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COVID-19: Original Article
Socioeconomic inequality in compliance with precautions and health behavior changes during the COVID-19 outbreak: an analysis of the Korean Community Health Survey 2020
Ga Bin Lee, Sun Jae Jung, Yang Yiyi, Jea Won Yang, Hoang Manh Thang, Hyeon Chang Kim
Epidemiol Health. 2022;44:e2022013.   Published online January 9, 2022
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AbstractAbstract AbstractSummary PDFSupplementary Material
This study examined socioeconomic inequalities in compliance with precautions and health behavior changes during the coronavirus disease 2019 (COVID-19) outbreak using a representative Korean sample.
This exploratory study utilized around 210,000 participants aged ≥25 years in the Korean Community Health Survey 2020. Socioeconomic status was measured with educational attainment and household income. Outcomes included non-compliance with 8 precaution measures and deterioration in 6 health behaviors. The relative inequality index (RII) was calculated to quantify the degree of inequality by education and income level. RII values >1.0 indicate that deprived people have a higher frequency of health problems, and RII values <1.0 conversely indicate a higher frequency of health problems in more advantaged groups.
People with lower education or income levels tended to have higher rates of non-compliance with COVID-19 safety precautions (RII range, 1.20 to 3.05). Lower education and income levels were associated with an increased smoking amount (RII=2.10 and 1.67, respectively) and sleep duration changes (RII=1.21 and 1.36, respectively). On the contrary, higher education and income levels were associated with decreased physical activity (RII=0.59 and 0.77, respectively) and increased delivery food consumption (RII=0.27 and 0.37, respectively). However, increased alcohol drinking was associated with lower education and income levels in younger men (RII=1.73 and 1.31, respectively), but with higher levels in younger women (RII=0.73 and 0.68, respectively).
Our findings suggest the need to develop customized strategies, considering the characteristics of the target population, to decrease the burden and impact of the COVID-19 outbreak.
Korean summary
코로나19 유행기간 동안 예방지침 준수율과 건강관련 생활습관이 나빠지는 정도는 사회경제적 수준에 따라 차이가 있다. 전반적으로 코로나19 예방지침 준수율은 높았지만, 사회경제수준이 낮을수록 예방지침 준수율도 낮아지는 경향을 보였다. 하지만, 사회경제수준과 생활습관 악화의 관계는 성, 연령, 생활습관의 종류에 따라 달랐다.
Key Message
This study of a representative Korean sample found that socioeconomic inequalities existed in compliance with COVID-19 precautions and in health behavior deterioration. There is a need to develop target group-specific strategies to reduce health inequalities and the long-term health burden of the COVID-19 outbreak.


Citations to this article as recorded by  
  • Association of Depression With Precautionary Behavior Compliance, COVID-19 Fear, and Health Behaviors in South Korea: National Cross-sectional Study
    Hyerine Shin, Ji-Su Kim, HyunHae Lee
    JMIR Public Health and Surveillance.2023; 9: e42677.     CrossRef
  • Trends in socioeconomic inequalities in obesity among Korean adolescents: the Korea Youth Risk Behavior Web-based Survey (KYRBS) 2006 to 2020
    Eunji Kim, Ga Bin Lee, Dong Keon Yon, Hyeon Chang Kim
    Epidemiology and Health.2023;[Epub]     CrossRef
  • Communication inequalities in the COVID-19 pandemic: socioeconomic differences and preventive behaviors in the United States and South Korea
    Woohyun Yoo, Yangsun Hong, Sang-Hwa Oh
    BMC Public Health.2023;[Epub]     CrossRef
  • Compliance Trajectory and Patterns of COVID-19 Preventive Measures, Japan, 2020–2022
    Taro Kusama, Kenji Takeuchi, Yudai Tamada, Sakura Kiuchi, Ken Osaka, Takahiro Tabuchi
    Emerging Infectious Diseases.2023;[Epub]     CrossRef
  • Factors associating to the increased smoking time among South Korean male workers during COVID-19 pandemic
    Mi Young Kwon, Myong Sun Cho
    Korean Journal of Health Education and Promotion.2022; 39(2): 53.     CrossRef
  • Trust and compliance: Milieu-specific differences in social cohesion during the COVID-19 pandemic in Germany
    Tim Schröder, Anne Speer, Patrick Sachweh, Olaf Groh-Samberg
    Frontiers in Sociology.2022;[Epub]     CrossRef
  • Effect of socioeconomic disparities on the risk of COVID-19 in 8 metropolitan cities in the Korea: a community-based study
    Myung-Jae Hwang, Shin Young Park, Tae-Ho Yoon, Jinhwa Jang, Seon-Young Lee, Myeongsu Yoo, Yoo-Yeon Kim, Hae-Kwan Cheong, Donghyok Kwon, Jong-Hun Kim
    Epidemiology and Health.2022; 44: e2022107.     CrossRef

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