling unit and SDPSTRA6 to designate the strata for the survey analysis. All cause and all cancer mortalities were used as binary outcomes. The effect of health insurance coverage status on all cause and all cancer mortalities were analyzed with potential socioeconomic, behavioral and health status confounders. Results: There were 2398 sample persons included in this study. The mean age was 40 years and the mean (S.E.) follow up was 171.85 (3.12) person months from the MEC examination. For all cause mortality, the odds ratios (significant p-values) of the covariates were: age, 1.0095 (0.000); no health insurance coverage (using subjects with health insurance), 1.71 (0.092); black race (using non-Hispanic white subjects as the reference group) 1.43, (0.083); Mexican-Americans, 0.60 (0.089); DMPPIR, 0.82, (0.000); and drinking hard liquor, 1.014 (0.007). For all cancer mortality, the odds ratio (significant p-values) of the covariates were: age, 1.0072 (0.00); no health insurance coverage, using with health coverage as the reference group, 2.91 (0.002); black race, using non-Hispanic whites as the reference group, 1.64 (0.047); Mexican Americans, 0.33 (0.008) and smoking, 1.017 (0.118). Conclusion: There was a 70% increase in risk of all cause death and almost 300% of all cancer death for people without any health insurance coverage.

• Asian Pacific Journal of Cancer Prevention
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• 제16권18호
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• pp.8541-8551
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• 2016

Background: The coverage of breast and cervical cancer screening has only slightly increased in the past decade in Thailand, and these cancers remain leading causes of death among women. This study identified socioeconomic and contextual factors contributing to the variation in screening uptake and coverage. Materials and Methods: Secondary data from two nationally representative household surveys, the Health and Welfare Survey (HWS) 2007 and the Reproductive Health Survey (RHS) 2009 conducted by the National Statistical Office were used. The study samples comprised 26,951 women aged 30-59 in the 2009 RHS, and 14,619 women aged 35 years and older in the 2007 HWS were analyzed. Households of women were grouped into wealth quintiles, by asset index derived from Principal components analysis. Descriptive and logistic regression analyses were performed. Results: Screening rates for cervical and breast cancers increased between 2007 and 2009. Education and health insurance coverage including wealth were factors contributing to screening uptake. Lower or non-educated and poor women had lower uptake of screenings, as were young, unmarried, and non-Buddhist women. Coverage of the Civil Servant Medical Benefit Scheme increased the propensity of having both screenings, while the universal coverage scheme increased the probability of cervical screening among the poor. Lack of awareness and knowledge contributed to non-use of both screenings. Women were put off from screening, especially Muslim women on cervical screening, because of embarrassment, fear of pain and other reasons. Conclusions: Although cervical screening is covered by the benefit package of three main public health insurance schemes, free of charge to all eligible women, the low coverage of cervical screening should be addressed by increasing awareness and strengthening the supply side. As mammography was not cost effective and not covered by any scheme, awareness and practice of breast self examination and effective clinical breast examination are recommended. Removal of cultural barriers is essential.

• Journal of Preventive Medicine and Public Health
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• 제55권1호
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• pp.68-79
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• 2022

Objectives: This study investigated associations between ethnicity and malaria awareness in East Nusa Tenggara Province (ENTP), Indonesia. Methods: A community-based cross-sectional study was conducted upon 1503 adults recruited by multi-stage cluster random sampling. A malaria awareness questionnaire was used to collect data, according to which participants were classified as aware or unaware of malaria. Logistic regression was applied to quantify the strength of associations of factors with malaria awareness. Results: The participation rate in this study was high (99.5%). The participants were distributed relatively evenly among the Manggarai, Atoni, and Sumba ethnicities (33.0, 32.3, and 30.2%, respectively). Malaria awareness was significantly different amongst these groups; it was most common in the Manggarai ethnicity (65.1%; 95% confidence interval [CI], 59.9 to 70.3) and least common in the Sumba ethnicity (35.0%; 95% CI, 27.6 to 42.4). The most prominent factor influencing the malaria awareness in the Sumba and Manggarai ethnicities was education level, whilst it was socioeconomic status (SES) in the Atoni ethnicity. The likelihood of malaria awareness was significantly higher in adults with an education level of diploma or above (adjusted odds ratio [aOR], 21.4; 95% CI, 3.59 to 127.7 for Manggarai; aOR, 6.94; 95% CI, 1.81 to 26.6 for Sumba). Malaria awareness was significantly more common amongst high-SES adults in the Atoni group (aOR, 24.48; 95% CI, 8.79 to 68.21). Conclusions: Low education levels and low SES were prominent contributors to lower levels of malaria awareness in rural ENTP. Interventions should focus on improving malaria awareness to these groups to support the Indonesian government's national commitment to achieve a malaria elimination zone by 2030.

• 농촌의학ㆍ지역보건
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• 제38권3호
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• pp.182-194
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• 2013

본 연구는 국민건강영양조사를 이용하여 도시와 농촌지역에 거주하는 노인의 건강행태와 질병수준을 파악하고, 사회인구학적 특성을 통제한 상태에서 도시와 농촌지역의 노인의 건강수준을 비교하고자 수행하였다. 제4기 국민건강 영양조사(2007년-2009년) 자료를 이용하였으며, 65세 이상 노인으로 건강면접조사, 보건의식행태조사, 검진조사에 참여하여 분석에 필요한 변수가 모두 확보된 3,823명을 최종 연구대상으로 하였다. 지역의 분류는 행정지역과 동, 읍면으로 구분된 거주지역을 이용하여 '대도시', '도시', '농촌'으로 분류하였다. 가중치를 적용한 복합표본분석을 시행하여 지역에 따른 건강행태, 정신 건강 및 만성질환수준 증의 건강상태를 비교하였다. 연구결과, 우리나라 65세 이상 노인의 건강수준은 농촌지역이 사회경제적 여건은 도시지역에 비해 열악하지만 노인의 건강행태나 건강상태는 도시지역에 비해 더 양호함을 알 수 있었다. 농촌지역을 대도시 지역과 비교할 경우 건강행태 및 건강상태의 교차비는 독감접종 1.58(95% 신뢰구간 1.25-2.01)로 유의하게 높았고, 유연성운동 0.47(0.37-0.59), 근력운동 0.56(0.38-0.81), 비만 0.76(0.62-0.92)로 유의하게 낮았다. 질환 이환 중 관절염(0.81, 95% 신뢰구간: 0.66-0.99)과 당뇨병(0.70, 0.55-0.89)의 교차비는 농촌지역에서 대도시지역에 비해 통계적으로 유의하게 낮았다. 결론적으로 65세 이상 노인의 건강행태와 건강 수준은 이들의 거주 지역에 따라 차이가 있음을 알 수 있었다. 따라서 노인의 건강 수준의 향상을 위해서는 지역 특성과 여건에 맞는 프로그램의 개발이 필요하며, 거주 지역에 따른 차이를 설명할 수 있는 특성을 파악하고자 하는 연구가 이루어져야 할 것으로 생각된다.