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Original article Determinants of unhealthy living by gender, age group, and chronic health conditions across districts in South Korea using the 2010-2017 Community Health Surveys
Thi Tra Bui1orcid , Thi Huyen Trang Nguyen1orcid , Jinhee Lee1orcid , Sun Young Kim1orcid , Jin-Kyoung Oh1,2orcid
Epidemiol Health 2024;e2024014
DOI: https://doi.org/10.4178/epih.e2024014 [Accepted]
Published online: January 4, 2024
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1National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Korea
2Division of Cancer Prevention, National Cancer Control Institute, National Cancer Center, Goyang , Korea
Corresponding author:  Jin-Kyoung Oh,
Email: jkoh@ncc.re.kr
Received: 11 September 2023   • Revised: 26 November 2023   • Accepted: 2 December 2023

OBJECTIVES
We investigated the prevalence and determinants of unhealthy living by gender, age, and comorbidities across South Korean districts.
METHODS
For 806,246 men and 923,260 women from 245 districts who participated in the 2010–2017 Korean Community Health Surveys, risk scores were calculated based on obesity, physical inactivity, smoking, and high-risk alcohol consumption, each scored from 0 (lowest risk) to 2 (highest risk). A risk score ≥4 was defined as indicating unhealthy living, and weighted proportions were calculated for each district. Using multivariate regression, an ecological model including community socioeconomic, interpersonal, and neighborhood factors was examined by gender, age, and comorbidities.
RESULTS
The mean age-standardized rate of unhealthy living was 24.05% for men and 4.91% for women (coefficients of variation, 13.94% and 29.51%, respectively). Individuals with chronic diseases more frequently exhibited unhealthy lifestyles. Unhealthy lifestyles were associated with educational attainment (β-coefficients: men, −0.21; women, −0.15), high household income (β=0.08 and 0.03, respectively), pub density (β=0.52, 0.22), and fast-food outlet density (β=2.81, 1.63). Negative associations were observed with manual labor, social activity participation, and hospital bed density. Unhealthy living was positively associated with living alone among women and with being unemployed among middle-aged men. Access to parks was negatively associated with unhealthy living among young men and women. The ecological model explained 32% of regional variation in men and 41% in women.
CONCLUSIONS
Improving the neighborhood built and socioeconomic environment may reduce regional disparities in lifestyle behaviors; however, the impacts may vary according to sociodemographic traits and comorbidities.


Epidemiol Health : Epidemiology and Health