BACKGROUND/OBJECTIVES: Urban-rural inequities in health and mortality exist in Korea, a highly centralized developed country. The potential impact of multiple health-related lifestyle behaviors on mortality and difference between urban and rural areas is not fully understood. This study aimed to investigate the effect of high-risk health behaviors on all-cause mortality among residents living in urban and rural in Korea. SUBJECTS/METHODS: Cross-sectional analyses were conducted on 8,298 adults aged 40 yrs and older from the Korea National Health and Nutrition Examination Survey 2013-2015. High-risk behaviors were defined as having poor diet quality, current smoking, high-risk drinking, or insufficient physical activity. Mortality status was linked to the Cause of Death data followed up to December 31, 2019. The associations between all-cause mortality and high-risk behaviors were evaluated using Cox proportional hazard regression models adjusted for age, sex, education, income, and survey year. Population attributable fractions (PAFs) were calculated, and effect modification analysis was conducted. Participants were stratified by residential area (urban or rural). RESULTS: During the follow-up (median: 5.4 yrs), 313 deaths occurred. A higher proportion of rural residents than urban residents engaged in multiple high-risk behaviors (28.9% vs. 22.6%; P < 0.0001). As individual factors, a greater risk of mortality was associated with poor diet quality, current smoking, and inadequate physical activity, and these tendencies persisted in rural residents, especially for diet quality. Multiple high-risk behaviors were positively associated with a higher risk of mortality in Koreans living in urban and rural areas. PAF (95% confidence interval) was 18.5% (7.35-27.9%) and 29.8% (16.1-40.2%) in urban and rural residents, respectively. No additive or multiplicative effect of the region was observed. CONCLUSION: The higher prevalence of multiple high-risk lifestyle behaviors in rural residents may explain the higher mortality in rural areas compared to urban areas. Comprehensive public health policies to improve health-related behaviors in rural populations may be needed.
Fan, Jin-Hu;Wang, Jian-Bing;Jiang, Yong;Xiang, Wang;Liang, Hao;Wei, Wen-Qiang;Qiao, You-Lin;Boffetta, Paolo
Asian Pacific Journal of Cancer Prevention
/
v.14
no.12
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pp.7251-7256
/
2013
Objectives: To estimate the proportion of liver cancer cases and deaths due to infection with hepatitis B virus (HBV), hepatitis C virus (HCV), aflatoxin exposure, alcohol drinking and smoking in China in 2005. Study design: Systemic assessment of the burden of five modifiable risk factors on the occurrence of liver cancer in China using the population attributable fraction. Methods: We estimated the population attributable fraction of liver cancer caused by five modifiable risk factors using the prevalence data around 1990 and data on relative risks from meta-analyses, and large-scale observational studies. Liver cancer mortality data were from the 3rd National Death Causes Survey, and data on liver cancer incidence were estimated from the mortality data from cancer registries in China and a mortality/incidence ratio calculated. Results: We estimated that HBV infection was responsible for 65.9% of liver cancer deaths in men and 58.4% in women, while HCV was responsible for 27.3% and 28.6% respectively. The fraction of liver cancer deaths attributable to aflatoxin was estimated to be 25.0% for both men and women. Alcohol drinking was responsible for 23.4% of liver cancer deaths in men and 2.2% in women. Smoking was responsible for 18.7% and 1.0%. Overall, 86% of liver cancer mortality and incidence (88% in men and 78% in women) was attributable to these five modifiable risk factors. Conclusions: HBV, HCV, aflatoxin, alcohol drinking and tobacco smoking were responsible for 86% of liver cancer mortality and incidence in China in 2005. Our findings provide useful data for developing guidelines for liver cancer prevention and control in China and other developing countries.
Park, Jong-Ho;Kim, Yoo-Mi;Kim, Sung-Soo;Kim, Won-Joong;Kang, Sung-Hong
Journal of the Korea Academia-Industrial cooperation Society
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v.13
no.4
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pp.1739-1750
/
2012
This study was to develop the assessment of medical service outcome using administration data through compared with hospital standardized mortality ratios(HSMR) in various hospitals. This study analyzed 63,664 cases of Hospital Discharge Injury Data of 2007 and 2008, provided by Korea Centers for Disease Control and Prevention. We used data mining technique and compared decision tree and logistic regression for developing risk-adjustment model of in-hospital mortality. Our Analysis shows that gender, length of stay, Elixhauser comorbidity index, hospitalization path, and primary diagnosis are main variables which influence mortality ratio. By comparing hospital standardized mortality ratios(HSMR) with standardized variables, we found concrete differences (55.6-201.6) of hospital standardized mortality ratios(HSMR) among hospitals. This proves that there are quality-gaps of medical service among hospitals. This study outcome should be utilized more to achieve the improvement of the quality of medical service.
Due to the rapid development of medical information, vast amounts of medical data are accumulating, and such medical data is highly likely to be used as an important data for solving the aging population and the rapid rise in medical cost. Especially in Korea, there are resident registration numbers and computerized usage data for all citizens, so it can be superior to other countries in terms of medical infrastructure that can utilize big data. The purpose of this study was to analyze the factors affecting the mortality and death rate of Gangwon using the Big Data and the National Statistical Office data centered on Kangwon province. As a result of analysis, major variables related to the mortality rate of Gangwon were hospital infrastructure utilization rate, income level, aging population and population density. Therefore, inequalities due to income disparities and insufficient local medical infrastructures were affecting the local mortality rate, and policy support was needed to improve the local hospital infrastructure and income level. The results of this study were meaningful in that medical big data were used to analyze the deaths of people in Gangwon, and the causes of the deaths were analyzed through various social indicators and correlation analysis.
Data and pedigree information for Lori-Bakhtiari sheep used in this study were 6,239 records of lamb mortality from 246 sires and 1,721 dams, collected from 1989 through 2007 from a Lori-Bakhtiari flock at Shooli station in Shahrekord. The traits investigated were cumulative lamb mortality from birth up to 7 days, up to 14 days, up to 21 days, and up to 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 and 12 months of age. The models included fixed factors that had significant effects and random direct genetic, maternal genetic and maternal permanent environmental effects. Variance components were estimated using the restricted maximum likelihood procedure applying three animal models with and without maternal and common environmental effects. The overall mean of cumulative lamb mortality rate was 22.95% from birth to 1 year of age, while the overall mortality rate up to 3 and from 3 to 6 months of age was 6.14% and 12.76%, respectively. The mortality rate after 6 months of age declined as the lambs grew older. The age of dam had no important effect on lamb mortality. The type of birth was more important during the preweaning period than at later ages, and lamb mortality rate was higher in twins. The year of birth, month of birth and sex of lamb significantly (p${\leq}$0.01) affected the cumulative lamb mortality rate at all ages. The least square mean of mortality during the final one-third of the lambing period was higher than the first and middle onethird of the lambing period. Male lambs were found to be at a higher risk of mortality than females. Birth weight of the lamb had a highly significant (p${\leq}$0.01) effect on lamb mortality at all ages as a quadratic regression. Direct and maternal heritability estimates of lamb mortality ranged from 0.01 to 0.13 and 0.01 to 0.05, respectively. Direct heritability increased with age of lamb, while maternal effects (genetic and common environmental) were important in the preweaning period. These results indicate that lamb mortality can be reduced first through farm management practices and secondly by genetic selection. Both animal and maternal effects should be considered in breeding programmes for reducing lamb mortality at preweaning.
Ha, Jae-Hyeok;Kim, Soo-Geun;Paek, Do-Myung;Park, Jung-Sun
Safety and Health at Work
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v.2
no.1
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pp.70-82
/
2011
Objectives: Ischemic heart disease (IHD) is a major cause of death in Korea and known to result from several occupational factors. This study attempted to estimate the current magnitude of IHD mortality due to occupational factors in Korea. Methods: After selecting occupational risk factors by literature investigation, we calculated attributable fractions (AFs) from relative risks and exposure data for each factor. Relative risks were estimated using meta-analysis based on published research. Exposure data were collected from the 2006 Survey of Korean Working Conditions. Finally, we estimated 2006 occupation-related IHD mortality. Results: For the factors considered, we estimated the following relative risks: noise 1.06, environmental tobacco smoke 1.19 (men) and 1.22 (women), shift work 1.12, and low job control 1.15 (men) and 1.08 (women). Combined AFs of those factors in the IHD were estimated at 9.29% (0.3-18.51%) in men and 5.78% (-7.05-19.15%) in women. Based on these fractions, Korea's 2006 death toll from occupational IHD between the age of 15 and 69 was calculated at 353 in men (total 3,804) and 72 in women (total 1,246). Conclusion: We estimated occupational IHD mortality of Korea with updated data and more relevant evidence. Despite the efforts to obtain reliable estimates, there were many assumptions and limitations that must be overcome. Future research based on more precise design and reliable evidence is required for more accurate estimates.
Background: This study used pre-hepatitis A vaccination era data in U.S. to study the relationship between serum hepatitis A antibody positivity with pancreas cancer mortality in adults. Patients and Methods: Public use National Health and Nutrition Examination Survey (NHANES III) data were employed. NHANES III uses complex probabilistic methods to sample nationally representative samples. Household adult laboratory and mortality data were merged. Sample persons who were available to be examined in the Mobile Examination Center (MEC) were included in this study. All results were obtained by using specialized survey software taking into account the primary sampling unit and stratification variables and the weights assigned to the sample persons examined in the MEC. Thus they are representative of the U.S. population. Results: The mean risk (95%CI) of death in the study population for pancreas cancer was 0.0014 (-0.000069 -.0029); their mean age (95%CI) at the mobile examination center (MXPAXTMR) was 473.43 (463.85-482.10); the follow up in months from their medical examination (permth_exm) was 170.12 (164.17-176.07). The odds ratios (S.E.) of the statistically significant univariables were: age, 1.007 (1.005-1.009); serum anti-hepatitis antibody status, 0.038 (0.004-0.376); and drinking hard liquor, 1.014 (1.004-1.023). The coefficients (S.E.) of the statistically significant variables after multivariate analysis were 0.006 (0.002-0.010) for age and -2.528 (-4.945--0.111) for serum anti-hepatitis A antibody negativity (using serum anti-hepatitis A antibody positivity as a reference). Conclusion: Serum hepatitis A antibody positivity correlates with higher pancreas cancer mortality in adults.
Purpose: Analysis of descriptive epidemiological characteristics of pancreatic cancer in Vojvodina, Serbia. Materials and Methods: The study covers population of Vojvodina in the period from 2000 to 2009. The method used for data processing was the descriptive. The data, referring to a specified period of time, were analyzed from chronological and demographic aspects and according to histological diagnosis. Results: In the period from 2000 to 2009, there were 2,108 registered cases of pancreatic cancer of which 1,886 had a fatal outcome. Standardized incidence rates varied between 5.7 and 9.1 per 100,000 population in males and between 4.2 and 5.3 in females. Linear incidence trends in males in the specified period of time, based on crude (r=0.7883, p<0.05) and standardized (r=0,6373, p<0,05) incidence rates, demonstrated increase. Annual percent increase in the crude incidence rate was 4.5% in males, and 2.8% in females. Age-standardized mortality rates varied between 5.2 and 7.5 per 100,000 population in males and 3.6 and 4.7 in females. Linear mortality trends in males in the specified period of time, based on crude (r=0.8795, p<0.05) and standardized (r=0.7669, p<0.05) mortality rates, also demonstrated annual percent increase. Conclusions: Data analysis shows unfavorable onco-epidemiological situation related to pancreatic cancer in Vojvodina, in aspects of both incidence and mortality. Absence of primary and secondary prevention does not allow medical institutions to successfully fight against this disease.
Objective : Several studies have reported inconsistent findings among countries on whether off-hour hospital presentation is associated with worse outcome in patients with acute stroke. However, its association is yet not clear and has not been thoroughly studied in Korea. We assessed nationwide administrative data to verify off-hour effect in different subtypes of acute stroke in Korea. Methods : We respectively analyzed the nationwide administrative data of National Emergency Department Information System in Korea; 7144 of ischemic stroke (IS), 2424 of intracerebral hemorrhage (ICH), and 1482 of subarachnoid hemorrhage (SAH), respectively. "Off-hour hospital presentation" was defined as weekends, holidays, and any times except 8:00 AM to 6:00 PM on weekdays. The primary outcome measure was in-hospital mortality in different subtypes of acute stroke. We adjusted for covariates to influence the primary outcome using binary logistic regression model and Cox's proportional hazard model. Results : In subjects with IS, off-hour hospital presentation was associated with unfavorable outcome (24.6% off hours vs. 20.9% working hours, p<0.001) and in-hospital mortality (5.3% off hours vs. 3.9% working hours, p=0.004), even after adjustment for compounding variables (hazard ratio [HR], 1.244; 95% confidence interval [CI], 1.106-1.400; HR, 1.402; 95% CI, 1.124-1.747, respectively). Off-hours had significantly more elderly ≥65 years (35.4% off hours vs. 32.1% working hours, p=0.029) and significantly more frequent intensive care unit admission (32.5% off hours vs. 29.9% working hours, p=0.017) than working hours. However, off-hour hospital presentation was not related to poor short-term outcome in subjects with ICH and SAH. Conclusion : This study indicates that off-hour hospital presentation may lead to poor short-term morbidity and mortality in patients with IS, but not in patients with ICH and SAH in Korea. Excessive death seems to be ascribed to old age or the higher severity of medical conditions apart from that of stroke during off hours.
This paper attempts to explore the relation between health care availability and child mortality among ethnic groups with different cultural traditions of sex preference. Micro-data from the 1990 Census of China for Yanbian and Xishuangbanna Prefectures are used. Based on the analysis of data for Koreans, Hans, and Dais in these prefectures, a new model explaining the relation between sex preference, health care. and differentials in child mortality is proposed in this paper. In societies, where health care is easily available, the level of child mortality is not likely to be a function of sex preference. In societies where there is little availability of health care, members of ethnic groups with strong sex preference do whatever possible to assure survival of their children of the preferred sex. But actions to assure survival of children of the sex not preferred by their parents depend on the costs involved and other considerations. Therefore, the level of child mortality for the preferred sex is likely to be substantially lower than that of the not-preferred sex. However, as availability of health care improves and the cost of obtaining health care becomes lower, survival of children of the not-preferred sex are likely to improve. It is generally agreed that Koreans and Hans show strong son preference, while Dais have cultural traditions of daughter preference. In Yanbian, where virtually all children receive health care whenever it is needed, Korean females and Han females show lower child mortality than their male counterparts, although the difference is not found to be significant for Koreans. In Xishuangbanna, where there is little availability of health care, Dai males show markedly higher child mortality than Dai females, and Han females have higher child mortality than Han males. However, small improvements in the availability of health care in Xishuangbanna translate into substantial improvements in survival of male children for Dais, and survival of female children for Hans.
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