Epidemiology and Health

Original Articles

Socioeconomic inequality in health-related quality of life among Korean adults with chronic disease: an analysis of the Korean Community Health Survey: Thi Huyen Trang Nguyen, Thi Tra Bui, Jinhee Lee, Kui Son Choi, Hyunsoon Cho, Jin-Kyoung Oh; Epidemiol Health. 2024;46:e2024018. Published online January 8, 2024; DOI: https://doi.org/10.4178/epih.e2024018

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Abstract

OBJECTIVES
Health-related quality of life is crucial for people dealing with chronic illness. This study investigated the quality of life in individuals with 5 common chronic conditions in Korea. We also analyzed socioeconomic factors such as education, income, occupation, and urbanization to identify determinants of inequality.

METHODS

Using 2016 Korea Community Health Survey data, we examined individuals aged 30 or older with chronic diseases (diabetes, hypertension, cardiovascular disease, hyperlipidemia, arthritis) using the EuroQol 5-Dimension 3 Level tool. We analyzed the associations between socioeconomic factors (education, income, occupation, urbanization) and quality of life using descriptive statistics and regression analysis. Inequality indices (relative inequality index, absolute inequality index) were used to measure inequality in quality of life.

RESULTS

Individuals with higher income levels showed a 1.95-fold higher likelihood of a better quality of life than those with the lowest income. The lowest income group had higher odds of mobility (adjusted odds ratio [aOR], 2.2), self-care (aOR, 2.1), activity limitations (aOR, 2.4), pain/discomfort (aOR, 1.8), and anxiety/depression (aOR, 2.3). Educational disparities included a 3-fold increase in mobility and daily activity problems for those with elementary or lower education. Well-educated participants had a 1.94 times higher quality of life, with smaller differences in anxiety/depression and self-management. The income gap accounted for 14.1% of variance in quality-of-life disparities.

CONCLUSIONS

Addressing socioeconomic disparities in the quality of life for individuals with chronic diseases necessitates tailored interventions and targeted health policies. This research informs policymakers in developing focused initiatives to alleviate health inequities. It emphasizes the importance of mental health support and ensuring affordable, accessible healthcare services.

Summary

Korean summary
- 지역사회건강조사 자료를 통해 확인한 한국인에게 호발하는 만성질환자(당뇨, 고혈압, 심혈관질환, 고지혈증, 관절염)에서 삶의 질 점수(EQ-5D)는 평균 0.7점으로, 남성에서 높고, 연령이 높을수록 낮다. - 소득이 낮거나 교육수준이 낮은 군에서 삶의 질이 상대적으로 낮으며, 특히 운동능력, 자기관리, 통증/불편, 불안/우울 각각에서 두배 가량 어려움을 겪는 것으로 나타났다. - 만성질환자에서 삶의 질은 사회경제적 여건에 따라 격차가 존재하므로, 취약한 계층 발굴과 지원이 필요하다.

Key Message
- Quality of life score (EQ-5D) in patients with chronic diseases (i.e., diabetes, hypertension, cardiovascular disease, hyperlipidemia, and arthritis) that are prevalent in Koreans identified through data from community health surveys averaged 0.7, lower in women than in men, and decreased by age. - Low-income or low-educated patients have relatively low quality of life, and they have more than twice as much problem in mobility, self-care, pain/discomfort, and anxiety/depression. - Disparities in quality of life in patients with chronic diseases according to socioeconomic conditions have been found, and support for the vulnerable is needed.

Citations

Citations to this article as recorded by

Analysis of asthma incidence and mortality rates among children aged 0–14 in 204 countries from 1990 to 2019
Fei Cheng, Li He, Dachuan Deng, Jinhui Zhang, Cheng Liu
Journal of Asthma.2024; : 1. CrossRef

Decomposition of socioeconomic inequalities in glaucoma knowledge in Taiwan: Chiun-Ho Hou, Christy Pu; Epidemiol Health. 2024;46:e2024004. Published online December 5, 2023; DOI: https://doi.org/10.4178/epih.e2024004

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Abstract Summary PDF: Abstract
OBJECTIVES
Glaucoma knowledge is strongly associated with medication adherence and preventive behavior. Studies have frequently reported socioeconomic inequalities in glaucoma knowledge. This study aimed to decompose such inequalities. Decomposition analysis enables the design of policies directly targeting the underlying causes of inequality.
METHODS
We performed a cross-sectional survey from January 1, 2019 to June 30, 2019, at the departments of ophthalmology of 2 medical centers belonging to a hospital chain in northern Taiwan. Socioeconomic inequalities in glaucoma knowledge were ranked based on 3 aspects of socioeconomic status (SES): (1) education, (2) income, and (3) self-perceived financial status. The concentration index was calculated and decomposed using decomposition analysis. Elasticity and marginal effects were estimated for each decomposed factor.
RESULTS
In total, 1,203 patients completed the survey. Both measures of glaucoma knowledge and overall glaucoma knowledge score significantly contributed to the progressivity of knowledge inequalities (pro-high-SES inequalities). The concentration index for overall knowledge score with respect to education was 0.166 (p<0.001). Both objective and subjective measures of SES were associated with pro-high-SES inequalities. Our decomposition analysis revealed that demographic factors and attitudinal factors such as the level of concern regarding developing glaucoma contributed significantly to SES-based inequalities in glaucoma knowledge.
CONCLUSIONS
Our decomposition analysis provided empirical evidence regarding the underlying causes of SES-based inequalities in glaucoma knowledge. Efforts to improve glaucoma knowledge should consider specific factors that drive SES-based inequalities, such as age, sex, and concern about vision health, to ultimately achieve low SES-based inequalities.; Summary

Key Message
This study investigates the relationship between glaucoma knowledge and socioeconomic status (SES) inequalities, and the underlying causes of these disparities. The study concludes that understanding the drivers of SES-based inequalities in glaucoma knowledge, like age, gender, and concerns about vision health, is crucial. This understanding can guide efforts to improve glaucoma awareness and address SES-based disparities in knowledge, aiming to reduce these inequalities.

Irritable bowel syndrome is concentrated in people with higher educations in Iran: an inequality analysis: Asieh Mansouri, Mostafa Amini Rarani, Mosayeb Fallahi, Iman Alvandi; Epidemiol Health. 2017;39:e2017005. Published online February 1, 2017; DOI: https://doi.org/10.4178/epih.e2017005

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15 Web of Science
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Abstract PDF

Abstract

OBJECTIVES
Like any other health-related disorder, irritable bowel syndrome (IBS) has a differential distribution with respect to socioeconomic factors. This study aimed to estimate and decompose educational inequalities in the prevalence of IBS.

METHODS

Sampling was performed using a multi-stage random cluster sampling approach. The data of 1,850 residents of Kish Island aged 15 years or older were included, and the determinants of IBS were identified using a generalized estimating equation regression model. The concentration index of educational inequality in cases of IBS was estimated and decomposed as the specific inequality index.

RESULTS

The prevalence of IBS in this study was 21.57% (95% confidence interval [CI], 19.69 to 23.44%). The concentration index of IBS was 0.20 (95% CI, 0.14 to 0.26). A multivariable regression model revealed that age, sex, level of education, marital status, anxiety, and poor general health were significant determinants of IBS. In the decomposition analysis, level of education (89.91%), age (−11.99%), and marital status (9.11%) were the three main contributors to IBS inequality. Anxiety and poor general health were the next two contributors to IBS inequality, and were responsible for more than 12% of the total observed inequality.

CONCLUSIONS

The main contributors of IBS inequality were education level, age, and marital status. Given the high percentage of anxious individuals among highly educated, young, single, and divorced people, we can conclude that all contributors to IBS inequality may be partially influenced by psychological factors. Therefore, programs that promote the development of mental health to alleviate the abovementioned inequality in this population are highly warranted.

Summary

Citations

Citations to this article as recorded by

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Maryam Soheilipour, Atefeh Chahichi, Hamid Mohajer, Niousha Ghomashi, Hamidreza Roohafza, Peyman Adibi
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BMC Public Health.2023;[Epub] CrossRef
The prevalence and risk factors of irritable bowel syndrome in Saudi Arabia in 2019
NaifH Alqahtani, MohammadEid M Mahfouz
International Journal of Preventive Medicine.2022; 13(1): 13. CrossRef
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