한국산학기술학회논문지 (Journal of the Korea Academia-Industrial cooperation Society)

  • 제17권10호
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  • Pages.382-395
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  • 2016
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  • 1975-4701(pISSN)
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  • 2288-4688(eISSN)
한국산학기술학회 (The Korea Academia-Industrial cooperation Society)
권호 표지
DOI QR코드

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한국사회의 지역박탈과 사회적 자본이 주관적 건강수준에 미치는 영향

Effect of Area deprivation and Social capital on Self rated health among Koreans

  • 박은주 (충남대학교 보건대학원) ;
  • 연미연 (충남대학교 의과대학/의학전문대학원 예방의학교실) ;
  • 김철웅 (충남대학교 의과대학/의학전문대학원 예방의학교실)
  • Park, Eun-Joo (Department of public health, Chungnam national University Graduate school) ;
  • Yeon, Mi-Yeon (Department of Preventive Medecine, Chungnam national University school of medicine) ;
  • Kim, Chul-Woung (Department of Preventive Medecine, Chungnam national University school of medicine)
  • 투고 : 2016.07.12
  • 심사 : 2016.10.07
  • 발행 : 2016.10.31
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초록

본 연구의 목적은 지역박탈지수와 사회적 자본이 주관적 건강수준에 미치는 영향을 알아봄으로써 주거지역의 특성이 그 지역에 거주하는 인구집단의 건강에 영향을 미치는지를 파악해 보고자 함이다. 이를 위해 2011년 지역사회건강조사를 활용하여 전국 253개 지역의 229,186명을 대상으로 다수준 로지스틱 회귀분석을 실시하였다. 주관적 건강수준에 대한 5개의 응답범주 중 자신의 건강을 '보통', '좋지 않음', '매우 좋지 않음' 이라고 응답한 인구집단을 대상으로 첫번째 분석이 이루어 졌으며, '보통'을 제외하고 '좋지 않음', '매우 좋지 않음' 이라고 응답한 인구집단을 대상으로 두번째 분석이 이루어졌다. 분석결과 두 번째 분석에서 지역박탈지수가 통계적으로 유의미했던 반면 '보통'이라고 응답한 인구집단이 비양호건강 집단에 포함된 첫 번째 그룹에서는 유의미하지 않았다. 사회적 자본은 두 그룹 모두 유의미하지 않았다. 본 연구에서 값이 크지는 않지만 지역박탈지수가 지역의 맥락효과로서의 설명력을 보였으며 그 효과는 일부지역에 국한된 것이 아니라 한국 사회 전체에 영향을 미치는 것을 확인할 수 있었다. 향후 지역적 개입을 통한 건강수준향상을 위한 노력이 경주되어야 함을 알 수 있었다. 또한 주관적 건강수준 평가 연구에서 기존 연구결과와 비교 분석을 하려면 '비양호' 또는 '양호'의 기준을 동일하게 설정할 필요가 있다.

The purpose of this study is to examine how area characteristics influence the health of a population in a particular area by investigating how area deprivation and social capital influence self-rated health. For this study, a multi-level logistic regression was employed to analyze the data collected by Community Health Survey conducted on a target population of 229,186 living at 253 administrative areas of Korea in 2011. First, an analysis was conducted for subjects who have rated their self-health assessment as 'fair', 'poor', and 'very poor' in a 5 -item response survey. Then, a second analysis was conducted for the same subjects by excluding those with a rating of 'fair'. As a result, we found that area deprivation significantly influenced the population's health, according to our second analysis, while it was not significant according to our first analysis. Moreover, social capital was not significant in both analyses. Area deprivation-although the value of it was not so high-seems to explain the differences of individual self-rated health assessment as a contextual effect. In addition, influence of area characteristics is not limited to certain local areas, but to all local areas of Korea. Therefore, it is suggested that efforts to improve area characteristics are necessary to upgrade the individual's health level. A standardized classification system-distinguishing between good and poor self-rated health-is necessary through further comparative studies on self-rated health assessment.

키워드

참고문헌

  1. Fone D, Dunstan F, Lloyd K, Williams G, Watkins J, Palmer S. Does social cohesion modify the association between area income deprivation and mental health? A multilevel analysis. International Journal of Epidemiology, 36:338-345, 2007. DOI: http://dx.doi.org/10.1093/ije/dym004
  2. Mansyur C, Amick BC, Harist RB, Franzini, L. Social capital, income inequality, and self-rated health in 45 countries. Social Science & Medicine, 66:43-56, 2008. DOI: http://dx.doi.org/10.1016/j.socscimed.2007.08.015
  3. Mohnen SM, Groenewegen PP, Volker B, Flap H. Neighborhood social capital and individual health. Social Science & Medicine, 72:660-667, 2011. DOI: http://dx.doi.org/10.1016/j.socscimed.2010.12.004
  4. Pickett KE, Pearl M. Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review. Journal of Epidemiology and Community Health, 55:111-122, 2001. DOI: http://dx.doi.org/10.1136/jech.55.2.111
  5. Riva M, Gauvin L, Barnett TA. Toward the next generation of research into small area effects on health: a synthesis of multilevel investigations published since July 1998. Journal of Epidemiology and Community Health, 61:853-861, 2007. DOI: http://dx.doi.org/10.1136/jech.2006.050740
  6. Becares L, Nazroo J, Albor C, Chandola T, Stafford M. Examining the differential association between self-rated health and area deprivation among white British and ethnic minority people in England. Social Science & Medicine, 74:616-624, 2012. DOI: http://dx.doi.org/10.1016/j.socscimed.2011.11.007
  7. Diez Roux AV, Mair C. Neighborhoods and health. Annals of the New York Academy of Sciences, 1186:125-145, 2010. DOI: http://dx.doi.org/10.1111/j.1749-6632.2009.05333.x
  8. White HL, Matheson FI, Moineddin R, Dunn JR, Glazier RH. Neighbourhood deprivation and regional inequalities in self-reported health among Canadians: Are we equally at risk? Health & Place, 17:361-169, 2011. DOI: http://dx.doi.org/10.1016/j.healthplace.2010.11.016
  9. Cummins S, Stafford M, Macintyre S, Marmot M, Ellaway A. Neighbourhood environment and its association with self rated health: evidence from Scotland and England. Journal of Epidemiology and Community Health, 59:207-213, 2005. DOI: http://dx.doi.org/10.1136/jech.2003.016147
  10. Kondo N, Sembajwe G, Kawachi I, Van Dam RM, Subramanian SV, Yamagata Z. Income inequality, mortality, and self rated health: metaanalysis of multilevel studies. British Medical Journal, 339: b4471, 2009. DOI: http://dx.doi.org/10.1136/bmj.b4471
  11. Poortinga W, Dunstan FD, Fone DL. Perceptions of the neighbourhood environment and self rated health: a multilevel analysis of the Caerphilly Health and Social Needs Study. BMC Public Health, 7:285, 2007. DOI: http://dx.doi.org/10.1186/1471-2458-7-285
  12. Kawach I. Social capital and health. In: Bird CE, Conard P, Fremont AM, Timmermans S, Editors. Handbook of medical sociology. 6th ed. Vanderbilt University Press Nashville; 2010.p.18-32.
  13. Coleman JS. The Foundations of Social Theory. Cambridge, Mass: Harvard University Press; 1990:300-321.
  14. Putnam RD. Making Democracy Work Princeton, NJ: Princeton University Press; 1993.
  15. Kawachi I, Kennedy BP, Glass R. Social Capital and Self-Rated Health: A Contextual Analysis. American Journal of Public Health, 89:1187-1193, 1999. DOI: http://dx.doi.org/10.2105/AJPH.89.8.1187
  16. Chung DY, Rho KH. An Exploratory Study on the Effects of Social Capital mediated Corporate Entrepreneurship of Venture upon Corporate Performance. Journal of the Korea Academia-Industrial cooperation Society, 11(5): 1863-1872, 2010. DOI: http://dx.doi.org/10.5762/KAIS.2010.11.5.1863
  17. Hwang KS, Effect of Social Capital on Goendang culture(a traditional community culture on Jeju) and Local Development. Journal of the Korea Academia-Industrial cooperation Society, 16(3):1764-1772, 2015. DOI: http://dx.doi.org/10.5762/KAIS.2015.16.3.1764
  18. Kim IS, Hwang KS, Ko KW. Effects of the Social Capital of individual Civil Servants on the Efficiency of Public Service -Focus of civil servants in Jeju province. Journal of the Korea Academia-Industrial cooperation Society, 15(10):6036-6045, 2014. https://doi.org/10.5762/KAIS.2014.15.10.6036
  19. Kim D, Subramanian SV, Kawachi I. Bonding versus bridging social capital and their associations with self rated health: a multilevel analysis of 40 US communities. Journal of Epidemiology and Community Health, 60:116-122, 2006. DOI: http://dx.doi.org/10.1136/jech.2005.038281
  20. Lofors J, Sundquist K. Low-linking social capital as a predictor of mental disorders: a cohort study of 4.5million Swedes. Social Science & Medicine, 64:21-34, 2007. DOI: http://dx.doi.org/10.1016/j.socscimed.2006.08.024
  21. Fujiwara T, Kawachi I. A prospective study of individual-level social capital and major depression in the United States. Journal of Epidemiology and Community Health, 62:627-633, 2008. DOI: http://dx.doi.org/10.1136/jech.2007.064261
  22. Martikainen P, Kauppinen TM, Valkonen T. Effects of the characteristics of neighborhoods and the characteristics of people on cause specific mortality: a register based follow up study of 252,000 men. Journal of Epidemiology and Community Health, 57:210-217, 2003. DOI: http://dx.doi.org/10.1136/jech.57.3.210
  23. Lochner KA, Kawachi I, Brennan RT, Buka SL, Social capital and neighborhood mortality rates in Chicago. Social Science & Medicine, 56:1797-1805, 2003. DOI: http://dx.doi.org/10.1016/S0277-9536(02)00177-6
  24. Van Hooijdonk C, Droomers M, Deerenberg IM, Mackenbach JP, Kunst AE. The diversity in associations between community social capital and health per health outcome, population group and location studied. International Journal of Epidemiology, 37:1384-1392, 2008. DOI: http://dx.doi.org/10.1093/ije/dyn181
  25. Kim D, Subramanian SV, Gortmaker SL, Kawachi I. US state-and county-level social capital in relation to obesity and physical inactivity: a multilevel, multivariable analysis. Social Science & Medicine, 63:1045-1059, 2006. DOI: http://dx.doi.org/10.1016/j.socscimed.2006.02.017
  26. Poortinga W. Do health behaviors mediate the association between social capital and health? Preventive Medicine, 43:488-493, 2006. https://doi.org/10.1016/j.ypmed.2006.06.004
  27. Kim KH, Lee SK, Yoon HJ, Kwon GH. The effects of Social Capital of old-old elderly of more than 70-year-old on their health-related quality of life. Journal of the Korea Academia-Industrial cooperation Society, 16(6):3889-3901, 2015. DOI: http://dx.doi.org/10.5762/KAIS.2015.16.6.3889
  28. Jung SW, Cho YT. Neighborhood Characteristics and Individual Health under Korean Context. J Prev Med Public Health, 8(3): 259-266, 2005.
  29. Kim YH, Cho YT. Impact of Area Characteristics on the Health of Vulnerable Populations in Seoul. The Population Association of Korea, 31(1):1-26, 2008.
  30. Kim HY. Community Inequalities in Health: The Contextual Effect of Social Capital. Korean Journal of Sociology, 44(2):59-92, 2010. DOI: http://dx.doi.org/10.1080/10810730.2010.514031
  31. Jung MS, Viswanath K. Does community capacity influence self-rated health? Multilevel contextual effects in Seoul, Korea. Social Science & Medicine, 77:60-69, 2013. DOI: http://dx.doi.org/10.1016/j.socscimed.2012.11.005
  32. Lee Y, The predictive value of self assessed general, physical, and mental health on functional decline and mortality in older adults. Journal of Epidemiology and Community Health, 54:123-129, 2000. DOI: http://dx.doi.org/10.1136/jech.54.2.123
  33. Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B. Depression, chronic diseases, and decrements in health: results from the world health surveys. Lancet, 370:851-858, 2007. DOI: http://dx.doi.org/10.1016/S0140-6736(07)61415-9
  34. Lee KH. Effects of Neighborhood Environment on Residents' Subjective Health -A Case study of Changwon. Journal of the Korea Academia-Industrial cooperation Society 14(8):4019-4027, 2013. https://doi.org/10.5762/KAIS.2013.14.8.4019
  35. Kim TH. A study on the Effect of Family Affluence on Happiness : The analysis of the Mediating effect of Self-rated Health. Journal of the Korea Academia-Industrial cooperation Society, 16(3)1692-1698, 2015. DOI: http://dx.doi.org/10.5762/KAIS.2015.16.3.1692
  36. Kaplan GA, Camacho T. Perceived health and mortality: a nine-year follow up of the human population laboratory cohort. American Journal of Epidemiology, 117:292-304, 1983. https://doi.org/10.1093/oxfordjournals.aje.a113541
  37. Kaplan GA, Goldberg DE, Everson SA, Cohen RD, Salonen R, Tuomilehto J, et al. Perceived health status and morbidity and mortality: evidence from the Kuopio Ischaemic Heart Disease risk factor study. International Journal of Epidemiology 25:259-265, 1996. DOI: http://dx.doi.org/10.1093/ije/25.2.259
  38. Segovia J, Bartlett RF, Edwards AC. An empirical analysis of the dimensions of health status measures. Social Science and Medicine, 29:761-768, 1989. DOI: http://dx.doi.org/10.1016/0277-9536(89)90156-1
  39. Health at a Glance 2013 OECD INDICATORS Available from: http://www.oecd.org/els/health-systems/Health-at-a-Glance-2013.pdf
  40. 2011 Guidebook for using Community Health Survey raw data. Korea center for disease control and prevention. 2011.
  41. Kim DJ, Lee SY, Ki M, Kim MH, Kim SS, Kim YM et al. Developing Health Inequalities Indicators and Monitoring the Status of Health Inequalities in Korea. Korea institute for health and social affairs, 10:175-179, 2013.
  42. Putnam RD. Making Democracy Work Princeton, NJ: Princeton University Press; 1993.
  43. Health at a Glance 2013. Korea institute for health and social affairs p. 40
  44. Bopp M, Braun J, Gutzwiller F, Faeh D. Health Risk or Resource? Gradual and Independent Association between Self-Rated Health and Mortality Persists Over 30 Years. PLoS ONE, 7:e30795, 2012. DOI: http://dx.doi.org/10.1371/journal.pone.0030795
  45. Boo GC, Chang JY. Self rated health among older adult in Korea: A cross national comparative study between German, Sweden and Italy. Labor Review, 9:66-81, 2007.
  46. Han SH. Compositional and contextual associations of social capital and self rated health in Seoul, South Korea: A multilevel analysis of longitudinal evidence. Social Science & Medicine, 80:113-120, 2013. DOI: http://dx.doi.org/10.1016/j.socscimed.2012.12.005
  47. Jung MS, Cho BH. The Influence of Community Capacity in Health Status. Health and Social Science, 22:153-182, 2007.
  48. Duncan C, Jones K, Moon G. Context, composition and heterogeneity: using multilevel models in health research. Soc Sci Med, 46:97-117, 1998. DOI: http://dx.doi.org/10.1016/S0277-9536(97)00148-2