Epidemiology and Health

Brief Communication

Occupational inequalities in mortality in Korea: an analysis using nationally representative mortality follow-up data from the late 2000s and after: Eunjeong Noh, Young-Ho Khang; Epidemiol Health. 2022;44:e2022038. Published online April 6, 2022; DOI: https://doi.org/10.4178/epih.e2022038

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Abstract

Many Korean and international studies have found higher mortality rates and poorer health conditions among manual workers than among non-manual workers. However, a recent study using unlinked data argued that since the economic crisis in Korea in the late 2000s, the mortality estimates of male Korean non-manual workers have been higher than those of manual workers. Our work using individually linked data from the late 2000s and after aimed to examine mortality inequality by occupational class. We analyzed Korea National Health and Nutrition Examination Survey data that were individually linked to cause-of-death data. Cox regression analysis was used to identify the hazard ratios for mortality by occupational class. Of 11,766 males aged between 35 and 64, 397 died between 2007 and 2018: 142 died from cancer, 68 from cardiovascular disease, 88 from external causes, and 99 from other causes. After controlling for age, the mortality estimates for manual workers were 1.85 times higher than those for upper non-manual workers (p<0.05). We observed no evidence of reversed mortality inequality among occupational classes in Korea since the 2000s; this previously reported finding might have been due to numerator-denominator bias arising from the use of unlinked data.

Summary

Korean summary
개인 단위 연계자료가 아닌 분모(센서스)-분자(사망신고) 집합 자료를 사용하여 2000년대 후반 경제위기 이후 한국 남성 비육체직의 사망률이 육체직보다 높게 나타난다고 기존의 한 연구가 주장했다. 이 연구는 2000년대 이후 개인 단위로 연계된 코호트 자료를 활용하여 여전히 한국에서 육체직의 사망위험이 비육체직보다 높다는 점을 보임으로써, 기존 연구가 비연계자료의 사용으로 인한 분자-분모 바이어스(numerator-denominator bias) 때문에 그와 같은 결과를 보였다고 지적하였다.

Key Message
This paper using individually linked data from the late 2000s and after observed no evidence of reversed mortality inequality among occupational classes in Korea since the 2000s. The previously reported finding showing reversed occupational mortality inequality might have been due to numerator-denominator bias arising from the use of unlinked data.

Citations

Citations to this article as recorded by

Mortality of Suicide and Cerebro-Cardiovascular Diseases by Occupation in Korea, 1997–2020
Jungwon Jang, Inah Kim
International Journal of Environmental Research and Public Health.2022; 19(16): 10001. CrossRef

Original Article

Income gaps in self-rated poor health and its association with life expectancy in 245 districts of Korea: Ikhan Kim, Jinwook Bahk, Sung-Cheol Yun, Young-Ho Khang; Epidemiol Health. 2017;39:e2017011. Published online March 15, 2017; DOI: https://doi.org/10.4178/epih.e2017011

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Abstract

OBJECTIVES
To examine the income gaps associated with self-rated poor health at the district level in Korea and to identify the geographical correlations between self-rated poor health, life expectancy, and the associated income gaps.

METHODS

We analyzed data for 1,578,189 participants from the Community Health Survey of Korea collected between 2008 and 2014. The age-standardized prevalence of self-rated poor health and the associated income gaps were calculated. Previously released data on life expectancy and the associated income gaps were also used. We performed correlation and regression analyses for self-rated poor health, life expectancy, and associated income gaps.

RESULTS

Across 245 districts, the median prevalence of self-rated poor health was 15.7% (95% confidence interval [CI], 14.6 to 16.8%), with interquartile range (IQR) of 3.1 percentage points (%p). The median interquintile gaps in the prevalence of self-rated poor health was 11.1%p (95% CI, 8.1 to 14.5%p), with IQR of 3.6%p. Pro-rich inequalities in self-rated health were observed across all 245 districts of Korea. The correlation coefficients for the association between self-rated poor health and the associated income gaps, self-rated poor health and life expectancy, and income gaps associated with self-rated poor health and life expectancy were 0.59, 0.78 and 0.55 respectively.

CONCLUSIONS

Income gaps associated with self-rated poor health were evident across all districts in Korea. The magnitude of income gaps associated with self-rated poor health was larger in the districts with greater prevalence of self-rated poor health. A strong correlation between self-rated poor health and life expectancy was also observed.

Summary

Korean summary
본 연구에서는 우리나라 245개 시군구의 자가평가 불건강 유병률의 소득수준 간 격차 크기를 규명하고, 시군구 단위 자가평가 불건강 유병률과 그것의 소득수준 간 격차, 기대수명 및 기대수명의 소득수준 간 격차의 상관성에 대하여 분석하였다. 연구 결과, 우리나라 245개 모든 시군구에서 자가평가 불건강 유병률에서의 저소득층에 불리한 불평등이 존재하였다. 또한, 자가평가 불건강 유병률과 그것의 소득수준 간 격차, 기대수명 그리고 자가평가 불건강 유병률의 소득수준 간 격차와 기대수명의 소득수준 간 격차는 높은 상관성이 나타났다. 이 연구는 지방정부 차원에서 건강 형평성 현황에 관한 유의미한 정보를 제공하여 지역별 보건정책 수립의 근거로 활용할 수 있다는데 의의를 찾을 수 있다.

Citations

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The effect of body mass index on self-rated health in middle-aged and older adults: evidence from the China health and retirement longitudinal study
Jingyi Wang, Yingying Cai, Xiaohe Ren, Bin Ma, Ou Chen
Aging Clinical and Experimental Research.2023; 35(12): 2929. CrossRef
Health status and public health education for internal older migrants in China: Evidence from a nationally representative survey
Wen Zeng, Cui Wang, Hongbo Chen, Beibei Tong, Dan Li, Ziqiu Zou, Peiyuan Liu, Yuanrong Yao, Shaomei Shang
Frontiers in Public Health.2022;[Epub] CrossRef
Spatio-temporal Analysis of District-level Life Expectancy from 2004 to 2017 in Korea
Hwa-Kyung Lim, Hee-Yeon Kang, Ikhan Kim, Young-Ho Khang
Journal of Korean Medical Science.2021;[Epub] CrossRef
Self-rated health status in relation to aircraft noise exposure, noise annoyance or noise sensitivity: the results of a cross-sectional study in France
Clémence BAUDIN, Marie LEFÈVRE, Patricia CHAMPELOVIER, Jacques LAMBERT, Bernard LAUMON, Anne-Sophie EVRARD
BMC Public Health.2021;[Epub] CrossRef
The Effects of Social Support and Morbidities on Self-Rated Health among Migrant Elderly Following Children to Jinan, China
Suqing Wei, Fanlei Kong, Shixue Li
Healthcare.2021; 9(6): 686. CrossRef
Statin use for primary prevention in patients with type 2 diabetes: Can it benefit all ages? – A nationwide propensity-matched cohort study
Ji Eun Jun, In-Kyung Jeong, Kyu Jeung Ahn, Ho Yeon Chung, You-Cheol Hwang
Diabetes Research and Clinical Practice.2021; 180: 109044. CrossRef
Cancer-free Life Expectancy in Small Administrative Areas in South Korea and Its Associations with Regional Health Insurance Premiums
Eunjeong Noh, Hee-Yeon Kang, Jinwook Bahk, Ikhan Kim, Young-Ho Khang
Journal of Korean Medical Science.2021;[Epub] CrossRef
Socioeconomic Status and Mental Health among Low-income Employees: A Systematic Literature Review
Errna Nadhirah Kamalulil, Siti Aisyah Panatik
Pertanika Journal of Social Sciences and Humanities.2021;[Epub] CrossRef
Physical Disorders and Poor Self-Rated Health in Adults Living in Four Latin American Cities: A Multilevel Approach
Camila Vaz, Amanda Cristina Andrade, Uriel Silva, Daniel Rodríguez, Xize Wang, Kari Moore, Amélia Augusta Friche, Ana Victoria Diez-Roux, Waleska Teixeira Caiaffa
International Journal of Environmental Research and Public Health.2020; 17(23): 8956. CrossRef
A publicly well-accepted measure versus an academically desirable measure of health inequality: cross-sectional comparison of the difference between income quintiles with the slope index of inequality
Young-Ho Khang, Dohee Lim, Jinwook Bahk, Ikhan Kim, Hee-Yeon Kang, Youngs Chang, Kyunghee Jung-Choi
BMJ Open.2019; 9(6): e028687. CrossRef
Allocation of Time and Household-level Consumption Equivalent Welfare: A Case of South Korea
Ki Young Park, Soohyon Kim
Global Economic Review.2018; 47(3): 337. CrossRef

Methods

The causality between smoking and lung cancer among groups and individuals: addressing issues in tobacco litigation in South Korea: Young-Ho Khang; Epidemiol Health. 2015;37:e2015026. Published online May 31, 2015; DOI: https://doi.org/10.4178/epih/e2015026

19,519 View
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2 Web of Science
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Abstract Summary PDF Supplementary Material

Abstract

This article discusses issues on the causality between smoking and lung cancer, which have been raised during the tobacco litigation in South Korea. It should be recognized that the explanatory ability of risk factor(s) for inter-individual variations in disease occurrence is different from the causal contribution of the risk factor(s) to disease occurrence. The affected subjects of the tobacco litigation in South Korea are lung cancer patients with a history of cigarette smoking. Thus, the attributable fraction of the exposed rather than the population attributable fraction should be used in the tobacco litigation regarding the causal contribution of smoking to lung cancer. Scientific evidence for the causal relationship between smoking and lung cancer is based on studies of individuals and groups, studies in animals and humans, studies that are observational or experimental, studies in laboratories and communities, and studies in both underdeveloped and developed countries. The scientific evidence collected is applicable to both groups and individuals. The probability of causation, which is calculated based on the attributable fraction for the association between smoking and lung cancer, could be utilized as evidence to prove causality in individuals.

Summary

Korean summary
이 글에서는 우리나라 담배소송 과정에서 제기된 흡연과 폐암의 인과성에 대하여 논하였다. 질병 발생의 개인 간 변이에 대한 위험 요인의 설명력과 질병발생에 미치는 위험요인의 인과적 기여도는 다르다는 점을 지적하였다. 개인에서의 흡연과 폐암의 인과성에 대한 정보로 인과확률이 활용될 수 있음을 강조하였다.

Citations

Citations to this article as recorded by

A different causal perspective with Necessary Condition Analysis
Jan Dul
Journal of Business Research.2024; 177: 114618. CrossRef
Trends in the of epidemiological perspectives on the causality of occupational diseases
Jun-Pyo Myong, Hyeongsu Kim, Kunsei Lee, Soung Hoon Chang
Journal of the Korean Medical Association.2018; 61(8): 466. CrossRef
Tobacco and epidemiology in Korea: old tricks, new answers?
Alex Broadbent, Seung-sik Hwang
Journal of Epidemiology and Community Health.2016; 70(6): 527. CrossRef

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