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Trends and disparities in avoidable, treatable, and preventable mortalities in South Korea, 2001-2020: comparison of capital and non-capital areas
Sang Jun Eun
Epidemiol Health. 2022;44:e2022067.   Published online August 16, 2022
DOI: https://doi.org/10.4178/epih.e2022067
  • 9,062 View
  • 286 Download
  • 6 Web of Science
  • 5 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study aimed to describe the regional avoidable mortality trends in Korea and examine the trends in avoidable mortality disparities between the Seoul Capital Area and non-Seoul-Capital areas, thereby exploring the underlying reasons for the trend changes.
METHODS
Age-standardized mortality rates from avoidable causes between 2001-2020 were calculated by region. Regional disparities in avoidable mortality were quantified on both absolute and relative scales. Trends and disparities in avoidable mortality were analyzed using joinpoint regression models.
RESULTS
Avoidable, treatable, and preventable mortalities in Korea decreased at different rates over time by region. The largest decreases were in the non-Seoul-Capital non-metropolitan area for avoidable and preventable mortality rates and the non-Seoul- Capital metropolitan area for treatable mortality rates, despite the largest decline being in the Seoul Capital Area prior to around 2009. Absolute and relative regional disparities in avoidable and preventable mortalities generally decreased. Relative disparities in treatable mortality between areas widened. Regional disparities in all types of mortalities tended to improve after around 2009, especially among males. In females, disparities in avoidable, treatable, and preventable mortalities between areas improved less or even worsened.
CONCLUSIONS
Trends and disparities in avoidable mortality across areas in Korea seem to have varied under the influence of diverse social changes. Enhancing health services to underserved areas and strengthening gender-oriented policies are needed to reduce regional disparities in avoidable mortality.
Summary
Korean summary
2001년부터 2020년까지 회피가능, 예방가능 사망률의 수도권과 비수도권 대도시, 비수도권 비대도시 지역 간 절대적, 상대적 격차는 대체로 감소했지만, 치료가능 사망률의 상대적 격차는 커졌다. 회피가능, 치료가능, 예방가능 사망률의 지역 간 격차는 2009년경 이후에 특히 남성에서 개선됐지만, 여성의 경우 덜 개선되거나 오히려 악화되기도 했다.
Key Message
Regional disparities in avoidable, treatable, and preventable mortalities tended to improve after around 2009, especially among males, but, in females, disparities in all types of mortalities between areas improved less or even worsened.

Citations

Citations to this article as recorded by  
  • Evaluating the effects of the 2017 National Health Insurance coverage expansion on amenable mortality and its disparities between areas in South Korea using Bayesian structural time-series models
    Sang Jun Eun
    Social Science & Medicine.2024; 344: 116574.     CrossRef
  • Residential mobility according to health status in South Korea's largest metropolitan city during the COVID-19 pandemic using generalized estimating equations for longitudinal data
    Ikhan Kim, Duwon Kim
    Health & Place.2024; 88: 103265.     CrossRef
  • Regional Health Disparities in Hypertension-Related Hospitalization of Hypertensive Patients: A Nationwide Population-Based Nested Case-Control Study
    Woo-Ri Lee, Jun Hyuk Koo, Ji Yun Jeong, Min Su Kim, Ki-Bong Yoo
    International Journal of Public Health.2023;[Epub]     CrossRef
  • Regional Disparities in the Infant Mortality Rate in Korea Between 2001 and 2021
    Hyeongtaek Woo, Ji Sook Kim
    Journal of Korean Medical Science.2023;[Epub]     CrossRef
  • Changes in Barriers That Cause Unmet Healthcare Needs in the Life Cycle of Adulthood and Their Policy Implications: A Need-Selection Model Analysis of the Korea Health Panel Survey Data
    Woojin Chung
    Healthcare.2022; 10(11): 2243.     CrossRef
Secular trends and related factors in leisure-time sedentary behavior among Koreans: an analysis of data from the 2011-2017 Korea Community Health Survey
Hyun-Ju Seo, Min-Jung Choi, Soon-Ki Ahn
Epidemiol Health. 2022;44:e2022023.   Published online February 14, 2022
DOI: https://doi.org/10.4178/epih.e2022023
  • 9,914 View
  • 416 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Sedentary behavior has gradually increased and has become a public health problem. Therefore, this study investigated trends in weekday leisure-time sedentary behaviors, as well as characteristic socio-demographic and lifestyle correlates in Korean adults.
METHODS
We analyzed data from 914,946 adults aged ≥19 years who participated in the Korea Community Health Survey (2011, 2013, 2015, and 2017). Leisure-time sedentary behavior was categorized as a binary variable (<4 and ≥4 hr/day). Multivariable regression analysis was used to model the prevalence of sedentary behavior and estimate odds ratios.
RESULTS
The prevalence of leisure-time sedentary behavior decreased from 15.2% to 14.4% in men and from 16.6% to 16.0% in women between 2011 and 2017, respectively. However, a significant increase was observed in subjects with an education lower than high school in both genders (β coefficient=0.12 for men and 0.08 for women, p for trend <0.001). Women in the lowest household income level (β coefficient=0.08, p for trend=0.001) and with poor subjective health status (β coefficient=0.05, p for trend=0.013) showed an increasing trend. Other factors associated with sedentary behavior were age, education level, body mass index, household income, walking activity, perceived stress level, and subjective health status in both genders.
CONCLUSIONS
Identifying the secular trends and correlates of sedentary behavior by gender and associated factors will provide empirical evidence for developing public health campaigns and promotion programs to reduce sedentary behavior in Koreans.
Summary
Korean summary
본 연구는 지역사회건강조사에서 2011년부터 2017년까지 격년으로 수집된 성인의 좌식행동에 대한 시간적 추세와 관련 요인에 대해 분석한 시계열 단면연구이다. 분석결과, 주중 여가시간에 4시간 이상 앉아 있는 경우는 남성의 경우 15.2%에서 14.4%로, 여성의 경우 16.6%에서 16.0%로 감소되었다. 그러나, 남녀 모두에서 노인인 경우, 중졸 이하의 학력을 가진 경우, 소득수준이 월 100만원 미만인 경우, 주관적 건강상태가 부정적인 경우 좌식행동이 증가하였다. 따라서, 본 연구에서 나타난 좌식행동 관련 요인을 가진 대상자를 목표집단으로 한 건강증진 및 공중보건 캠페인이 개발 및 실행될 필요가 있다.
Key Message
This study is a serial cross-sectional study analyzing the temporal trend and related factors of sedentary behavior of adults using KCHS collected biennially from 2011 to 2017. The prevalence of leisure-time sedentary behavior decreased from 15.2% to 14.4% in men and from 16.6% to 16.0% in women, respectively. However, elderly, subjects with an education lower than high school, with the lowest household income level, and with poor subjective health status showed an increasing sedentary behavior trend. These findings suggest that health promotion and public health campaigns are need to reduce the prevalence of sedentary behavior in population with related factors.

Citations

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  • Temporal trends and the association between self-rated oral health and falls in community-dwelling older adults in South Korea: a secondary analysis of survey data
    Hyun-Ju Seo, Soon-Ki Ahn, Min-Jung Choi
    BMJ Open.2024; 14(4): e081549.     CrossRef
  • Association between long working hours and physical inactivity in middle-aged and older adults: a Korean longitudinal study (2006–2020)
    Seong-Uk Baek, Won-Tae Lee, Min-Seok Kim, Myeong-Hun Lim, Jin-Ha Yoon, Jong-Uk Won
    Journal of Epidemiology and Community Health.2023; 77(6): 355.     CrossRef
Preventable causes of cancer in Texas by race/ethnicity: tobacco smoking
Franciska J. Gudenkauf, Aaron P. Thrift
Epidemiol Health. 2021;43:e2021046.   Published online July 13, 2021
DOI: https://doi.org/10.4178/epih.e2021046
  • 9,428 View
  • 258 Download
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Tobacco smoking is classified as carcinogenic to humans (International Agency for Research on Cancer Group 1). We aimed to estimate the percentage and number of incident cancer cases diagnosed in Texas in 2015 that were attributable to tobacco smoking, and we examined differences in the proportions of smoking-attributable cancers between the major racial/ethnic subgroups of the population.
METHODS
We calculated population-attributable fractions for cancers attributable to tobacco smoking using prevalence data from the Texas Behavioral Risk Factor Surveillance System and relative risks associated with smoking status from pooled analyses of cohort studies or meta-analyses. Cancer incidence data were collected from the Texas Cancer Registry.
RESULTS
We estimated that 19,000 excess cancer cases or 18.4% of all cancers diagnosed in 2015 in Texans aged ≥ 25 years were caused by tobacco smoking. Males had a higher overall proportion of cancers attributable to tobacco smoking than females (male, 23.3%, 11,993 excess cases; female, 13.5%, 7,006 cases). Approximately 20% of cancer cases in non-Hispanic Whites and non-Hispanic Blacks were attributable to tobacco smoking compared to 12.8% among Hispanics.
CONCLUSIONS
Despite ongoing public health campaigns combatting tobacco use, this preventable behavior still contributes significantly to cancer incidence in Texas. Racial/ethnic differences in smoking prevalence and smoking-attributable cancer incidence should be considered when designing cancer prevention programs.
Summary
Key Message
Tobacco smoking remains a major contributor to cancer burden in the United States, particularly among men, non-Hispanic whites and non-Hispanic Blacks due to historically higher smoking rates.
Overall health and drinking behavior among pregnant and breastfeeding women in Korea
Eun Gyeong Kim
Epidemiol Health. 2019;41:e2019036.   Published online September 1, 2019
DOI: https://doi.org/10.4178/epih.e2019036
  • 10,405 View
  • 206 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
The study was to conduct a comparative assessment of drinking behaviors and overall health among pregnant and breastfeeding women.
METHODS
This study used data collected from the Korean Community Health Survey in 2015. Data obtained from 2,156 pregnant or breastfeeding women were analyzed using descriptive statistics, the t-test, the chi-square test, and the Pearson correlation coefficient.
RESULTS
Current drinking and alcohol consumption were higher among pregnant women than among breastfeeding women. Depression was twice as common among breastfeeding women than among pregnant women, and stress was much higher among breastfeeding women as well. Breastfeeding women also had lower subjective dental health and more unmet medical needs than pregnant women.
CONCLUSIONS
Although pregnant women were in better overall health than breastfeeding women, many of them were unable to stop drinking, which is a risky and adverse health behavior that negatively affects maternal and fetal health. In order to reduce drinking among pregnant and breastfeeding women, it is necessary to develop a tailored, standardized educational program and national guidelines.
Summary
Korean summary
최근 한국 사회는 출산이 점점 늦어져 고령 임산부가 증가하고 있는 실정이고, 초저출산 시대를 맞이하여 미래세대 인구의 자질향상의 기반이 되는 여성건강은 매우 중요하다고 할 수 있다. 이에 본 연구는 지역사회건강조사(Community Health Survey, CHS)의 조사자료를 활용한 이차분석연구로 임산부와 수유부의 음주 및 건강행태를 파악하고 비교하여 여성건강증진을 위한 근거자료로 활용하고자 수행되었다. 연구결과 현재 음주와 음주량은 임신여성에서, 우울과 스트레스는 수유여성에서 많은 것으로 나타났다.

Citations

Citations to this article as recorded by  
  • Maternal tobacco, alcohol and caffeine consumption during the perinatal period: A prospective cohort study in Greece in the midst of COVID-19 pandemic
    Maria Tigka, Dimitra Metallinou, Maria Tzeli, Katerina Lykeridou
    Tobacco Induced Diseases.2023; 21(June): 1.     CrossRef
  • Moderate ethanol exposure during early ontogeny of the rat alters respiratory plasticity, ultrasonic distress vocalizations, increases brain catalase activity, and acetaldehyde-mediated ethanol intake
    Genesis D’aloisio, María Belén Acevedo, Asier Angulo-Alcalde, Verónica Trujillo, Juan Carlos Molina
    Frontiers in Behavioral Neuroscience.2022;[Epub]     CrossRef
  • Alcohol use in pregnancy and its impact on the mother and child
    Ju Lee Oei
    Addiction.2020; 115(11): 2148.     CrossRef
Health behaviors and health status of Korean middleaged men by marital status: Korea Community Health Study, 2015
Yongho Jee, Youngtae Cho
Epidemiol Health. 2019;41:e2019019.   Published online May 15, 2019
DOI: https://doi.org/10.4178/epih.e2019019
  • 10,634 View
  • 190 Download
  • 2 Web of Science
  • 5 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Previous studies have shown that marital status is associated with household composition and living arrangements, which partially explain observed differences in health status according to marital status. However, due to the rapid socioeconomic and demographic transformations of the last few decades, the distribution of marital status among middle-aged adults has become more diverse. Therefore, this study aimed to obtain up-to-date information on the associations between marital status and health and to investigate the implications of these findings for conventional explanations of the health effects of marriage.
METHODS
The data for this study were obtained from the 2015 Korean Community Health Study. We compared 4 modifiable lifestyle behaviors—smoking, alcohol consumption, physical activity, and self-rated health status—as outcome variables in association with marital status in Korean middle-aged men (age 40-44) living in Seoul and other regions.
RESULTS
Married men showed the lowest cigarette smoking prevalence and the highest subjective health status both before and after adjusting for education and income. The odds of engaging in vigorous physical activity did not show a major difference before and after adjustment for income and education.
CONCLUSIONS
In married men, the prevalence of cigarette smoking was lowest and subjective health status was highest, similar to previous studies. However, the prevalence of engaging in physical activity was highest in divorced/widowed/separated men. The health behaviors and health status of Korean middle-aged adults should be more closely followed, since they are representative of demographic changes in the Korean population.
Summary
Korean summary
결혼 상태에 따른 건강을 다룬 이전연구에서 가구구성행태 위주의 연구, 기혼자일수록 일관되게 양호한 건강상태를 보인다는 결과들이 많이 보고되었으나 저출산 고령화의 흐름속에 1인 가구가 증가하고 가구 형태가 다양화되면서 기존의 연구결과들이 오늘날에도 유의한지에 따른 연구가 필요하며, 따라서 본 연구에서는 한국 중년 남성들의 결혼여부에 따른 건강상태를 분석하고자 하였다.

Citations

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  • Marital status, marital transition and health behaviour and mental health outcomes among middle-aged and older adults in Thailand: A national longitudinal study
    Supa Pengpid, Karl Peltzer, Dararatt Anantanasuwong
    Archives of Gerontology and Geriatrics.2024; 117: 105196.     CrossRef
  • Changing associations of coronary heart disease incidence with current partnership status and marital history over three decades
    Karri Silventoinen, Kaarina Korhonen, Pekka Martikainen
    SSM - Population Health.2022; 18: 101080.     CrossRef
  • Socioeconomic disparities between oral cavity cancer patients in Germany
    David Muallah, Jan Matschke, Sophie Muallah, Anna Klimova, Lysann Michaela Kroschwald, Tom Alexander Schröder, Günter Lauer, Dominik Haim
    Frontiers in Public Health.2022;[Epub]     CrossRef
  • Hemodiyaliz Hastalarında Sigara Kullanımı, Nikotin Bağımlılık Durumu Ve İlişkili Faktörler
    Zeynep KENDİ ÇELEBİ, Didem TURGUT
    Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi.2020; 7(2): 188.     CrossRef
  • A Multi-Disciplinary Study Into the Drivers of Smoking Cessation in South Korea
    James E. Prieger, Anna Choi
    SSRN Electronic Journal.2020;[Epub]     CrossRef
Health disparities between lesbian, gay, and bisexual adults and the general population in South Korea: Rainbow Connection Project I
Horim Yi, Hyemin Lee, Jooyoung Park, Bokyoung Choi, Seung-Sup Kim
Epidemiol Health. 2017;39:e2017046.   Published online October 19, 2017
DOI: https://doi.org/10.4178/epih.e2017046
  • 52,619 View
  • 369 Download
  • 22 Web of Science
  • 21 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study aims to investigate health disparities between lesbian, gay, and bisexual (LGB) adults and the general population in Korea, where there is low public acceptance of sexual minorities and a lack of research on the health of sexual minorities.
METHODS
The research team conducted a nationwide survey of 2,335 Korean LGB adults in 2016. Using the dataset, we estimated the age-standardized prevalence ratios (SPRs) for poor self-rated health, musculoskeletal pain, depressive symptoms, suicidal behaviors, smoking, and hazardous drinking. We then compared the SPRs of the LGB adults and the general population which participated in three different nationally representative surveys in Korea. SPRs were estimated for each of the four groups (i.e., gay men, bisexual men, lesbians, and bisexual women).
RESULTS
Korean LGB adults exhibited a statistically significantly higher prevalence of depressive symptoms, suicidal ideation and attempts, and musculoskeletal pain than the general population. Lesbian and bisexual women had a higher risk of poor self-rated health and smoking than the general women population, whereas gay and bisexual men showed no differences with the general men population. Higher prevalence of hazardous drinking was observed among lesbians, gay men, and bisexual women compared to the general population, but was not observed in bisexual men.
CONCLUSIONS
The findings suggest that LGB adults have poorer health conditions compared to the general population in Korea. These results suggest that interventions are needed to address the health disparities of Korean LGB adults.
Summary
Korean summary
본 연구는 만 19세 이상의 한국 성인 동성애자와 양성애자를 대상으로 이들의 건강상태에 대한 설문조사를 시행하고, 수집한 자료를 분석하여 동성애자·양성애자의 건강불평등 실태를 파악하고자 하였다. 본 연구의 목적은 자가평가건강, 정신건강(우울, 자살생각 및 자살시도), 신체적 건강(근골격계 통증) 및 건강관련행동(흡연율, 위험음주율)을 포함하여 다양한 측면에서 한국 성인 동성애자·양성애자와 일반인구집단의 건강수준을 비교하는 것이다.

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    International Journal of Transgender Health.2024; 25(2): 283.     CrossRef
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    Society and Mental Health.2024;[Epub]     CrossRef
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    Minkyung Yim, Gyumyoung Kim, Eunjin Jo, Ji-Won Hur
    Journal of LGBT Youth.2024; : 1.     CrossRef
  • Internalized homophobia and HIV testing among Korean gay and bisexual men: a study in a high-income country with pervasive HIV/AIDS stigma
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    AIDS Care.2023; 35(5): 672.     CrossRef
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    Gerard W. Toh, Wee Ling Koh, Jack Ho, Jackson Chia, Ad Maulod, Irene Tirtajana, Peter Yang, Mathia Lee
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Analysis of the relationship between community characteristics and depression using geographically weighted regression
Hyungyun Choi, Ho Kim
Epidemiol Health. 2017;39:e2017025.   Published online June 21, 2017
DOI: https://doi.org/10.4178/epih.e2017025
  • 14,768 View
  • 237 Download
  • 1 Web of Science
  • 4 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Achieving national health equity is currently a pressing issue. Large regional variations in the health determinants are observed. Depression, one of the most common mental disorders, has large variations in incidence among different populations, and thus must be regionally analyzed. The present study aimed at analyzing regional disparities in depressive symptoms and identifying the health determinants that require regional interventions.
METHODS
Using health indicators of depression in the Korea Community Health Survey 2011 and 2013, the Moran’s I was calculated for each variable to assess spatial autocorrelation, and a validated geographically weighted regression analysis using ArcGIS version 10.1 of different domains: health behavior, morbidity, and the social and physical environments were created, and the final model included a combination of significant variables in these models.
RESULTS
In the health behavior domain, the weekly breakfast intake frequency of 1-2 times was the most significantly correlated with depression in all regions, followed by exposure to secondhand smoke and the level of perceived stress in some regions. In the morbidity domain, the rate of lifetime diagnosis of myocardial infarction was the most significantly correlated with depression. In the social and physical environment domain, the trust environment within the local community was highly correlated with depression, showing that lower the level of trust, higher was the level of depression. A final model was constructed and analyzed using highly influential variables from each domain. The models were divided into two groups according to the significance of correlation of each variable with the experience of depression symptoms.
CONCLUSIONS
The indicators of the regional health status are significantly associated with the incidence of depressive symptoms within a region. The significance of this correlation varied across regions.
Summary
Korean summary
정신질환 중 가장 흔한 우울증의 경우 집단의 특성 간 발생 현황에 차이를 보이고 있어 지역별 접근을 통한 연구가 요구됨에 따라 본 연구에서는 우울증의 지역적 변이요인을 분석하여 지역별 중재가 필요한 건강결정요인을 파악하고자 지역사회건강조사 자료를 이용하여 공간적 지리가중회귀분석을 시행하였다. 본 연구를 통해 지역단위보건관련지표는 지역의 우울증 발생과 유의미한 연관성이 있으며 연관성 우선순위는 지역별 차이가 있음이 밝혀졌다. 지역적 특성에 따른 우선순위를 제시하였음에 본 연구의 의의가 있으며 공중 보건 영역의 다른 사례에 본 연구방법론 및 연구결과 제시 방안을 적용함에 따라 지역의 건강수준향상 프로그램 개발에 유용한 기초자료의 제공을 기대할 수 있다.

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Exploring neighborhood inequality in female breast cancer incidence in Tehran using Bayesian spatial models and a spatial scan statistic
Erfan Ayubi, Mohammad Ali Mansournia, Ali Ghanbari Motlagh, Alireza Mosavi-Jarrahi, Ali Hosseini, Kamran Yazdani
Epidemiol Health. 2017;39:e2017021.   Published online May 17, 2017
DOI: https://doi.org/10.4178/epih.e2017021
  • 15,395 View
  • 229 Download
  • 11 Web of Science
  • 13 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
The aim of this study was to explore the spatial pattern of female breast cancer (BC) incidence at the neighborhood level in Tehran, Iran.
METHODS
The present study included all registered incident cases of female BC from March 2008 to March 2011. The raw standardized incidence ratio (SIR) of BC for each neighborhood was estimated by comparing observed cases relative to expected cases. The estimated raw SIRs were smoothed by a Besag, York, and Mollie spatial model and the spatial empirical Bayesian method. The purely spatial scan statistic was used to identify spatial clusters.
RESULTS
There were 4,175 incident BC cases in the study area from 2008 to 2011, of which 3,080 were successfully geocoded to the neighborhood level. Higher than expected rates of BC were found in neighborhoods located in northern and central Tehran, whereas lower rates appeared in southern areas. The most likely cluster of higher than expected BC incidence involved neighborhoods in districts 3 and 6, with an observed-to-expected ratio of 3.92 (p<0.001), whereas the most likely cluster of lower than expected rates involved neighborhoods in districts 17, 18, and 19, with an observed-to-expected ratio of 0.05 (p<0.001).
CONCLUSIONS
Neighborhood-level inequality in the incidence of BC exists in Tehran. These findings can serve as a basis for resource allocation and preventive strategies in at-risk areas.
Summary

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Validity analysis on merged and averaged data using within and between analysis: focus on effect of qualitative social capital on self-rated health
Sang soo Shin, Young-jeon Shin
Epidemiol Health. 2016;38:e2016012.   Published online April 8, 2016
DOI: https://doi.org/10.4178/epih.e2016012
  • 18,357 View
  • 166 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
With an increasing number of studies highlighting regional social capital (SC) as a determinant of health, many studies are using multi-level analysis with merged and averaged scores of community residents’ survey responses calculated from community SC data. Sufficient examination is required to validate if the merged and averaged data can represent the community. Therefore, this study analyzes the validity of the selected indicators and their applicability in multi-level analysis.
METHODS
Within and between analysis (WABA) was performed after creating community variables using merged and averaged data of community residents’ responses from the 2013 Community Health Survey in Korea, using subjective self-rated health assessment as a dependent variable. Further analysis was performed following the model suggested by WABA result.
RESULTS
Both E-test results (1) and WABA results (2) revealed that single-level analysis needs to be performed using qualitative SC variable with cluster mean centering. Through single-level multivariate regression analysis, qualitative SC with cluster mean centering showed positive effect on self-rated health (0.054, p<0.001), although there was no substantial difference in comparison to analysis using SC variables without cluster mean centering or multi-level analysis.
CONCLUSIONS
As modification in qualitative SC was larger within the community than between communities, we validate that relational analysis of individual self-rated health can be performed within the group, using cluster mean centering. Other tests besides the WABA can be performed in the future to confirm the validity of using community variables and their applicability in multi-level analysis.
Summary
Korean summary
이 연구는 개인의 주관적 건강감에 미치는 지역 사회 자본의 효과를 보기 위하여 개인 응답치의 합산 평균한 자료를 지역 변인으로 활용하는 것이 타당한지 WABA 를 수행하였다. 분석 결과 다수준 분석을 하는 것이 적절치 않았으며 개인 수준의 사회자본에서 지역 수준의 사회자본을 뺀 값을 단수준 분석에 활용할 것을 제안하였다.

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    Justin Rodgers, Anna V. Valuev, Yulin Hswen, S.V. Subramanian
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Epidemiol Health : Epidemiology and Health