Epidemiology and Health

Original Article

Socioeconomic status and adverse pregnancy outcome increase the risk of long-term cardiovascular disease: an analysis using the UK Biobank: Ji Hoi Kim, Un Yung Choi, Jeesun Lee, Manu Shivakumar, Dokyoon Kim, Kue Hyun Kang, So-hee Kim, Haibin Bai, Chan-Wook Park, Joong Shin Park, Juwon Lim, Jeehoon Kang, Soo Heon Kwak, Seung Mi Lee; Epidemiol Health. 2025;47:e2025075. Published online December 25, 2025; DOI: https://doi.org/10.4178/epih.e2025075

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Abstract PDF: Abstract
OBJECTIVES
Adverse pregnancy outcomes (APOs) and low socioeconomic status (SES) are both associated with an increased long-term risk of atherosclerotic cardiovascular disease (ASCVD). In this analysis, we evaluated whether the association between a history of APO and ASCVD risk varies across different SES groups.
METHODS
We conducted this analysis using data from the UK Biobank, a large prospective cohort including participants aged 40 years to 69 years recruited between 2006 and 2010, with ongoing follow-up. APOs included hypertensive disorders of pregnancy, gestational diabetes mellitus, low birth weight (<2.5 kg), and stillbirth. At enrollment, SES was assessed using the following indicators: household income, education, employment, and Townsend Deprivation Index. The adjusted hazard ratio (aHR) for new-onset ASCVD was analyzed according to history of APO and SES categories.
RESULTS
Among 146,064 women, those with a history of APO had a higher risk of new-onset ASCVD and overall lower SES—including lower income, less education, higher unemployment, and greater deprivation—compared with those without APO (p<0.001). The increased ASCVD risk associated with APO history was significant only in the low SES group (aHR, 1.26; 95% confidence interval [CI], 1.16 to 1.36), but not in the high SES group (aHR, 1.07; 95% CI, 0.74 to 1.55, p=0.716).
CONCLUSIONS
We found that women with low SES were more vulnerable to the adverse effects of APO history, resulting in a greater increase in ASCVD risk. This study highlights the need for SES-tailored preventive policies to reduce long-term cardiovascular disease in women with a history of APO.; Summary

Systematic Review

Socioeconomic factors affecting breast and cervical cancer screening compliance in Asian National Cancer Centers Alliance countries: a systematic review: Seowoo Bae, Ye Ji Kang, Jeonghoon Ahn, Bo-Hyoung Jang, Kui Son Choi, Hyeon Ji Lee, Mina Suh; Epidemiol Health. 2025;47:e2025050. Published online August 28, 2025; DOI: https://doi.org/10.4178/epih.e2025050

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Breast and cervical cancers are the most frequently diagnosed cancers in women. The Asian National Cancer Centers Alliance (ANCCA) has strengthened cancer control efforts in the Asia region; however, only a few countries have achieved sufficient participation rates. This systematic review aimed to synthesize the existing evidence on socioeconomic factors influencing women’s compliance with breast and cervical cancer screening in ANCCA countries. This study was conducted as a systematic review, with studies collected from PubMed, Cochrane Library, Scopus, and Embase. All included studies employed cross-sectional designs to identify socioeconomic factors affecting compliance with breast or cervical cancer screening. Study selection, quality assessment, and data extraction were carried out by 2 independent reviewers with cross-checking. In total, 48 studies were reviewed. Education level and family history were associated with participation in breast cancer screening, while education level, household income, marital status, and medical insurance were linked with cervical cancer screening. When stratified by Human Development Index (HDI) level or by the presence of a National Cancer Screening Program, differences were observed in the factors influencing screening compliance. Nevertheless, higher education consistently correlated with higher screening rates for both cancer types, regardless of HDI level. This systematic review identified multiple socioeconomic factors that shape breast and cervical cancer screening compliance in Asian countries. To reduce disparities in participation, tailored multi-strategy approaches adapted to each country’s specific context are required. These findings may provide useful evidence for future research and policy initiatives aimed at addressing health equity issues.; Summary

Korean summary
여성의 유방암 및 자궁경부암 검진 참여는 다양한 사회경제적 요인의 영향을 받는다. 두 암 모두에서 교육 수준이 높을수록 검진 참여율이 높았으며, 기타 요인들은 암 종류에 따라 달랐다. 검진 참여 격차를 줄이고 건강 형평성을 향상시키기 위해서는 각 국가의 특성을 반영한 다차원적 맞춤형 전략이 필요하다.

Key Message
Breast and cervical cancer screening compliance among women is influenced by various socioeconomic factors. Higher education consistently increased screening participation for both cancers, whereas other factors differed by cancer type. To reduce disparities and promote health equity, multi-strategy approaches tailored to each country’s specific context are required.

COVID-19: Original Article

Decentralized pandemic response and health equity: an analysis of socioeconomic disparities in COVID-19 mortality in Japan: Hasan Jamil, Aminu Abubakar Kende, Shuhei Nomura, Fumiya Inoue, Takao Suzuki, Stuart Gilmour; Epidemiol Health. 2025;47:e2025049. Published online August 28, 2025; DOI: https://doi.org/10.4178/epih.e2025049

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OBJECTIVES
Global data often link greater socioeconomic deprivation to higher coronavirus disease 2019 (COVID-19) mortality. However, whether decentralized governance can mitigate this disparity by enabling tailored, equitable local responses remains unclear. We assessed whether Japan’s decentralized pandemic response moderated the association between area-level socioeconomic deprivation and COVID-19 mortality across municipalities.
METHODS
We analyzed 20,760 COVID-19 deaths from all Japanese municipalities during 2020-2021. We computed standardized mortality ratios using national age-specific and sex-specific rates to derive expected counts. We then fit a Bayesian spatial Poisson regression model with the log of expected counts as an offset to estimate smoothed relative risks (RRs). The Area Deprivation Index (ADI) represented the primary predictor; structured and unstructured random effects captured spatial correlation and residual variability.
RESULTS
Mapping of smoothed RRs, categorized into quintiles, revealed higher mortality risk in northern, central, and western municipalities, with lower risk in southern and scattered central regions. Contradicting global trends, deprivation and COVID-19 mortality demonstrated an inverse association (ADI coefficient, -0.095; 95% credible interval, -0.173 to -0.018), indicating that more deprived municipalities exhibited lower RRs for COVID-19 mortality (9.1% reduction per 1-unit increase in ADI).
CONCLUSIONS
The inverse relationship between area deprivation and COVID-19 mortality in Japan contrasts with global patterns. Although Japan’s decentralized health system ensured equitable access to COVID-19 treatment, lower mortality in more deprived areas likely reflects additional protective factors, including population density patterns and community-specific adaptations. These findings underscore the complex interplay between socioeconomic conditions and health outcomes during global health emergencies.; Summary

Key Message
Japan exhibited an inverse COVID-19 mortality pattern: 9% lower risk per unit increase in area deprivation, contrasting with patterns elsewhere. This occurred where universal healthcare access and decentralized public health infrastructure operated in a geographic context of rural, lower-density deprived areas. The convergence of health system characteristics, population distribution, and social factors likely produced this divergence from typical pandemic inequities.

Original Articles

Individual- and neighborhood-level factors influencing diet quality: a multilevel analysis using Korea National Health and Nutrition Examination Survey data, 2010-2019: Dahyun Park, Min-Jeong Shin, S V Subramanian, Clara Yongjoo Park, Rockli Kim; Epidemiol Health. 2025;47:e2025043. Published online August 4, 2025; DOI: https://doi.org/10.4178/epih.e2025043

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OBJECTIVES
Although environmental factors influence lifestyle choices, few studies have examined how individual-level and neighborhood-level socio-demographic factors interact to affect diet quality in Korea. We investigated the associations between multilevel factors and diet quality among Korean adults and explored potential interactions by gender and age.
METHODS
We conducted a cross-sectional analysis of 42,035 adults from 1,671 towns using data from the Korea National Health and Nutrition Examination Survey (2010-2019) and the Population and Housing Census of Korea (2010-2019). Individual-level variables included gender, age, education, income, number of household members, smoking, drinking, physical activity, and subjective health status. Neighborhood-level variables included residential area, housing type, number of restaurants per capita, population size, and the proportion of low-income households and older adults. Associations with the Korean Healthy Eating Index (KHEI) were assessed using 2-level hierarchical models.
RESULTS
Of the total variance in KHEI, 5.2% was attributable to neighborhood-level differences. Individual-level factors explained 48.1% of variance at the neighborhood-level, while neighborhood-level factors accounted for an additional 12.4%. Individuals living in rural areas, non-apartment housing, neighborhoods with higher proportions of low-income households and older adults, or in areas with smaller populations, had lower KHEI scores than their counterparts. In random slope models with cross-level interaction terms, diet quality among adults aged 70 years and older varied significantly according to neighborhood- level characteristics.
CONCLUSIONS
Both individual-level and neighborhood-level factors influence diet quality in Korea, with older adults being especially vulnerable to neighborhood characteristics. Multilevel approaches are needed to identify at-risk populations and improve dietary outcomes.; Summary

Korean summary
한국에서 식이 질은 개인적 요인 뿐 만 아니라 지역사회 수준 요인에 의해서도 유의하게 영향을 받는다. 농촌 거주, 비아파트 주거, 저소득층 또는 고령 인구 비율이 높은 지역에 거주하는 경우 한국 건강식이 지수(KHEI) 점수가 낮게 나타났다. 특히 노인은 불리한 지역사회 환경에 더욱 취약하여, 젊은 성인보다 더 강한 교차 수준 상호작용을 보였다.

Key Message
Both individual- and neighborhood-level factors significantly influence diet quality in Korea. Rural residence, non-apartment housing, and neighborhoods with higher proportions of low-income or elderly residents were associated with lower Korean Healthy Eating Index (KHEI) scores. Older adults were especially vulnerable to adverse neighborhood environments, show- ing stronger cross-level interactions than younger adults.

Inequality in mortality according to regional deprivation during the COVID-19 pandemic: Min Hui Moon, Young Gyu Ko, Min Hyeok Choi; Epidemiol Health. 2025;47:e2025022. Published online April 29, 2025; DOI: https://doi.org/10.4178/epih.e2025022

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Vulnerability to coronavirus disease 2019 (COVID-19) is significantly greater in regions with lower socioeconomic status (SES). However, detailed analyses of regional socioeconomic disparities have rarely been conducted in Korea. This study aimed to identify and compare mortality inequalities associated with regional SES across different areas of Korea during the COVID-19 pandemic.
METHODS
Using cause-of-death statistics from 2020 to 2022, we calculated age-standardized mortality rates (ASMRs) for total mortality, COVID-19 mortality, and pneumonia mortality. The SES of each region was assessed using the regional deprivation index. Additionally, we calculated the rate difference, rate ratio, slope index of inequality (SII), and relative index of inequality (RII) for each socioeconomic level to examine the extent of mortality inequality and its temporal changes. These analyses were stratified by gender and urban-rural classification.
RESULTS
The total mortality rate, as well as COVID-19-specific and pneumonia-specific mortality rates, increased during the COVID-19 pandemic. The ASMR for COVID-19 was higher in rural areas (ASMR, 27.79), which have lower healthcare accessibility, compared to urban areas (ASMR, 26.63). However, mortality inequality indicators for COVID-19 were more pronounced in urban areas compared to rural areas (SII: urban, 2.72; rural, -0.05, RII: urban, 0.10; rural, 0.00). Notably, significant inequalities were observed among men residing in urban areas.
CONCLUSIONS
In disaster situations such as the COVID-19 pandemic, it is essential to implement strategies aimed at reducing overall mortality rates and addressing regional socioeconomic inequalities.; Summary

Korean summary
COVID-19 팬데믹 기간 동안, 지역의 사회경제적 수준은 한국의 사망률에 중요한 영향을 미쳤다. 총사망률, COVID-19 사망률, 폐렴 사망률에 대한 연령표준화사망률(ASMR)은 의료 접근성이 낮고 박탈 수준이 높은 농촌 지역에서 더 높게 나타났으나, 상대적인 사망 불평등은 특히 남성을 중심으로 도시 지역에서 더 두드러지게 나타났다. 이러한 결과는 공중보건 위기 상황에서 건강 불평등이 지역의 사회경제적 수준과 맥락에 따라 복합적으로 작용함을 보여준다. 정책 입안자들은 지역 간 사회경제적 수준에 따른 절대적 불평등과 상대적 불평등을 모두 고려한 맞춤형 개입 전략을 수립하고, 형평한 의료 접근성을 확보함으로써 향후 팬데믹에서의 사망 위험을 줄이기 위한 노력을 강화해야 한다.

Key Message
During the COVID-19 pandemic, regional socioeconomic disparities significantly influenced mortality in Korea. Mortality rates were higher in deprived rural areas, while relative inequalities were more evident in urban men. Tailored policies addressing both absolute and relative inequalities are essential to ensure equitable healthcare access in future crises.

Prevalence of cardiovascular-kidney-metabolic syndrome in Korea: Korea National Health and Nutrition Examination Survey 2011-2021: Sung-Bin Hong, Ji-Eun Kim, Seung Seok Han, Joseph J. Shearer, Jungnam Joo, Ji-Yeob Choi, Véronique L. Roger; Epidemiol Health. 2025;47:e2025005. Published online February 14, 2025; DOI: https://doi.org/10.4178/epih.e2025005

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
The American Heart Association (AHA) recently defined cardiovascular-kidney-metabolic (CKM) syndrome to better characterize the associations among cardiovascular, kidney, and metabolic diseases. Although about 9 in 10 United States adults have at least 1 risk factor for CKM syndrome, its prevalence in other populations is less understood. To fill this gap, we examined the prevalence of CKM syndrome in Korea and its association with demographic and socioeconomic status (SES).

METHODS

Using data from the Korean National Health and Nutrition Examination Survey between 2011 and 2021, we calculated the prevalence of CKM syndrome across the following stages: stage 0 (no risk factors), stage 1 (excess or dysfunctional adiposity), stage 2 (other metabolic risk factors or chronic kidney disease), and stages 3-4 (subclinical/clinical cardiovascular diseases) among adults aged ≥20 years. Weighted analyses were used to estimate prevalence and 95% confidence intervals (CIs) for each CKM syndrome stage, stratified by age, gender, and SES factors.

RESULTS

Among 54,994 Korean adults, the prevalence of CKM syndrome was as follows: stage 0 (25.2%; 95% CI, 24.7 to 25.8), stage 1 (19.3%; 95% CI, 18.9 to 19.7), stage 2 (51.6%; 95% CI, 51.1 to 52.2), and stages 3-4 (3.9%; 95% CI, 3.7 to 4.0). The prevalence of stages 2 and 3-4 was higher in men than in women. In addition, stages 3-4 were more prevalent among rural residents and those with lower education or income.

CONCLUSIONS

About 3 out of 4 Koreans are at risk for CKM syndrome. These findings highlight that CKM syndrome is a global health problem and that interventions are urgently needed to prevent further progression.

Summary

Korean summary
최근, 심장-신장-대사 증후군을 하나로 묶어 관리하는 것의 필요성이 대두되고 있다. 본 연구 결과 20세 이상의 한국 성인들의 74.8%가 심장-신장-대사 증후군의 위험군에 속해 있었다. 또한 그 정도가 증가하는 추세로 나타나 적절한 관리가 필요해 보인다.

Key Message
Recently, the need for an integrated approach to managing cardiovascular-kidney-metabolic (CKM) syndrome has been emphasized. This study found that 74.8% of Korean adults aged 20 and older had a risk for CKM syndrome. Moreover, the prevalence is increasing, highlighting the necessity of proper management.

Citations

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Residual cholesterol inflammatory index and its prognostic role in mortality among individuals with cardiovascular–kidney–metabolic syndrome stages 0–3 based on U.S. and Chinese national cohorts
Shouxin Wei, Sijia Yu, Chuan Qian, Zhengwen Xu, Yindong Jia
European Journal of Medical Research.2025;[Epub] CrossRef
Relationship between estimated pulse wave velocity trajectories and cardiovascular disease risk in patients with cardiovascular-kidney-metabolic syndrome stages 0–3
Tingting Chen, Huangyi Yin, Yubo Zhou, Min Liang
Nutrition, Metabolism and Cardiovascular Diseases.2025; 35(11): 104192. CrossRef
The Reply
Ji-Eun Kim, Véronique L. Roger, Joseph J. Shearer
The American Journal of Medicine.2025; 138(8): e163. CrossRef
Prevalence of Cardiovascular–Kidney–Metabolic (CKM) Syndrome in Lithuanian Adults: Insights from a Nationwide Real-World Study Using Electronic Health Records
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Medicina.2025; 61(12): 2106. CrossRef
Data-driven cluster analysis identifies distinct types of cardiovascular-kidney-metabolic syndrome
Mengge Yang, Chang Su, Xiaona Chang, Guang Wang, Jia Liu
European Journal of Preventive Cardiology.2025;[Epub] CrossRef
Stage-specific risks of mortality and renal outcomes in cardiovascular-kidney-metabolic syndrome: findings from a nationwide Japanese cohort
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Clinical and Experimental Nephrology.2025;[Epub] CrossRef

Inequality in dental flossing behavior among Korean adults based on household income levels: Zi-Lan Wang, Eun-Jae Choi, Seung-Hee Ryu, Seon-Jip Kim, Hyun-Jae Cho; Epidemiol Health. 2024;46:e2024052. Published online May 24, 2024; DOI: https://doi.org/10.4178/epih.e2024052

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Abstract

OBJECTIVES
The aim of this study was to estimate the association between household income and dental flossing.

METHODS

This cross-sectional study investigated the impact of household income on flossing among 9,391 adults aged 30+ with ≥20 natural teeth, utilizing data from the seventh Korea National Health and Nutrition Examination Survey (2016-2018). Outcome measures included flossing (yes/no), with income categorized into 4 levels: lowest, medium to low, medium to high, and highest. Logistic regression, adjusted for age, gender, brushing frequency, recent dental exams, periodontitis, smoking, and alcohol use, was employed to evaluate the influence of socioeconomic status on oral hygiene practices.

RESULTS

In the highest income group, flossing was 62.6% more prevalent than in the lowest income group (adjusted odds ratio [aOR], 1.63; 95% CI, 1.27 to 2.08). The strongest association between income levels and flossing was observed in individuals aged ≥70 years (aOR, 3.64; 95% CI, 1.86 to 7.11), with a decreasing strength of association in the 60s (aOR, 1.72; 95% CI, 1.05 to 2.84) and 50s age groups (aOR, 1.69; 95% CI, 1.07 to 2.68). Higher-income women demonstrated a higher frequency of flossing than their lower-income counterparts (aOR, 1.67; 95% CI, 1.24 to 2.23). Higher-income individuals without periodontitis were more likely to floss (aOR, 1.64; 95% CI, 1.23 to 2.18), and among those with periodontitis, flossing was significantly associated only with the highest income category (aOR, 1.64; 95% CI, 1.10 to 2.44).

CONCLUSIONS

The findings of this study indicate a significant correlation between higher household income levels and an increased prevalence of flossing.

Summary

Korean summary
이 연구는 치실 사용이 개인의 건강행동 습관뿐만 아니라 사회경제적 지위에 의해 크게 영향을 받는다는 점을 강조합니다. 높은 소득층이 치실을 더 자주 사용하는 경향이 있으며, 이는 교육 수준과 건강 문해력, 경제적 여유와 관련이 있습니다. 공중보건 계획에서 경제적 요인을 고려하고, 치과 위생 교육과 제품 접근성을 개선해야 합니다.

Key Message
This study highlights that the use of dental floss is significantly influenced not only by personal health behavior habits but also by socioeconomic status. Individuals in higher income classes tend to use dental floss more frequently, which is associated with higher levels of education, health literacy, and economic resources. Public health planning should take economic factors into account and focus on improving dental hygiene education and access to dental care products.

Citations

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Histopathogenesis of proximal caries: An expanded hypothesis
Frederico Barbosa de Sousa, Nikolas Paganini Alves de Oliveira
Medical Hypotheses.2026; 206: 111851. CrossRef
Central adiposity indices and inflammatory markers mediate the association between life’s crucial 9 and periodontitis in US adults
Jia-Jie Guo, Qi-Qi Hang, Ting Xu, Wei-Xuan Liang, Jia-Kun Gao, Hong-Biao Ou, Fu-Zhen Jiang, Xi-Chen-Hui Qiu, Zu-Zhang Tian, Yu-zhong Zhang, Jing Zhang
Lipids in Health and Disease.2025;[Epub] CrossRef

The effect of public hospital closure on the death of long-term inpatients in Korea: Taeuk Kang, Minsung Sohn, Changwoo Shon; Epidemiol Health. 2024;46:e2024022. Published online January 17, 2024; DOI: https://doi.org/10.4178/epih.e2024022

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Abstract Summary PDF

Abstract

OBJECTIVES
This study aimed to examine the changes in health outcomes and the patterns of medical institution utilization among patients with long-term stays in public hospitals following the closure of a public medical center. It also sought to present a proposal regarding the role of public hospitals in countries with healthcare systems predominantly driven by private entities, such as Korea.

METHODS

To assess the impact of a public healthcare institution closure on health outcomes in a specific region, we utilized nationally representative health insurance claims data. A retrospective cohort study was conducted for this analysis.

RESULTS

An analysis of the medical utilization patterns of patients after the closure of Jinju Medical Center showed that 67.4% of the total medical usage was redirected to long-term care hospitals. This figure is notably high in comparison to the 20% utilization rate of nursing hospitals observed among patients from other medical facilities. These results indicate that former patients of Jinju Medical Center may have experienced limitations in accessing necessary medical services beyond nursing care. After accounting for relevant mortality factors, the analysis showed that the mortality rate in closed public hospitals was 2.47 (95% confidence interval, 0.85 to 0.96) times higher than in private hospitals.

CONCLUSIONS

The closure of public medical institutions has resulted in unmet healthcare needs, and an observed association was observed with increased mortality rates. It is essential to define the role and objectives of public medical institutions, taking into account the distribution of healthcare resources and the conditions of the population.

Summary

Korean summary
본 연구는 사회보험제도를 기반으로 하고 있는 한국의 상황에서 지방의 공공의료기관 폐쇄가 환자들의 건강에 어떠한 영향을 미쳤는지를 확인하고자 국민건강보험 청구자료를 기반으로 후향적코호트 자료를 구축하여 분석을 시행하였다. 연구결과 장기 입원 환자의 67.4%가 장기요양병원을 의료를 이용하였고, 이는 비교집단의 장기요양 이용비율인 20% 수준보다 3배 가량 높은 수치로, 의료이용에 일부 제약이 발생하였을 가능성을 시사하는 것이다. 폐업 후 1년 이내 사망률을 비교한 결과, 인근지역 내 민간병원 환자와 비교하여 공공의료기관 입원환자의 사망확률은 2.67배였고, 의료급여 수급권자들의 사망확률은 고소득 5분위에 비해 2.24배 높은 것으로 나타났다.

Key Message
Even in Korea's healthcare system with high medical accessibility, adverse health impacts have been observed due to the closure of public healthcare institutions. Systematic policy development is necessary to evaluate essential medical service provision and allocate medical resources comprehensively.

Citations

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Impacts of Inner-City Hospital Closures on Access to Surgical Care in Urban Communities
Eliel N. Arrey, Anahit Mehranian, Aaron M. Alford
The American Surgeon™.2026; 92(1): 129. CrossRef

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 Summary PDF

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

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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.2025; 62(1): 45. CrossRef
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Health-related Quality of Life in Multimorbid Adults: A Random Forest Cross-sectional Analysis of the Korean National Health and Nutrition Examination Survey
Moonchang You, Geun-Myun Kim
Journal of Korean Academy of psychiatric and Mental Health Nursing.2025; 34(3): 349. 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.

Citations

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Association between Household Income and Glaucoma Prevalence in South Korea: A SMOTE-Enhanced Analysis of KNHANES 2021
So Yeon Kim, Chae Hyun Song, Kyoung Hae Kang, Se Hie Park, Jaekyoung Lee, Jie James Sng, Sooyeon Choe, Jin Wook Jeoung, Ki Ho Park, Young Kook Kim
Advances in Glaucoma.2025; 14(1): 34. 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; Epidemiol Health. 2023;45:e2023033. Published online March 7, 2023; DOI: https://doi.org/10.4178/epih.e2023033

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Abstract

OBJECTIVES
This study investigated recent trends in the prevalence of obesity among Korean adolescents and explored socioeconomic disparities in obesity.

METHODS

This study used annual self-reported data on height, weight, and socioeconomic information from the Korea Youth Risk Behavior Web-based Survey from 2006 to 2020. With a 95.8% response rate, the sample consisted of 818,210 adolescents. Obesity prevalence was calculated according to 4 socioeconomic indicators (household income, father’s educational attainment, mother’s educational attainment, and urbanicity). Socioeconomic inequality was quantified using the relative index of inequality (RII).

RESULTS

The overall prevalence of obesity increased, doubling from 5.9% in 2006 to 11.7% in 2020. Boys and high school students showed a higher prevalence. The RIIs in household income and parental educational attainments significantly increased with time, indicating a growing inequality in obesity. Socioeconomic disadvantages had a greater influence on obesity among girls. The most recent RII values for boys were 1.25 for income, 1.79 for the father’s education, and 1.45 for the mother’s education, whereas the corresponding values for girls were 2.49, 3.17, and 2.62, respectively.

CONCLUSIONS

These findings highlight growing inequalities in adolescent obesity according to household income and parental educational attainments, especially for girls and middle schoolers.

Summary

Korean summary
2006년부터 2020년까지 청소년 비만의 유병은 증가 추세에 있을 뿐 아니라, 가정의 경제상태, 부모의 학력수준에 따른 비만의 위험 격차도 점점 심해지는 추세를 보였다. 특히, 남학생과 고등학생의 비만 유병률이 높게 나타났으나, 사회경제적 지표에 따른 비만의 불평등 격차는 여학생과 중학생에서 높게 나타났다.

Key Message
Not only the prevalence but also socioeconomic inequality in adolescent obesity increased between 2006 and 2020. The potential impact of socioeconomic disparity on obesity was greater in girls and middle school students than their counterparts.

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A Scoping Review of the Social Determinants of Pediatric and Adolescent Obesity
Deepali K. Ernest, Elizabeth A. Onugha, Bipin Singh, Shreela V. Sharma, Jayna M. Dave, Samuel Menahem
International Journal of Pediatrics.2025;[Epub] CrossRef
The Association Between Obesity Measures and Metabolic Syndrome Risk in Korean Adolescents Aged 10–18 Years
Munku Song, Seamon Kang, Hyunsik Kang
Journal of Multidisciplinary Healthcare.2024; Volume 17: 1769. CrossRef
Perceived Familial Financial Insecurity and Obesity Among Korean Adolescents During the COVID-19 Pandemic
Fumie Kaneko, Eunji Kim, Hokyou Lee, Kokoro Shirai, Ryo Kawasaki, Hyeon Chang Kim
Journal of Epidemiology.2024; 34(12): 587. CrossRef
Obesity-related behaviors and health-related quality of life in socioeconomically vulnerable children: A cross-sectional study
Jiyoung Park, Gill ten Hoor, Jeonghyun Cho, Seohyun Won, Soorack Ryu, Siew Tiang Lau
Journal of Pediatric Nursing.2024; 78: e270. CrossRef
A Comparison of Changes in Health Behavior, Obesity, and Mental Health of Korean Adolescents Before and During the COVID-19 Pandemic: Online Cross-Sectional Study
Mi-Sun Lee, Hooyeon Lee
Psychiatry Investigation.2023; 20(11): 1086. 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; Epidemiol Health. 2022;44:e2022107. Published online November 15, 2022; DOI: https://doi.org/10.4178/epih.e2022107

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Socioeconomic disparities have been reported as major risk factors contributing to the spread of coronavirus disease 2019 (COVID-19) at the community level. We conducted an epidemiological study on COVID-19 incidence risk using area-based deprivation indices (DIs) reflecting the characteristics of the susceptible population.

METHODS

A database of the confirmed COVID-19 cases in 8 metropolitan cities in Korea from January 20, 2020 to December 31, 2021 was combined with area-based DI scores and standardized prevalence rates of diabetes and hypertension from the Korean Community Health Survey. Relative risk (RR) levels were estimated using a generalized linear model with a Poisson distribution by age group.

RESULTS

The risk of COVID-19 incidence generally increased with increasing age, especially in patients aged ≥75 years. The RR of COVID-19 incidence per interquartile range increment of the composite deprivation index (composite DI) was 1.54 (95% confidence interval [CI], 1.34 to 1.70). Notably, in the first wave, the risk of COVID-19 incidence was approximately 3 times higher in the region with the lowest socioeconomic status than in the region with the highest status (RR, 3.08; 95% CI, 2.42 to 3.78 based on the the composite DI and RR, 3.13; 95% CI, 2.53 to 3.83 based on the social deprivation index).

CONCLUSIONS

This study provides scientific evidence that socioeconomic deprivation is an important risk factor for the spread of COVID-19. This finding suggests that a mid-term to long-term strategy is needed to protect susceptible populations and reduce the burden of COVID-19 in the community.

Summary

Korean summary
한국의 COVID-19 발생 위험은 지역박탈수준이 높은 지역에서 증가하였고, 특히 유행 초기 75세이상 연령층에서 뚜렷하게 증가하는 것으로 나타났다. 따라서 지역사회수준에서 사회경제적 여건을 고려하여 취약집단에서의 발생위험을 감소시키기 위해 중장기 전략을 세워야 한다는 것을 시사한다.

Key Message
There is a need to develop long-term strategies to reduce the risk of COVID-19 outbreaks in vulnerable populations in areas with poor socioeconomic conditions

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Yearly Spatiotemporal Patterns of COVID-19 During the Pandemic Period: An In-Depth Analysis of Regional Trends and Risk Factors in the Republic of Korea
Chiara Achangwa, Jung-Hee Park, Moo-Sik Lee
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Association between Job Types and Income Change after COVID-19
Jung-Won Lee, Young-Jin Kim, Min-Hee Heo, Ji-Hee Lyu, Jin-Won Noh, Kyoung-Beom Kim
The Korean Journal of Health Service Management.2025; 19(3): 139. CrossRef
Association between area deprivation index and concerns to COVID-19: A multi-level analysis of individual and area factors
Doo Woong Lee, Jieun Jang, Jaeyong Shin
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Social deprivation and SARS-CoV-2 testing: a population-based analysis in a highly contrasted southern France region
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Frontiers in Public Health.2023;[Epub] CrossRef

Changes in eating behaviors according to household income in adolescents during the COVID-19 pandemic: findings from the Korea National Health and Nutrition Examination Survey: Hye Ah Lee, Ho Jung Lee, Bomi Park, Yoonhee Shin, Hyunjin Park, Hyesook Park; Epidemiol Health. 2022;44:e2022102. Published online November 9, 2022; DOI: https://doi.org/10.4178/epih.e2022102

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Abstract

OBJECTIVES
To assess social inequalities in changes in dietary behaviors among adolescents during the coronavirus disease 2019 (COVID-19) pandemic, we compared changes in dietary behavior indicators by household income.

METHODS

Using cross-sectional data from the 2019 and 2020 Korea National Health and Nutrition Examination Survey, the prevalence of dietary behaviors in adolescents (12-18 years old) was estimated and changes in dietary behaviors during the COVID-19 pandemic were evaluated. We assessed changes in dietary behaviors with a household income (as a measure of socioeconomic status, SES) disparity.

RESULTS

During the COVID-19 pandemic, the average consumption of vegetables decreased and food insecurity worsened. Adolescents were more likely to skip breakfast than before COVID-19 (33.1 and 37.4%). Soft drink consumption also increased in 2020 from 2019 (7.6 and 14.8%), especially among boys. Average sugar intake and sodium intake showed a tendency to decrease only in girls, but there was no significant difference according to SES level. Skipping breakfast was particularly evident in the low-SES group, and the difference according to household income level (high vs. low) was greater during COVID-19 than before. The prevalence of soft drink consumption increased significantly in the low-SES group, but the rate of increase did not differ by SES level.

CONCLUSIONS

We found that the social disparity in skipping breakfast was further aggravated during the COVID-19 pandemic. To reach a better understanding of the dietary behaviors of adolescents, continuous monitoring is necessary.

Summary

Korean summary
국민건강영양조사 자료를 활용하여, COVID-19 팬데믹 전후 청소년의 식생활 변화 및 가구소득 수준에 따른 차이를 평가하였다. 대체로, 평균 채소 섭취량은 감소하고 탄산음료 소비는 증가한 것으로 나타났으며, 아침식사 결식율도 약간 증가한 것으로 나타났다. 게다가, 가구소득 수준에 따라 평가하였을 때, 아침식사 결식율 증가는 가구소득이 높은 군에 비해 가구소득 수준이 낮은 군에서 두드러진 것으로 나타났다. COVID-19 팬데믹이 장기화됨에 따라, 청소년의 식생활 변화에 대해서는 지속적인 모니터링이 필요하다.

Key Message
Using data from the 2019 and 2020 Korea National Health and Nutrition Examination Survey, changes in dietary behaviors of adolescents (12-18 years old) during the COVID-19 pandemic were evaluated. During the COVID-19 pandemic, average consumption of vegetables decreased and consumption of soft drinks increased in 2020 from 2019 (7.6% and 14.8%). In addition, the social disparity in skipping breakfast among adolescents was further aggravated. To reach a better understanding of the dietary behaviors of adolescents, continuous monitoring is necessary.

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Dietary Changes of Youth during the COVID-19 Pandemic: A Systematic Review
Nicolas Woods, Jamie A Seabrook, Holly Schaafsma, Shauna Burke, Trish Tucker, Jason Gilliland
The Journal of Nutrition.2024; 154(4): 1376. CrossRef
Perceived Familial Financial Insecurity and Obesity Among Korean Adolescents During the COVID-19 Pandemic
Fumie Kaneko, Eunji Kim, Hokyou Lee, Kokoro Shirai, Ryo Kawasaki, Hyeon Chang Kim
Journal of Epidemiology.2024; 34(12): 587. CrossRef
Intake of energy and macronutrients according to household income among elementary, middle, and high school students before and during the COVID-19 pandemic: a cross-sectional study
Chae-Eun Jeong, Heejin Lee, Jung Eun Lee
Korean Journal of Community Nutrition.2024; 29(3): 234. CrossRef
Analysis of health behavior, mental health, and nutritional status among Korean adolescents before and after COVID-19 outbreak: based on the 2019–2020 Korea National Health and Nutrition Examination Survey
Misun Lee, Sarang Jeong, Chong-Su Kim, Yoon Jung Yang
Journal of Nutrition and Health.2023; 56(6): 667. CrossRef

Income-based disparities in the risk of distant-stage cervical cancer and 5-year mortality after the introduction of a National Cancer Screening Program in Korea: Erdenetuya Bolormaa, Seung-Ah Choe, Mia Son, Myung Ki, Domyung Paek; Epidemiol Health. 2022;44:e2022066. Published online August 11, 2022; DOI: https://doi.org/10.4178/epih.e2022066

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Abstract

OBJECTIVES
This study assessed the socioeconomic gradient in the risk of distant-stage cervical cancer (CC) at presentation and 5-year mortality for new CC patients after the introduction of a national Cancer Screening Program (NCSP) in Korea.

METHODS

All new CC cases from 2007 to 2017 were retrieved from the Korea Central Cancer Registry database linked with the National Health Information Database of the National Health Insurance Service. The age-standardized cumulative incidence of CC, adjusted odds ratios (ORs) of distant metastasis at presentation, and adjusted all-cause mortality hazard ratios (HRs) within 5 years post-diagnosis were assessed according to the income gradient.

RESULTS

The 11-year age-standardized cumulative incidence of CC ranged from 48.9 to 381.5 per 100,000 women, with the richest quintile having the highest incidence. Of 31,391 new cases, 8.6% had distant metastasis on presentation, which was most frequent among Medical Aid beneficiaries (9.9%). Distant-stage CC was more likely when the income level was lower (OR, 1.46; 95% confidence interval [CI]), 1.28 to 1.67 for the lowest compared to the richest) and among Medical Aid beneficiaries (OR, 1.50; 95% CI, 1.24 to 1.82). The 5-year mortality was greater in the lower-income quintiles and Medical Aid beneficiaries than in the richest quintile.

CONCLUSIONS

The incidence of CC was higher in the richest quintile than in the lower income quintiles, while the risk of distant-stage CC and mortality was higher for women in lower income quintiles in the context of the NCSP. A more focused approach is needed to further alleviate disparities in the timely diagnosis and treatment of CC.

Summary

Korean summary
새로이 자궁경부암을 진단받은 여성에서 소득수준에 따른 진단시 원격 전이가 있을 위험도와 진단 이후 5년 사망위험도를 연령과 체질량 지수등의 개인 수준의 위험 요인을 보정하여 구했다. 소득 수준이 낮을수록, 의료급여 환자일수록 진단시 원격 전이가 있을 위험과 5년 내 사망 위험이 높은 것으로 나타났다. 자궁경부암에 대한 전국민 대상 선별 검사가 있지만 여전히 소득 수준에 따른 자궁경부암의 적시 진단과 진단 후 생존의 불평등이 남아 있으며 이에 대한 추가 정책이 필요하다.

Key Message
This study adds empirical evidence for an income-based disparity in the cancer stage at presentation and five-year survival among cervical cancer patients even in the presence of a universal screening program.

Citations

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Nomogram model for predicting the long-term prognosis of cervical cancer patients: a population-based study in Mato Grosso, Brazil
Sancho Pedro Xavier, Noemi Dreyer Galvão, Marco Aurélio Bertúlio das Neves, Kátia Moreira da Silva, Adila de Queiroz Neves Almeida, Ageo Mario Cândido da Silva
BMC Cancer.2025;[Epub] CrossRef
Individual and community-level determinants of cervical cancer screening among Kenyan women: a multilevel analysis of a Kenya demographic and health surveys 2022
Beminate Lemma Seifu, Angwach Abrham Asnake, Teshale Belayneh, Tesfahun Hailemariam
BMC Cancer.2025;[Epub] CrossRef
Age and socioeconomic disparities in cervical cancer incidence and mortality: a SEER-based analysis
Yuyi Ou, Santosh Chokkakula, Sio Mui Chong, Hao Wang, Andrew In-Cheong Si, Yong Jiang, Liying Huang, Xiaohua Xu, Chengliang Yin, Jun Lyu, Xiaobin Huang, Hui-ling Shang
Frontiers in Public Health.2025;[Epub] CrossRef
Individual and joint effect of socioeconomic status and lifestyle factors on cancer in Korea
Chi Lan Tran, Kui Son Choi, Sun‐Young Kim, Jin‐Kyoung Oh
Cancer Medicine.2023; 12(16): 17389. CrossRef
Menopausal hormone therapy and risk of dementia: health insurance database in South Korea-based retrospective cohort study
Jin-Sung Yuk, Jin San Lee, Joong Hyun Park
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Disparities in Cancer Incidence across Income Levels in South Korea
Su-Min Jeong, Kyu-Won Jung, Juwon Park, Nayeon Kim, Dong Wook Shin, Mina Suh
Cancers.2023; 15(24): 5898. CrossRef

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.

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Original Articles

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

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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.

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Gender-specific secular trends and related factors of high perceived stress level among Korean older adults: a nation-wide serial cross-sectional study
Eunjeong Choi, Hyun-Ju Seo, Kye Ha Kim, Sun-Young Jung
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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
Factors related to sedentary behavior in older adult stroke patients in China: a study based on decision tree and logistic regression model
Shuxian Liu, Juan Li, Xi Chen, Xiaowen Jiang, Rong Tang, Yumei Lv
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Evaluation of sedentary lifestyle as a risk factor
Max Ramiro Ochoa Ortega, Bárbara del Rosario Hernández Bravo , Adolfo Miguel Zorrilla Quiñones, Noelvis Ramírez Pérez, Yanet Rodríguez Pérez
Health Leadership and Quality of Life.2024;[Epub] CrossRef
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Seong-Uk Baek, Won-Tae Lee, Min-Seok Kim, Myeong-Hun Lim, Jin-Ha Yoon, Jong-Uk Won
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Socioeconomic disparities in Korea by health insurance type during the COVID-19 pandemic: a nationwide study: Han Eol Jeong, Jongseong Lee, Hyun Joon Shin, Ju-Young Shin; Epidemiol Health. 2021;43:e2021007. Published online January 13, 2021; DOI: https://doi.org/10.4178/epih.e2021007

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study explored socioeconomic disparities in Korea using health insurance type as a proxy during the ongoing coronavirus disease 2019 (COVID-19) pandemic.

METHODS

We conducted a retrospective cohort study using Korea’s nationwide healthcare database, which contained all individuals who received a diagnostic test for COVID-19 (n=232,390) as of May 15, 2020. We classified our cohort by health insurance type into beneficiaries of the National Health Insurance (NHI) or Medicaid programs. Our study outcomes were infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and COVID-19-related outcomes, a composite of all-cause death, intensive care unit admission, and mechanical ventilation use. We estimated age-, sex-, and Charlson comorbidity index score–adjusted odds ratios (aORs) with 95% confidence intervals (CIs) using a multivariable logistic regression analysis.

RESULTS

Of the 218,070 NHI and 14,320 Medicaid beneficiaries who received COVID-19 tests, 7,777 and 738 tested positive, respectively. The Medicaid beneficiaries were older (mean age, 57.5 vs. 47.8 years), more likely to be males (47.2 vs. 40.2%), and had a higher comorbidity burden (mean CCI, 2.0 vs. 1.7) than NHI beneficiaries. Compared to NHI beneficiaries, Medicaid beneficiaries had a 22% increased risk of SARS-CoV-2 infection (aOR, 1.22; 95% CI, 1.09 to 1.38), but had no significantly elevated risk of COVID-19-related outcomes (aOR 1.10, 95% CI 0.77 to 1.57); the individual events of the composite outcome yielded similar findings.

CONCLUSIONS

As socioeconomic factors, with health insurance as a proxy, could serve as determinants during the current pandemic, pre-emptive support is needed for high-risk groups to slow its spread.

Summary

Korean summary
사회경제적 수준과 코로나19 발생률 및 예후 간 연관성 등 코로나19로 인한 건강 불평등 현상은 아직 확인된 바가 없다. 건강보험 가입자 대비 의료급여 수급권자에서 SARS-CoV-2의 감염 위험이 더 높게 나타났다. 코로나19의 확산을 늦추기 위해서는, 의료급여 수급권자를 비롯한 취약계층 대상의 선제적 지원이 제공되어야 한다.

Key Message
Socioeconomic status, with health insurance as a proxy, could explain health inequalities in clinical outcomes, diverse disease incidence and prognosis, during the COVID-19 pandemic.

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Unraveling the inhibitory potential of fatty acids from Cola lepidota seed against monoclonal antibody Fab fragment (9F8) (3VG0) leptin antagonism and restoration of ‘satiety’ in obesity condition: insight from quantum chemical analysis, pharmacokinetics,
Obinna C. Godfrey, Eze A. Adindu, Uwem O. Edet, Elizabeth N. Mbim, Gabriel C. Eze, Fredrick C. Asogwa, Innocent Benjamin, Terkumbur E. Gber, Rawlings A. Timothy, Hitler Louis
Zeitschrift für Physikalische Chemie.2024; 238(4): 763. CrossRef
Does Maintained Medical Aid Coverage Affect Healthy Lifestyle Factors, Metabolic Syndrome-Related Health Status, and Individuals’ Use of Healthcare Services?
Ilsu Park, Kyounga Lee, Eunshil Yim
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The Risk Factors of COVID-19 Infection and Mortality among Older Adults in South Korea
Sungmin Lee, Jungha Park, Jae-ryun Lee, Jin Yong Lee, Byung sung Kim, Chang Won Won, Hyejin Lee, Sunyoung Kim
Annals of Geriatric Medicine and Research.2023; 27(3): 241. CrossRef
The road to recovery: impact of COVID-19 on healthcare utilization in South Korea in 2016–2022 using an interrupted time-series analysis
Katelyn Jison Yoo, Yoonkyoung Lee, Seulbi Lee, Rocco Friebel, Soon-ae Shin, Taejin Lee, David Bishai
The Lancet Regional Health - Western Pacific.2023; 41: 100904. CrossRef
Unequal burdens of COVID-19 infection: a nationwide cohort study of COVID-19-related health inequalities in Korea
Jeangeun Jeon, Jieun Park, Min-Hyeok Choi, Hongjo Choi, Myoung-Hee Kim
Epidemiology and Health.2023; 45: e2023068. CrossRef
Increased Healthcare Delays in Tuberculosis Patients During the First Wave of COVID-19 Pandemic in Korea: A Nationwide Cross-Sectional Study
Jinsoo Min, Yousang Ko, Hyung Woo Kim, Hyeon-Kyoung Koo, Jee Youn Oh, Yun-Jeong Jeong, Hyeon Hui Kang, Kwang Joo Park, Yong Il Hwang, Jin Woo Kim, Joong Hyun Ahn, Yangjin Jegal, Ji Young Kang, Sung-Soon Lee, Jae Seuk Park, Ju Sang Kim
Journal of Korean Medical Science.2022;[Epub] CrossRef
Socioeconomic Inequalities in COVID-19 Incidence During Different Epidemic Phases in South Korea
Dae-sung Yoo, Minji Hwang, Byung Chul Chun, Su Jin Kim, Mia Son, Nam-Kyu Seo, Myung Ki
Frontiers in Medicine.2022;[Epub] CrossRef
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Healthcare.2022; 10(6): 997. 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
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Gender difference in socioeconomic factors affecting suicidal ideation and suicidal attempts among community-dwelling elderly: based on the Korea Community Health Survey: Jin-Young Jeong; Epidemiol Health. 2020;42:e2020052. Published online July 13, 2020; DOI: https://doi.org/10.4178/epih.e2020052

21,165 View
247 Download
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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study was performed to explore socioeconomic factors associated with suicidal ideation and suicidal attempts among the local community’s resident elderly.

METHODS

The subjects included 129,277 participants aged 65 years or above of the Korea Community Health Survey conducted in 2013 and 2017. Based on the questions for suicidal ideation and suicidal attempts, the subjects were divided into a no suicidal ideation group (n=111,344), a suicidal ideation group (n=17,487), and a suicidal attempt group (n=446). All analyses were stratified by gender, and a complex sample logistic regression analysis was performed to analyze associated factors. SAS version 9.4 was used for all analyses with a significance level of 0.05.

RESULTS

Common factors associated with suicidal ideation in both genders included marital status, frequency of contact with friends, social activity, and average monthly household income. Economic activity was demonstrated as relevant only to the elderly men subjects. According to the analysis, factors associated with suicidal attempts were the recipients of the National Basic Living Security Act for the elderly men compared to age, frequency of contact with family, frequency of contact with friends, and average monthly household income for the elderly women.

CONCLUSIONS

The study revealed that socioeconomic factors leading to suicidal ideation were similar in the elderly of both genders, while a difference was demonstrated for factors associated with suicidal attempts between the elderly of both genders. It is expected that the results of this study may be used as the basis for screening the local community’s elderly with a high suicidal risk, and in the development of suicide prevention services.

Summary

Korean summary
2013년과 2017년 지역사회건강조사에 참여한 129,277명의 노인을 대상으로 자살시도에 관련된 사회-경제적 요인을 탐색하였다. 분석결과, 남성 노인의 자살시도 관련요인은 국민기초생활수급자, 여성 노인의 자살시도 관련요인은 연령, 가족접촉빈도, 친구접촉빈도, 그리고 월평균가구소득으로 나타났다. 본 결과가 지역사회 거주 노인의 자살 고위험군 선별 및 자살 예방서비스 개발에 기초자료로 활용되기를 기대한다.

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Sex differences in lifetime suicide attempts in retired older adults between 2000 and 2021 in France: results from six national surveys
Helen-Maria Vasiliadis, Christophe Léon, Mathilde Husky
Social Psychiatry and Psychiatric Epidemiology.2025;[Epub] CrossRef
Depression subtypes, suicidality, and healthcare costs in older adults: results from a naturalistic study
Ismael Conejero, Alejandro Porras-Segovia, Lucía Albarracín-García, María Luisa Barrigón, Jorge Lopez-Castroman, Philippe Courtet, Enrique Baca-Garcia
Frontiers in Psychiatry.2025;[Epub] CrossRef
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Myung Ki, Sylvie Lapierre, Boeun Gim, Minji Hwang, Minku Kang, Luc Dargis, Myoungjee Jung, Emily Jiali Koh, Brian Mishara
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Socio-demographic inequalities in the uptake of Papanicolaou tests in Peru: analysis of the 2015-2017 Demographic and Family Health Survey: Antonio Barrenechea-Pulache, Emmanuel Avila-Jove, Akram Hernández-Vásquez, Fernando M. Runzer-Colmenares; Epidemiol Health. 2020;42:e2020043. Published online June 18, 2020; DOI: https://doi.org/10.4178/epih.e2020043

24,626 View
216 Download
5 Web of Science
3 Crossref

Abstract PDF

Abstract

OBJECTIVES
This study was conducted to analyze the inequalities in Papanicolaou test (also referred to as the Pap smear) uptake according to the socio-demographic characteristics of Peruvian women 30 years to 59 years of age using information from the 2015-2017 Demographic and Family Health Survey (ENDES, acronym in Spanish).

METHODS

This is an analytical, cross-sectional study based on information acquired from the 2015-2017 ENDES surveys. Socio-demographic characteristics were reported using absolute frequencies and weighted proportions with 95% confidence intervals, considering results with a p-value <0.05 as statistically significant. Concentration curves (CCs) and concentration indices (IndCs) were created based on the interaction of the wealth index and uptake of Pap smears, taking into account the different characteristics of the population studied for the measure of inequalities.

RESULTS

All the CCs were distributed below the line of equality. Similarly, all the IndCs were higher than zero, indicating inequality in the uptake of Pap smears, favoring those with a higher wealth index. The highest IndC values were obtained from women aged 50-59 (IndC, 0.293), those who lived in the jungle (IndC, 0.230), and those without health insurance (IndC, 0.173).

CONCLUSIONS

We found socio-demographic inequalities in the uptake of Pap smears in Peru, favoring women with a higher wealth index. More funding is needed to promote cervical cancer screening programs and to create systems that ensure equal access to healthcare in Peru.

Summary

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Ethnic inequalities in coverage and use of women’s cancer screening in Peru
Claudio Intimayta-Escalante
BMC Women's Health.2024;[Epub] CrossRef
Socioeconomic disparities in Papanicolaou test utilization in Western Iran
Bahare Safari-Faramani, Roya Safari-Faramani, Farid Najafi, Davoud Khorasani Zavareh, Ali Kazemi Karyani, Mitra Darbandi
BMC Public Health.2024;[Epub] CrossRef
Reasons for never receiving a pap test among Brazilian women: National health survey
Claudia Fernandes Rodrigues, José Victor Afonso Coutinho, Camila Drumond Muzi, Raphael Mendonça Guimarães
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The double burden of malnutrition among adults in India: evidence from the National Family Health Survey-4 (2015-16): Mili Dutta, Y Selvamani, Pushpendra Singh, Lokender Prashad; Epidemiol Health. 2019;41:e2019050. Published online December 18, 2019; DOI: https://doi.org/10.4178/epih.e2019050

29,359 View
357 Download
48 Web of Science
54 Crossref

Abstract PDF

Abstract

OBJECTIVES
India still faces the burden of undernutrition and communicable diseases, and the prevalence of overweight/obesity is steadily increasing. The discourse regarding the dual burden of underweight and overweight/obesity has not yet been widely explored in both men and women. The present study assessed the determinants of underweight and overweight/obesity in India among adult men and women aged 15-49.

METHODS

Population-based cross-sectional and nationally representative data from the National Family Health Survey-4 (2015-16), consisting of a sample of men and women, were analyzed. Stratified 2-stage sampling was used in the NFHS-4 study protocol. In the present study, bivariate and adjusted multinomial logistic regression analyses were performed to determine the correlates of underweight and overweight/obesity.

RESULTS

The results suggested a persistently high prevalence of underweight coexisting with an increased prevalence of overweight/obesity in India. The risk of underweight was highest in the central and western regions and was also relatively high among those who used either smoking or smokeless tobacco. Overweight/obesity was more prevalent in urban areas, in the southern region, and among adults aged 35-49. Furthermore, level of education and wealth index were positively associated with overweight/obesity. More educated and wealthier adults were less likely to be underweight.

CONCLUSIONS

In India, underweight has been prevalent, and the prevalence of overweight/obesity is increasing rapidly, particularly among men. The dual burden of underweight and overweight/obesity is alarming and needs to be considered; public health measures to address this situation must also be adopted through policy initiatives.

Summary

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Alcohol-related emergency department visits and income inequality in New York City, USA: an ecological study: Kathleen H. Reilly, Katherine Bartley, Denise Paone, Ellenie Tuazon; Epidemiol Health. 2019;41:e2019041. Published online October 8, 2019; DOI: https://doi.org/10.4178/epih.e2019041

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Abstract PDF

Abstract

OBJECTIVES
Previous research has found that greater income inequality is related to problematic alcohol use across a variety of geographical areas in the USA and New York City (NYC). Those studies used self-reported data to assess alcohol use. This study examined the relationship between within-neighborhood income inequality and alcohol-related emergency department (ED) visits.

METHODS

The study outcome was the alcohol-related ED visit rate per 10,000 persons between 2010 and 2014, using data obtained from the New York Statewide Planning and Research Cooperative System. The main predictor of interest was income inequality, measured using the Gini coefficient from the American Community Survey (2010-2014) at the public use microdata area (PUMA) level (n=55) in NYC. Variables associated with alcohol-related ED visits in bivariate analyses were considered for inclusion in a multivariable model.

RESULTS

There were 420,568 alcohol-related ED visits associated with a valid NYC address between 2010 and 2014. The overall annualized NYC alcohol-related ED visit rate was 100.7 visits per 10,000 persons. The median alcohol ED visit rate for NYC PUMAs was 88.0 visits per 10,000 persons (interquartile range [IQR], 64.5 to 133.5), and the median Gini coefficient was 0.48 (IQR, 0.45 to 0.51). In the multivariable model, a higher neighborhood Gini coefficient, a lower median age, and a lower percentage of male residents were independently associated with the alcohol-related ED visit rate.

CONCLUSIONS

This study found that higher neighborhood income inequality was associated with higher neighborhood alcohol-related ED visit rates. The precise mechanism of this relationship is not understood, and further investigation is warranted to determine temporality and to assess whether the results are generalizable to other locales.

Summary

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Factors associated with mortality from tuberculosis in Iran: an application of a generalized estimating equation-based zero-inflated negative binomial model to national registry data: Fatemeh Sarvi, Abbas Moghimbeigi, Hossein Mahjub, Mahshid Nasehi, Mahmoud Khodadost; Epidemiol Health. 2019;41:e2019032. Published online July 9, 2019; DOI: https://doi.org/10.4178/epih.e2019032

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Abstract PDF

Abstract

OBJECTIVES
Tuberculosis (TB) is a global public health problem that causes morbidity and mortality in millions of people per year. The purpose of this study was to examine the relationship of potential risk factors with TB mortality in Iran.

METHODS

This cross-sectional study was performed on 9,151 patients with TB from March 2017 to March 2018 in Iran. Data were gathered from all 429 counties of Iran by the Ministry of Health and Medical Education and Statistical Center of Iran. In this study, a generalized estimating equation-based zero-inflated negative binomial model was used to determine the effect of related factors on TB mortality at the community level. For data analysis, R version 3.4.2 was used with the relevant packages.

RESULTS

The risk of mortality from TB was found to increase with the unemployment rate (βˆ=0.02), illiteracy (βˆ=0.04), household density per residential unit (βˆ=1.29), distance between the center of the county and the provincial capital (βˆ=0.03), and urbanization (βˆ=0.81). The following other risk factors for TB mortality were identified: diabetes (βˆ=0.02), human immunodeficiency virus infection (βˆ=0.04), infection with TB in the most recent 2 years (βˆ=0.07), injection drug use (βˆ=0.07), long-term corticosteroid use (βˆ=0.09), malignant diseases (βˆ=0.09), chronic kidney disease (βˆ=0.32), gastrectomy (βˆ=0.50), chronic malnutrition (βˆ=0.38), and a body mass index more than 10% under the ideal weight (βˆ=0.01). However, silicosis had no effect.

CONCLUSIONS

The results of this study provide useful information on risk factors for mortality from TB.

Summary

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Robert Akpata, Jean-Baptiste Ntakpe, Eugène Messou, Nathalie De Castro, Corine Chazallon, Isabel Timana, Rodrigo Escada, Sandra Wagner Cardoso, Nilesh Bhatt, Celso Khosa, Didier Laureillard, Giang Do Chau, Frédéric Ello Nogbou, Donald Diomande Glao, Valdi
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Regional deprivation and cause-specific mortality in Russian adults in 2006–2022
Anastasia Zelenina
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Individual and regional factors associated with suicidal ideation among Korean elderly: a multilevel analysis of the Korea Community Health Survey: Sang Hee Jeong, Byung Chul Chun; Epidemiol Health. 2019;41:e2019022. Published online May 26, 2019; DOI: https://doi.org/10.4178/epih.e2019022

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study aimed to identify the individual and regional characteristics that influence suicidal ideation among the Korean elderly population.

METHODS

Using data collected from the 2013 Korea Community Health Survey, a multilevel analysis was performed to establish an understanding of individual behavioral patterns and regional influences on suicidal ideation.

RESULTS

Among the 77,407 individuals sampled, 11,236 (14.5%) elderly people over 60 years of age experienced suicidal ideation. Among individual factors, age, frequency of communication with friends, religious activity, social activity, leisure activity, trust in neighbors, subjective stress level, depressive symptoms, and subjective health status were significantly associated with suicidal ideation. The results showed that the lower the regional deprivation level, the higher the suicidal ideation odds ratio. In terms of regional size, the most significant effects were found in rural areas.

CONCLUSIONS

This study suggested that suicidal ideation in the elderly is associated with community factors, such as the regional deprivation index, as well as personal factors.

Summary

Korean summary
본 연구는 60세 이상 연령의 개인 요인에 따른 자살 생각에 영향을 미치는 요인과 지역 요인을 모두 반영하여 자살 생각에 영향을 미치는 요인을 파악하는 것으로 지역사회건강조사에 응답한 60대 이상 노인 77,407명 중 11,236(14.5%)명을 표본대상으로 선정하여 노인의 자살생각 가능성과 관련된 개인의 행태와 지역 또는 집단에서 영향력을 파악하기 위한 다수준 분석을 실시하였다. 결과적으로 본 연구는 60세이상의 노인에서 자살 생각에 개인적 요인 뿐 아니라 지역박탈지수와 같은 지역 요인이 관여한다는 점을 시사한다.

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Necessity of Analyzing the Korea Community Health Survey Using 7 Local Government Types
Seowoo Park, Haibin Bai, Jae-ryun Lee, Soomin Kim, Hyemin Jung, Jin Yong Lee
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The effects of socio-economic and environmental factors on Korean suicidal ideation: A Bayesian multilevel analysis
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Adult friendship and suicidality: A scoping review
Susan Stevens, Brian Shiner, Lynn Brunner, Lauren Kenneally, Natalie Riblet
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A systematic review of psychosocial protective factors against suicide and suicidality among older adults
Myung Ki, Sylvie Lapierre, Boeun Gim, Minji Hwang, Minku Kang, Luc Dargis, Myoungjee Jung, Emily Jiali Koh, Brian Mishara
International Psychogeriatrics.2024; 36(5): 346. CrossRef
Effects of health-related quality of life and long-term care insurance infrastructure on suicidal ideation among older Korean adults
Changsook Lee, Sun-Young Heo
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Han Zhou, Dong Han, Haisen Zhou, Xinfeng Ke, Dongdong Jiang
Heliyon.2023; 9(10): e21141. CrossRef
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Nicolas Raschke, Amir Mohsenpour, Leona Aschentrup, Florian Fischer, Kamil J. Wrona
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Hyunjin Son, Changhoon Kim
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Chae Eun Yong, Young Bum Kim, Jiyoung Lyu
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Associations between socioeconomic status and blood cadmium levels in Korea: Yongho Jee, Sung-il Cho; Epidemiol Health. 2019;41:e2019018. Published online May 15, 2019; DOI: https://doi.org/10.4178/epih.e2019018

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Abstract Summary PDF

Abstract

OBJECTIVES
Although smoking is associated with both low socioeconomic status and blood cadmium (Cd) levels, the association between socioeconomic status and Cd levels remains unclear. Therefore, our study aimed to examine this association and to clarify whether smoking is a confounding or mediating variable in this relationship.

METHODS

Data (n=7,734) were drawn from the Korea National Health and Nutrition Examination Survey (KNHANES, 2008- 2011), including years that contained data on blood Cd and urinary cotinine levels. We investigated the associations of income, education, and occupation with blood Cd levels. Smoking was investigated by categorizing participants by smoking status (never, former, and current) and pack-years into quartiles. The weekly frequency of rice and barley intake was analyzed to gain insights into participants’ dietary patterns. Additionally, urinary cotinine levels were used to ensure the validity of the smoking variables.

RESULTS

Participants earning a low income and with less formal education had higher blood Cd levels. After controlling for smoking, the association between income and Cd levels substantially weakened. Further controlling for education, the association between income and Cd levels disappeared. However, there was a strong negative association between education and Cd levels, even after controlling for smoking history, pack-years, and urinary cotinine levels.

CONCLUSIONS

In cross-sectional data from the KNHANES, blood Cd levels were significantly higher among those with a low income and less formal education. Smoking history contributed to, but did not fully explain, these associations.

Summary

Korean summary
흡연은 낮은 사회경제적 상태와, 높은 혈중 카드뮴 상태 등과 관련이 있다고 보고가 되어 왔지만, 사회경제적 상태와 혈중 카드뮴 상태의 연관성은 불분명하다. 따라서, 본 연구는 혈중 카드뮴 농도와 사회경제적 상태와의 관련성을 분석하고, 흡연이라는 변수가 이 관련성에 어떠한 영향을 주는지 보고자 하였다.

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Relationship between Serum Cadmium Concentration and Lung Function: A Study Using Korea National Health and Nutrition Examination Survey Data
Oh Beom Kwon, Eun Ju Lee, Myoung-Nam Lim, Jeeyoung Kim, Woo Jin Kim
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Socioeconomic inequalities in obesity among Korean women aged 19-79 years: the 2016 Korean Study of Women’s Health-Related Issues: Eunji Choi, Ha Na Cho, Da Hea Seo, Boyoung Park, Sohee Park, Juhee Cho, Sue Kim, Yeong-Ran Park, Kui Son Choi, Yumie Rhee; Epidemiol Health. 2019;41:e2019005. Published online February 13, 2019; DOI: https://doi.org/10.4178/epih.e2019005

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Abstract Summary PDF

Abstract

OBJECTIVES
While the prevalence of obesity in Asian women has remained stagnant, studies of socioeconomic inequalities in obesity among Asian women are scarce. This study aimed to examine the recent prevalence of obesity in Korean women aged between 19 years and 79 years and to analyze socioeconomic inequalities in obesity.

METHODS

Data were derived from the 2016 Korean Study of Women’s Health-Related Issues. The chi-square test and logistic regression analysis were used to analyze the associations between socioeconomic factors and obesity using Asian standard body mass index (BMI) categories: low (<18.5 kg/m2 ), normal (18.5-22.9 kg/m2 ), overweight (23.0-24.9 kg/m2 ), and obese (≥25.0 kg/ m2 ). As inequality-specific indicators, the slope index of inequality (SII) and relative index of inequality (RII) were calculated, with adjustment for age and self-reported health status.

RESULTS

Korean women were classified into the following BMI categories: underweight (5.3%), normal weight (59.1%), overweight (21.2%), and obese (14.4%). The SII and RII revealed substantial inequalities in obesity in favor of more urbanized women (SII, 4.5; RII, 1.4) and against of women who were highly educated (SII, -16.7; RII, 0.3). Subgroup analysis revealed inequalities in obesity according to household income among younger women and according to urbanization among women aged 65-79 years.

CONCLUSIONS

Clear educational inequalities in obesity existed in Korean women. Reverse inequalities in urbanization were also apparent in older women. Developing strategies to address the multiple observed inequalities in obesity among Korean women may prove essential for effectively reducing the burden of this disease.

Summary

Korean summary
한국 성인 여성의 과체중 및 비만유병률은 서구여성에 비해 낮으며 2005년 이후 큰 변화 없이 약40%대로 일정하게 유지되어왔으나, 사회경제적불평등에 대한 연구는 체계적으로 이루어지지 않음. 경사불평등(Slope index of inequality)과 상대불평등(Relative index of inequality) 지표를 사용하여 비만유병률에서 발견되는 사회경제적불평등을 조사한 결과, 교육수준별 불평등이 유의하게 나타남. 19-44세의 젊은 여성층에서는 소득수준이 낮은 집단에, 65-79세의 노년기 여성층에서는 도시화된 지역에 사는 집단에 비만유병률이 치중되어있음.

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Dumilah Ayuningtyas, Dian Kusuma, Vilda Amir, Dwi Hapsari Tjandrarini, Pramita Andarwati
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Income-related inequality in completed suicide across the provinces of Iran: Mohammad Hassan Kazemi-Galougahi, Asieh Mansouri, Samaneh Akbarpour, Mahmood Bakhtiyari, Majid Sartipi, Rahmatollah Moradzadeh; Epidemiol Health. 2018;40:e2018012. Published online April 2, 2018; DOI: https://doi.org/10.4178/epih.e2018012

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Abstract PDF

Abstract

OBJECTIVES
The aim of this study was to measure income-related inequality in completed suicide across the provinces of Iran.

METHODS

This ecological study was performed using data from the Urban and Rural Household Income and Expenditure Survey-2010 conducted by the Iranian Center of Statistics, along with data on completed suicide from the Iranian Legal Medicine Organization in 2012. We calculated the Gini coefficient of per capita income and the completed suicide rate, as well as the concentration index for per capita income inequality in completed suicide, across the provinces of Iran.

RESULTS

The Gini coefficients of per capita income and the completed suicide rate in the provinces of Iran were 0.10 (95% confidence interval [CI], 0.06 to 0.13) and 0.34 (95% CI, 0.21 to 0.46), respectively. We found a trivial decreasing trend in the completed suicide incidence rate according to income quintile. The poorest-to-richest ratio in the completed suicide rate was 2.01 (95% CI, 1.26 to 3.22). The concentration index of completed suicide in the provinces of Iran was -0.12 (95% CI, -0.30 to 0.06).

CONCLUSIONS

This study found that lower income might be considered as a risk factor for completed suicide. Nonetheless, further individual studies incorporating multivariable analysis and repeated cross-sectional data would allow a more fine-grained analysis of this phenomenon.

Summary

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Socioeconomic disparities and difficulties to access to healthcare services among Canadian children with neurodevelopmental disorders and disabilities: Sana Raouafi, Sofiane Achiche, Maxime Raison; Epidemiol Health. 2018;40:e2018010. Published online March 29, 2018; DOI: https://doi.org/10.4178/epih.e2018010

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Abstract

OBJECTIVES
The aims of this study were to identify the associations of levels of severity of neurodevelopmental disorders and disabilities (NDD/D) in children with their household socioeconomic status (SES) and their frequency of visits to a healthcare provider, and to examine how the severity of disability varied with these determinants among NDD/D subgroups, in order to inform possible social policy changes and to improve access to the healthcare system.

METHODS

Data from the 2006 Participation and Activity Limitation Survey on children aged 5-14 years, collected by Statistics Canada, were analyzed (n=7,072 and weighted n=340,340). Children with NDD/D constituted those with impairments in motor, speech, neurosensory, and psychological functioning, as well as those who had issues with learning/cognition and social interactions. The weighted sample size for this group was n=111,630 (total sample size for children with limitations: n=174,810). We used logistic regression to assess the associations of household SES and frequency of visits to a healthcare provider with disability level. We included NDD/D subgroups as interaction terms in the model. Multiple correspondence analysis (MCA) was conducted to develop a profile of disability level.

RESULTS

After-tax low income, family assistance, out-of-pocket expenses, needing but not receiving health services from a social worker, condition of the dwelling, and residential location were associated with the severity of NDD/D. Using MCA, 2 disability profiles could be identified based on access to healthcare, household income status, and condition of the dwelling.

CONCLUSIONS

More social interventions are needed to reduce difficulties in accessing healthcare and to diminish the socially determined health inequalities faced by children with NDD/D.

Summary

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Decomposing Gender Disparity in Total Physical Activity among Iranian Adults: Ebrahim Rahimi, Seyed Saeed Hashemi-Nazari, Koorosh Etemad, Hamid Soori; Epidemiol Health. 2017;39:e2017044. Published online October 16, 2017; DOI: https://doi.org/10.4178/epih.e2017044

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Abstract PDF

Abstract

OBJECTIVES
While gender differences in physical activity (PA) have been reported, their origin is not well understood. The present study aimed to identify factors contributing to this disparity.

METHODS

This was a population-based cross-sectional study based on the 2011 surveillance of risk factors of non-communicable diseases that was conducted among Iranian adults. Multi-staged sampling was performed to obtain the required study sample. The primary outcome was gender differences in the prevalence of sufficient physical activity (SPA). Total physical activity (TPA) was calculated as metabolic equivalents (MET) per minute during a typical week, as recommended by the World Health Organization. On this basis, achieving 600 MET-min/wk or more was defined as SPA. The nonlinear Blinder-Oaxaca decomposition technique was used to explain the disparity.

RESULTS

The predicted gap was 19.50%. About one-third of the gap was due to differences in the level of observable covariates. Among them, work status contributed the most (29.61%). A substantial portion of the gap remained unexplained by such differences, of which about 40.41% was related to unobservable variables. The differential effects of standard of living, ethnicity, and smoking status made the largest contribution, accounting for 37.36, 35.47, and 28.50%, respectively.

CONCLUSIONS

Interventions to reduce the gender gap in PA should focus on increasing TPA among housewives and women with chronic diseases, as well as those with a higher standard of living. In addition, it is essential to explore the impact of ethnicity and smoking status on women’s TPA in order to promote health.

Summary

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Evaluating socioeconomic inequalities in self-rated oral health and its contributing factors in Brazilian older adults
Fabíola Bof de Andrade, José Leopoldo Ferreira Antunes, Mirza Rustum Baig
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Gender differences in cardiac rehabilitation participation and outcomes: an 18-year retrospective study in Iran
Marzieh Najafi, Zahra Teimouri-Jervekani, Marjan Jamalian, Hamidreza Roohafza, Mohammad Hossein Paknahad, Mohammad mahdi Hadavi, Neda Dorostkar, Masoumeh Sadeghi
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A detailed explanation and graphical representation of the Blinder-Oaxaca decomposition method with its application in health inequalities
Ebrahim Rahimi, Seyed Saeed Hashemi Nazari
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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 Summary PDF Supplementary Material

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.

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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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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

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The burden of infectious and cardiovascular diseases in India from 2004 to 2014: Kajori Banerjee, Laxmi Kant Dwivedi; Epidemiol Health. 2016;38:e2016057. Published online December 14, 2016; DOI: https://doi.org/10.4178/epih.e2016057

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Abstract

OBJECTIVES
In India, both communicable and non-communicable diseases have been argued to disproportionately affect certain socioeconomic strata of the population. Using the 60th (2004) and 71st (2014) rounds of the National Sample Survey, this study assessed the balance between infectious diseases and cardiovascular diseases (CVD) from 2004 to 2014, as well as changes in the disease burden in various socioeconomic and demographic subpopulations.

METHODS

Prevalence rates, hospitalization rates, case fatality rates, and share of in-patients deaths were estimated to compare the disease burdens at these time points. Logistic regression and multivariate decomposition were used to evaluate changes in disease burden across various socio-demographic and socioeconomic groups.

RESULTS

Evidence of stagnation in the infectious disease burden and rapid increase in the CVD burden was observed. Along with the drastic increase in case fatality rate, share of in-patients deaths became more skewed towards CVD from 2004 to 2014. Logistic regression analysis demonstrated a significant shift of the chance of succumbing to CVD from the privileged class, comprising non-Scheduled Castes and Tribes, more highly educated individuals, and households with higher monthly expenditures, towards the underprivileged population. Decomposition indicated that a change in the probability of suffering from CVD among the subcategories of age, social groups, educational status, and monthly household expenditures contributed to the increase in CVD prevalence more than compositional changes of the population from 2004 to 2014.

CONCLUSIONS

This study provides evidence of the ongoing tendency of CVD to occur in older population segments, and also confirms the theory of diffusion, according to which an increased probability of suffering from CVD has trickled down the socioeconomic gradient.

Summary

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Influence of behavioral determinants on deviation of body mass index among 12-15 years old school children of Panchkula: Amandeep Chopra, Nanak Chand Rao, Nidhi Gupta, Shelja Vashisth, Manav Lakhanpal; Epidemiol Health. 2014;36:e2014021. Published online September 29, 2014; DOI: https://doi.org/10.4178/epih/e2014021

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Abstract

OBJECTIVES
To evaluate the body mass index (BMI) and factors related to BMI in 12-15 years old adolescents attending school in the Panchkula district of Haryana, India.

METHODS

Our multistage sampling method enrolled 810 adolescents. Demographic data and dietary history data over 5 days were recorded. Height and weight were measured to calculate BMI, which was further categorized according to the World Health Organization classification system. Diet was analysed using the Nizel criteria and socioeconomic status (SES) was assessed using Prasad’s socioeconomic classification. The chi-squared test and analysis of variance test were performed, and a multinomial regression analysis was performed to find significant correlates with BMI.

RESULTS

The prevalences of underweight, normal weight, overweight, and obesity were 13.6, 58.4, 22.7, and 5.3%, respectively. The prevalence of both overweight and obesity was higher among males than that among females. The overall food group, nutrient, sweet, and oral health diet scores were higher among overweight and obese adolescents. Adolescents attending public school were 2.62 times more likely than private school adolescents were to be underweight. Private school adolescents were 2.08 times more likely than public school adolescents were to be overweight. Those with a high SES, vegetarians, and those aged 15 years were highly likely to be obese.

CONCLUSIONS

We found 41.6% of these adolescents to have a BMI that deviated from the norm. Important factors related with BMI were age, gender, socioeconomic score, mean daily diet score, and the type of school.

Summary

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The Relationship between Smoking, Socioeconomic Status and Grip Strength among Community-dwelling Elderly Men in Korea: Hallym Aging Study: ShanAi Quan, Jin-Young Jeong, Dong-Hyun Kim; Epidemiol Health. 2013;35:e2013001. Published online February 18, 2013; DOI: https://doi.org/10.4178/epih/e2013001

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Abstract

<sec><title>OBJECTIVES</title>Low grip strength is associated with decline in bone mineral density (BMD) and increased risk of spine fracture among the elderly. Smoking, a major factor determining BMD, is also known to have an indirect effect on bone loss. This study investigated whether smoking is associated with grip strength in the community-dwelling elderly in Korea.</sec><sec><title>METHODS</title>This study was an outcome of the second of three waves of the Hallym Aging Study from January to May 2007, a population-based study of Koreans aged 45 years and upwards dwelling in Chuncheon. Its 218 subjects comprised men aged 65 years or over. They were evaluated at a general hospital for socioeconomic status, smoking history, and various clinical measures including grip strength.</sec><sec><title>RESULTS</title>Grip strength was higher in non-, ex-, and current smokers (33.7 kg, 30.6 kg, and 29.3 kg, respectively). Current smoking was found to increase the risk of decreased grip strength (adjusted odds ratio [aOR], 4.58; 95% confidence interval [CI],1.31 to 16.04) compared with non-smoking, after adjustment for potential covariates including socioeconomic status. After adjustment for smoking effect, education of fewer than six years and monthly income of fewer than 500,000 Korean won increased the risk of decreased grip strength compared with education of more than six years (aOR, 2.88; 95% CI, 1.08 to 7.66) and monthly income of more than 1,500,000 Korean won (aOR, 2.86; 95% CI, 1.08 to 7.54).</sec><sec><title>CONCLUSIONS</title>These results showed that current smoking, low education and low income were independent risk factors for decreased grip strength among elderly men in Korea.</sec>

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The Associations between Social Support, Health-Related Behaviors, Socioeconomic Status and Depression in Medical Students: Yoolwon Jeong, Jin Young Kim, Jae Seon Ryu, Ko eun Lee, Eun Hee Ha, Hyesook Park; Epidemiol Health. 2010;32:e2010009. Published online November 24, 2010; DOI: https://doi.org/10.4178/epih/e2010009

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Abstract

<sec><title>OBJECTIVES</title>The objective of this study was to estimate the prevalence of depression in medical students and to evaluate whether interpersonal social support, health-related behaviors, and socio-economic factors were associated with depression in medical students.</sec><sec><title>METHODS</title>The subjects in this study were 120 medical students in Seoul, Korea who were surveyed in September, 2008. The subjects were all women and over the age of 20. Their age, body mass index (BMI), quality of sleep, diet, household income, smoking, alcohol consumption, exercise levels, and self-reported health status were surveyed. The degree of perceived social support was measured using the interpersonal support evaluation list (ISEL). Depression was evaluated using the center for epidemiology studies depression scale (CES-D).</sec><sec><title>RESULTS</title>The mean CES-D score was 14.1±8.6 and 37.1% of the participants appeared to suffer from depression. Low levels of perceived interpersonal support increased the risk of depression by more than 10 times and having higher household income did not necessarily decrease the risk of depression.</sec><sec><title>CONCLUSION</title>Medical students have a relatively high level of depression. Efforts should be made to encourage social support in order to promote mental health in medical students.</sec>

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Liang Sun, Li-Na Sun, Ye-Huan Sun, Lin-Sheng Yang, Hong-Yan Wu, Dong-Dong Zhang, Hong-Yuan Cao, Ying Sun
The International Journal of Psychiatry in Medicine.2011; 42(1): 29. CrossRef

Related Factors with Decreased Physical Function in the Community-Dwelling Elderly in Chuncheon: Hallym Aging Study(HAS).: Sun Ae Jeon, Jin Young Jeong, Seok Won Park, Young Ho Choi, Moon Gi Choi, Kyung Soon Hong, Sang Kon Lee, Hyun Ah Kim, Dong Hyun Kim; Korean J Epidemiol. 2008;30(2):216-229. Published online December 31, 2008; DOI: https://doi.org/10.4178/kje.2008.30.2.216

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Abstract

This study was conducted to elucidate the related factors with the decreased physical function in the community- dwelling elderly in Chuncheon. We used data obtained from Hallym Aging Study(HAS) from January to May in 2007. The participants were 505 elderly aged 65 years or over after excluding those who didn't complete physical function test and aged < 65. The measurement of physical function was based on the "Health Aging and Body Composition Study Physical Performance Battery(H-ABC PPB)" that included semi-tandem stance, tandem stance, single leg stance, 6m general walk, 6m narrow walk, and chair stand test. And we also included grip strength test. Overall physical function based on H-ABC PPB decreased with age in both men and women. Smoking appeared to increase the risk of decreased function of chair stand in women (adjusted OR=3.8, 95% CI=1.2-12.6). Regular exercise was found to reduce the risk of decreased physical function in both men(Balance OR=0.5, 95% CI=0.2-1.0; Usual walk OR=0.4, 95% CI=0.2- 0.9) and women(Balance OR=0.4, 95% CI=0.2-1.0; Usual walk OR=0.3, 95% CI=0.1- 0.9); Narrow walk OR=0.2, 95% CI=0.1-0.8). Higher level of education seemed to be associated with higher functional performance. It needs further researches on the effect of education on the physical function of the elderly in this population.

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Comparison of intradialytic neuromuscular electrical stimulation and oral nutritional supplements in hemodialysis patients: study protocol for a multicenter, parallel-group, randomized controlled trial in Korea
Mi-yeon Yu, Jae Hyeon Park, Yong Chul Kim, Jae Yoon Park, Ran-hui Cha
Trials.2021;[Epub] CrossRef
A First-year Cohort Study based on Health Behaviors of Older Adults in an Urban City: Gender and Age Differences
Ji Yeon Ha, Belong Cho, Misoon Song, Jaeyoung Lim, Ga Hye Kim, Young-soon Jung, Yeon-Hwan Park
Korean Journal of Adult Nursing.2017; 29(5): 505. CrossRef

Socioeconomic Differentials in Mortality: A Cohort Study in 759,665 Korean men.: Yun Mi Song; Korean J Epidemiol. 1998;20(2):219-225.

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BACKGROUND
The relationship between Socioeconomic status(SES) and mortality, commonly studied in the developed countries but not in the less developed countries, was evaluated in a cohort of 759,665 Korean male public servants aged 30-64.
METHODS
Data on the biological and social characteristics, SES defined as the grade of monthly salary were obtained from the Korea Medical Insurance Corporation. Vital status of the study subjects was followed-up from 1992 to 1996 through the dataset of the Korea National Statistical Office. The risk of ortality associated with SES was estimated using Cow proportional hazard model.
RESULTS
There were total 13,330 deaths during the five-year follow-up period. Lowest-SES group had significantly increased risk of all-cause mortality compared to the highest-SES group(Relative risk [RR]: 1.52). Mortality from cancer(RR=1.19) and cerebrovascular disease(RR=1.58) were also significantly increased in the lowest SES group. Mortality from ischemic heart desease, however, had no relationship with SES.
CONCLUSIONS
Socioeconomic differentials in mortality were reconfirmed in Korean men. The differences in the relationship between mortality and SES according to the specific cause of death suggest that SES influence health through the various pathways.; Summary

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