보건행정학회지 (Health Policy and Management)

  • 제26권1호
  • /
  • Pages.12-23
  • /
  • 2016
  • /
  • 1225-4266(pISSN)
  • /
  • 2289-0149(eISSN)
한국보건행정학회 (Korean Academy of Health Policy and Management)
권호 표지
DOI QR코드

DOI QR Code

지역별 심뇌혈관질환 사망률의 차이 및 영향요인

Regional Disparity of Cardiovascular Mortality and Its Determinants

  • 강현진 (서울대학교 보건대학원) ;
  • 권순만 (서울대학교 보건대학원)
  • Kang, Hyeon Jin (Graduate School of Public Health, Seoul National University) ;
  • Kwon, Soonman (Graduate School of Public Health, Seoul National University)
  • 투고 : 2015.10.15
  • 심사 : 2016.03.18
  • 발행 : 2016.03.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background: Many studies have explained regional disparities in health by socioeconomic status and healthcare resources, focusing on differences between urban and rural area. However some cities in Korea have the highest cardiovascular mortality, even though they have sufficient healthcare resources. So this study aims to confirm three hypotheses. (1) There are also regional health disparities between cities not only between urban and rural area. (2) It has different regional risk factors affecting cardiovascular mortality whether it is urban or rural area. (3) Besides socioeconomic and healthcare resources factors, there are remnant factors that affect regional cardiovascular mortality such as health behavior and physical environment. Methods: The subject of this study is 227 local authorities (si, gun, and gu). They were categorized into city (gu and si consisting of urban area) and non-city (gun consisting of rural area), and the city group was subdivided into 3 parts to reflect relative different city status: city 1 (Seoul, Gyeonggi cities), city 2 (Gwangyeoksi cities), and city 3 (other cities). We compared their mortalities among four groups by using analysis of variance analysis. And we explored what had contributed to it in whole authorities, city and non-city group by using multiple regression analysis. Results: Cardiovascular mortality is highest in city 2 group, lowest in city 1 group and middle in non-city group. Socioeconomic status and current smoking significantly increase mortality regardless of group. Other than those things, in city, there are some factors associated with cardiovascular mortality: walking practice(-), weight control attempt(-), deficiency of sports facilities(+), and high rate of factory lot(+). In non-city, there are other factors different from those of city: obesity prevalence(+), self-perceiving obesity(-), number of public health institutions(-), and road ratio(-). Conclusion: To reduce cardiovascular mortality and it's regional disparities, we need to consider differentiated approach, respecting regional character and different risk factors. Also, it is crucial to strengthen local government's capacity for practicing community health policy.

키워드

참고문헌

  1. Statistics Korea. Cause of death statistics 2009-2011. Daejeon: Statistics Korea.
  2. Yoon TH. Regional health inequity and local self-government. Welf Trend [Internet]. 2010 [cited 2016 Apr 4];(139). Available from http://www.peoplepower21.org/Welfare/669441.
  3. Filate WA, Johansen HL, Kennedy CC, Tu JV. Regional variations in cardiovascular mortality in Canada. Can J Cardiol 2003;19(11):1241-1248.
  4. Muller-Nordhorn J, Binting S, Roll S, Willich SN. An update on regional variation in cardiovascular mortality within Europe. Eur Heart J 2008;29(10):1316-1326. DOI: http://dx.doi.org/10.1093/eurheartj/ehm604.
  5. Khang YH. Historical advances in health inequality research. J Prev Med Public Health 2007;40(6):422-430. DOI: http://dx.doi.org/10.3961/jpmph.2007.40.6.422.
  6. Choi BH, Roh YH, Yoon BS, Shin HW, Kim MH, Kim CY. Measuring inequity in health care and policy proposals in Korea. Sejong: Korea Institute for Health and Social Affairs; 2004.
  7. Park EO. Standardized circulatory disease-specific mortality and the associated factors by residential area. Asia-Pac J Multimed Serv Converg Art Humanit Sociol 2015;5(2);89-96.
  8. Tu JV, Ko DT. Ecological studies and cardiovascular outcomes research. Circulation 2008;118(24):2588-2593. DOI: http://dx.doi.org/10.1161/CIRCULATIONAHA.107.729806.
  9. Morgenstern H. Ecologic studies in epidemiology: concepts, principles, and methods. Annu Rev Public Health 1995;16:61-81. DOI: http://dx.doi.org/10.1146/annurev.publhealth.16.1.61.
  10. Kim YH, Cho YT. Impact of area characteristics on the health of vulnerable populations in Seoul. J Popul Assoc Korea 2008;31(1);5-30.
  11. Kang EJ. Clustering of lifestyle behaviors of Korean adults using smoking, drinking, and physical activity. Health Soc Welf Rev 2007;27(2):44-66. DOI: http://dx.doi.org/10.15709/hswr.2007.27.2.44.
  12. Kaneko M, Oda E, Kayamori H, Nagao S, Watanabe H, Abe T, et al. Smoking was a possible negative predictor of incident hypertension after a five-year follow-up among a general Japanese population. Cardiol Res 2012;3(2):87-93. DOI: http://dx.doi.org/10.4021/cr95w.
  13. Kuller LH, Ockene JK, Meilahn E, Wentworth DN, Svendsen KH, Neaton JD. Cigarette smoking and mortality. MRFIT Research Group. Prev Med 1991;20(5):638-654. https://doi.org/10.1016/0091-7435(91)90060-H
  14. Vidrine JI, Reitzel LR, Wetter DW. Smoking and health disparities. Curr Cardiovasc Risk Rep 2009;3(6):403-408. https://doi.org/10.1007/s12170-009-0060-5
  15. Van Itallie TB. Health implications of overweight and obesity in the United States. Ann Intern Med 1985;103(6 Pt 2):983-988. DOI: http://dx.doi.org/10.7326/0003-4819-103-6-983.
  16. Sung EJ, Shin TS. The effect of overweight to cardiovascular risk factors among Korean adolescents. J Korean Acad Fam Med 2003;24(11):1017-1025.
  17. Naimi TS, Brown DW, Brewer RD, Giles WH, Mensah G, Serdula MK, et al. Cardiovascular risk factors and confounders among nondrinking and moderate-drinking U.S. adults. Am J Prev Med 2005;28(4):369-373. DOI: http://dx.doi.org/10.1016/j.amepre.2005.01.011.
  18. Ikehara S, Iso H, Toyoshima H, Date C, Yamamoto A, Kikuchi S, et al. Alcohol consumption and mortality from stroke and coronary heart disease among Japanese men and women: the Japan collaborative cohort study. Stroke 2008;39(11):2936-2942. DOI: http://dx.doi.org/10.1161/STROKEAHA.108.520288.
  19. Lee Y, Shin HK, Choi BM, Eun BL, Park SH, Lee KH, et al. A survey of body shape perception and weight control of adolescent girls in three areas of Korea. Korean J Pediatr 2008;51(2):134-144. DOI: http://dx.doi.org/10.3345/kjp.2008.51.2.134.
  20. Mueller KG, Hurt RT, Abu-Lebdeh HS, Mueller PS. Self-perceived vs actual and desired weight and body mass index in adult ambulatory general internal medicine patients: a cross sectional study. BMC Obes 2014;1:26. DOI: http://dx.doi.org/10.1186/s40608-014-0026-0.
  21. Moore SE, Harris C, Wimberly Y. Perception of weight and threat to health. J Natl Med Assoc 2010;102(2):119-124. DOI: http://dx.doi.org/10.1016/s0027-9684(15)30499-5.
  22. Han JA. Related factors effecting on the regional variation of standardized mortality in Gyeonggi province [master's thesis]. Suwon: Ajou University; 2010.
  23. Jung SY. An ecological study on the factors related with death rate in Busan Area [dissertation]. Busan: Inje University; 2011.
  24. Lee SM. Distributions of socioeconomic and health-related factors between regions with high and regions with low cerebrovascular mortality rates [master's thesis]. Daejeon: Konyang University; 2013.
  25. Park E. A comparison of community health status by region and an investigation of related factors using community health indicators. J Korean Acad Community Health Nurs 2012;23(1):31-39. DOI: http://dx.doi.org/10.12799/jkachn.2012.23.1.31.
  26. Park EO. Cardiovascular disease-specific standardized mortality and the related factor in South Korea. Health Soc Sci 2013;(34);257-271.
  27. Kim HR. Implication of health behaviors in socioeconomic health inequalities and policy directions. Health Welf Policy Forum 2009;(149):36-47.
  28. Son M. The relationships of occupational class, educational level and deprivation with mortality in Korea. Korean J Prev Med 2002;35(1):76-82.
  29. Liberatos P, Link BG, Kelsey JL. The measurement of social class in epidemiology. Epidemiologic reviews 1988;10(1):87-121. https://doi.org/10.1093/oxfordjournals.epirev.a036030
  30. Galobardes B, Shaw M, Lawlor DA, Lynch JW, Smith GD. Indicators of socioeconomic position (part 2). J Epidemiol Community Health 2006;60(2):95-101. DOI: http://dx.doi.org/10.1136/jech.2004.028092.
  31. Lee KH. Effects of neighborhood environment on residents' walking time and health: a case study of 40 areas in Seoul [dissertation]. Seoul: Seoul National University; 2008.
  32. Kwon HJ, Cho SH, Nyberg F, Pershagen G. Effects of ambient air pollution on daily mortality in a cohort of patients with congestive heart failure. Epidemiology 2001;12(4):413-419. DOI: http://dx.doi.org/10.1097/00001648-200107000-00011.
  33. Kim H, Kim Y, Hong YC. The lag-effect pattern in the relationship of particulate air pollution to daily mortality in Seoul, Korea. Int J Biometeorol 2003;48(1):25-30. DOI: http://dx.doi.org/10.1007/s00484-003-0176-0.
  34. Peters A, Dockery DW, Muller JE, Mittleman MA. Increased particulate air pollution and the triggering of myocardial infarction. Circulation 2001;103(23):2810-2815. DOI: http://dx.doi.org/10.1161/01.cir.103.23.2810.
  35. Peters A, von Klot S, Heier M, Trentinaglia I, Hormann A, Wichmann HE, et al. Exposure to traffic and the onset of myocardial infarction. N Engl J Med 2004;351(17):1721-1730. DOI: http://dx.doi.org/10.1056/nejmoa040203.
  36. Lee KH, Ahn GH. The correlation between neighborhood characteristics and walking of residents: a case study of 40 areas in Seoul. J Korean Plan Assoc 2007;42(6):105-118.
  37. Shin KS, Sung HG, Rho JH. Analysis of causal relationship between commuting behavior of office worker and body mass index using path analysis. J Korean Plan Assoc 2009;44(1):197-209.
  38. Humpel N, Owen N, Leslie E. Environmental factors associated with adults' participation in physical activity: a review. Am J Prev Med 2002;22(3):188-199. DOI: http://dx.doi.org/10.1016/s0749-3797(01)00426-3.
  39. Kaczynski AT, Henderson KA. Environmental correlates of physical activity: a review of evidence about parks and recreation. Leisure Sci 2007;29(4):315-354. DOI: http://dx.doi.org/10.1080/01490400701394865.
  40. Groenewegen PP, van den Berg AE, de Vries S, Verheij RA. Vitamin G: effects of green space on health, well-being, and social safety. BMC Public Health 2006;6:149. https://doi.org/10.1186/1471-2458-6-149
  41. Robert SA. Community-level socioeconomic status effects on adult health. J Health Soc Behav 1998;39(1):18-37. DOI: http://dx.doi.org/10.2307/2676387.
  42. Marler JR, Tilley BC, Lu M, Brott TG, Lyden PC, Grotta JC, et al. Early stroke treatment associated with better outcome: the NINDS rt-PA stroke study. Neurology 2000;55(11):1649-1655. DOI: http://dx.doi.org/10.1212/wnl.55.11.1649.
  43. Statistics Korea. Population census. Daejeon: Statstics Korea; 2010.
  44. Ministry of Security and Public Administration. Local finance. Seoul: Ministry of Security and Public Administration; 2010.
  45. Korea Centers for Disease Control and Prevention. Community health survey. Cheongju: Korea Centers for Disease Control and Prevention; 2010.
  46. Ministry of Culture, Sports and Tourism. Status of public sports facilities. Sejong: Ministry of Culture, Sports and Tourism; 2010.
  47. Ministry of Land, Infrastructure and Transport. Cadastral statistics. Sejong: Ministry of Land, Infrastructure and Transport; 2010.
  48. National Health Insurance Service. Health care use statistics. Seoul: National Health Insurance service; 2010.
  49. Park BH. A study on the utilization of the index to measure the fiscal autonomy of local governments. Korean Local Admin Rev 2006;20(1):165-190.
  50. Khang YH, Yun SC, Hwang IA, Lee MS, Lee SI, Jo MW, et al. Changes in mortality inequality in relation to the South Korean economic crisis: use of area-based socioeconomic position. J Prev Med Public Health 2005;38(3):359-365.
  51. Yoon TH. Regional health inequalities in Korea: the status and policytasks. J Crit Soc Policy 2010;(30):49-77.
  52. Seo YM, Ryu SH, Jang CS, Kang HJ, Park JH. A study on the urban industrial location policy for the vitalization of regional economy. Anyang: Korea Research Institute for Human Settlements; 2012.
  53. Doopedia. Industrial city [Internet]. Seoul: Doopedia [cited 2016 Apr 4]. Available from: http://terms.naver.com/entry.nhn?docId=1063508&cid=40942&categoryId=33136.
  54. Park DM, Kim KH. Comparison of air pollutants emissions in Korea industries. J Ind Stud 2003;16:331-351.
  55. Han JY. The relationship between local fiscal indices and standardized mortality rate [master's thesis]. Daejeon: Konyang University; 2010.
  56. Macintyre S, MacIver S, Sooman A. Area, class and health: should we be focusing on places or people? J Soc Policy 1993;22(2):213-234. DOI: http://dx.doi.org/10.1017/s0047279400019310.

피인용 문헌

  1. Strategy of Research for Developing Model of Community Based Non-Communicable Diseases Control and Prevention vol.26, pp.1, 2016, https://doi.org/10.4332/KJHPA.2016.26.1.1
  2. Health Empowerment of Older Adults with High-risk of Cardio-cerebrovascular Diseases vol.28, pp.4, 2017, https://doi.org/10.12799/jkachn.2017.28.4.410