• Tuberculosis and Respiratory Diseases
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• 제85권4호
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• pp.349-357
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• 2022

Background: The most consistently identified mortality determinants for the new coronavirus 2019 (COVID-19) infection are aging, male sex, cardiovascular/respiratory diseases, and cancer. They were determined from heterogeneous cohorts that included patients with different disease severity and previous conditions. The main goal of this study was to determine if activities of daily living (ADL) dependence measured by Barthel's index could be a predictor for COVID-19 mortality. Methods: A prospective cohort study was performed with a consecutive sample of 340 COVID-19 patients representing patients from all over the northern region of Portugal from October 2020 to March 2021. Mortality risk factors were determined after controlling for demographics, ADL dependence, admission time, comorbidities, clinical manifestations, and delay-time for diagnosis. Central tendency measures were used to analyze continuous variables and absolute numbers (proportions) for categorical variables. For univariable analysis, we used t test, chi-square test, or Fisher exact test as appropriate (α=0.05). Multivariable analysis was performed using logistic regression. IBM SPSS version 27 statistical software was used for data analysis. Results: The cohort included 340 patients (55.3% females) with a mean age of 80.6±11.0 years. The mortality rate was 19.7%. Univariate analysis revealed that aging, ADL dependence, pneumonia, and dementia were associated with mortality and that dyslipidemia and obesity were associated with survival. In multivariable analysis, dyslipidemia (odds ratio [OR], 0.35; 95% confidence interval [CI], 0.17-0.71) was independently associated with survival. Age ≥86 years (pooled OR, 2.239; 95% CI, 1.100-4.559), pneumonia (pooled OR, 3.00; 95% CI, 1.362-6.606), and ADL dependence (pooled OR, 6.296; 95% CI, 1.795-22.088) were significantly related to mortality (receiver operating characteristic area under the curve, 82.1%; p<0.001). Conclusion: ADL dependence, aging, and pneumonia are three main predictors for COVID-19 mortality in an elderly population.

• Asian Pacific Journal of Cancer Prevention
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• 제17권sup3호
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• pp.311-316
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• 2016

Breast cancer is one of the most common causes of cancer mortality in Iran. Social determinants of health are among the key factors affecting the pathogenesis of diseases. This cross-sectional study aimed to determine the social determinants of breast cancer survival time with parametric and semi-parametric regression models. It was conducted on male and female patients diagnosed with breast cancer presenting to the Cancer Research Center of Shohada-E-Tajrish Hospital from 2006 to 2010. The Cox proportional hazard model and parametric models including the Weibull, log normal and log-logistic models were applied to determine the social determinants of survival time of breast cancer patients. The Akaike information criterion (AIC) was used to assess the best fit. Statistical analysis was performed with STATA (version 11) software. This study was performed on 797 breast cancer patients, aged 25-93 years with a mean age of 54.7 (${\pm}11.9$) years. In both semi-parametric and parametric models, the three-year survival was related to level of education and municipal district of residence (P<0.05). The AIC suggested that log normal distribution was the best fit for the three-year survival time of breast cancer patients. Social determinants of health such as level of education and municipal district of residence affect the survival of breast cancer cases. Future studies must focus on the effect of childhood social class on the survival times of cancers, which have hitherto only been paid limited attention.

• Journal of Preventive Medicine and Public Health
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• 제39권6호
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• pp.469-476
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• 2006

Objectives : To investigate the effect of parents' social class on infant and child mortality rates among the birth cohort, for the period of transition to and from the Koran economic crisis 1995-2004. Methods : All births reported to between 1995 and 2004 (n=5,711,337) were analyzed using a Cox regression model, to study the role of the social determinants of parents in infant and child mortality. The results were adjusted for the parents' age, education and occupation, together with mother's obstetrical history. Results. The crude death rate among those under 10 was 3.71 per 1000 births (21,217 deaths among 5,711,337 births) between 1995 and 2004. The birth cohorts from lower educated parents less than elementary school showed higher mortality rates compared with those from higher educated parents over university level (HR:3.0 (95%CI:2.8-3.7) for father and HR:3.4 (95%CI:3.3-4.5) for mother). The mother's education level showed a stronger relationship with mortality among the birth cohort than that of the fathers. The gaps in infant mortality rates by parents' social class, and educational level became wider from 1995 to 2004. In particular, the breadth of the existing gap between higher and lower parents' social class groups has dramatically widened since the economic crisis of 1998. Discussions : This study shows that social differences exist in infant and child mortality rates. Also, the gap for the infant mortality due to social class has become wider since the economic crisis of 1998.

• Korean Circulation Journal
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• 제48권12호
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• pp.1148-1156
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• 2018

Background and Objectives: It is controversial that decreased left ventricular function could predict poststroke outcomes. The purpose of this study is to elucidate whether left ventricular ejection fraction (LVEF) can predict cardiovascular events and mortality in acute ischemic stroke (AIS) without atrial fibrillation (AF) and coronary heart disease (CHD). Methods: Transthoracic echocardiography was conducted consecutively in patients with AIS or transient ischemic attack at Soonchunhyang University Hospital between January 2008 and July 2016. The clinical data and echocardiographic LVEF of 1,465 patients were reviewed after excluding AF and CHD. Poststroke disability, major adverse cardiac events (MACE; nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death) and all-cause mortality during 1 year after index stroke were prospectively captured. Cox proportional hazards regressions analysis were applied adjusting traditional risk factors and potential determinants. Results: The mean follow-up time was $259.9{\pm}148.8days$ with a total of 29 non-fatal strokes, 3 myocardial infarctions, 33 cardiovascular deaths, and 53 all-cause mortality. The cumulative incidence of MACE and all-cause mortality were significantly higher in the lowest LVEF (<55) group compared with the others (p=0.022 and 0.009). In prediction models, LVEF (per 10%) had hazards ratios of 0.54 (95% confidence interval [CI], 0.36-0.80, p=0.002) for MACE and 0.61 (95% CI, 0.39-0.97, p=0.037) for all-cause mortality. Conclusions: LVEF could be an independent predictor of cardiovascular events and mortality after AIS in the absence of AF and CHD.

• 보건행정학회지
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• 제20권1호
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• pp.1-18
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• 2010

This article examines social determinants of population health in OECD countries, where life years, infant mortality, and PYLL are used as proxy variables of health. The unit of analysis is a country which is the OECD affiliate. A panel regression estimation is chosen as a method, using OECD Health Data. The results are: the increasing national health expenditure affected positively to improve population health. Education was rather a significant determinant of health than income level. The government direct investment for public health did not contribute positively to enhance population health. The expansion of health care coverage was working positively for improving health, but with a time lag. The supply of doctors was a most influential determinant of health. In case of Korea, the coverage expansion of health care was the most important determinant of health. The supply of doctors was, however, not a positive factor for better health, which is different result with the case of OECD countries.

• 보건교육건강증진학회지
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• 제30권1호
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• pp.41-52
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• 2013

Objectives: Rural-urban differences in suicide have been observed in many settings. However, there has been little research addressing what factors can explain these differences. The purpose of this study was to analyze which compositional factors and contextual factors in local areas might be related to local suicide. Methods: The study design was cross-sectional. The data for 251 primary local governments on their age-standardized suicide mortality and their predefined indicators of compositional factors and contextual factors were obtained from Korean Statistical Information Service as of year 2010. Bivariate analysis including one-way ANOVA and chi-square test were used to identify the differences in local features by area type. Seven poisson regression models for each of total, males, and females were used to analyze which compositional and contextual factors were related to suicide. Results: There were differences in suicide between gu and goon in total, male, and female groups. For total, compositional factors including divorce and smoking rate, and contextual factors including financial independency, water and waterwaste coverage, and number of wastewater discharge factories were found to explain the urban-rural differences. Conclusions: This study provided some evidence that contextual factors at the local level as well as compositional factors are useful for predicting local suicide mortality.

• Asian Pacific Journal of Cancer Prevention
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• 제17권sup3호
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• pp.11-15
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• 2016

Gastrointestinal cancers remain the most prevalent cancers in many developing countries such as Iran. The aim of this study was to estimate incidence, prevalence and mortality, as well as time trends for gastrointestinal cancers in Isfahan province of Iran for the period 2001 to 2010 and to project these estimates to the year 2020. Estimates were driven by applying the MIAMOD method (a backward calculation approach using mortality and relative survival rates). Mortality data were obtained from the Ministry of Health and the relative survival rate for all gastrointestinal cancers combined was derived from the Eurocare 3 study. Results indicated that there were clear upward trends in age adjusted incidence (males 22.9 to 74.2 and females 14.9 to 44.2), prevalence (males 52.6 to 177.7 and females 38.3 to 111.03), and mortality (males 14.6 to 47.2 and females 9.6 to 28.2) rates per 100,000 for the period of 2001 to 2010 and this upward state would persist for the projected period. For the entire period, the male to female ratio increased slightly for all parameters (incidence rate increased from 1.5 to 1.7, prevalence from 1.4 to 1.6, and mortality from 1.5 to 1.7). In males, totals of 2,179 incident cases, 5,097 prevalent cases and 1,398 mortality cases were predicated to occur during the study period. For females the predicted figures were 1,379, 3,190 and 891, respectively. It was concluded that the upward trend of incidence alongside increase in survival rates would induce a high burden on the health care infrastructure in the province of Isfahan in the future.

• 보건교육건강증진학회지
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• 제25권4호
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• pp.67-82
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• 2008

Purpose: The objective of this study were to examine the determinants of self-rated health, specially focused on the effect of functional capacity of community dwelling sedentary older adults on self-rated health. Method: The data has been collected from 654 community-dwelling sedentary older adults (mean age: 75 years) during the period from April to June in 2007. The data were collected by the in-person interview and direct measurement of functional capacity. The data were analyzed using chi-square test and multiple regression analysis with the SPSS 9.1 program. Result: The elderly rated their health as very good (3%), good (28%), fair (38%), poor (29%0, and very poor (2%). The higher average daily walk minutes ($\beta$=0.12, p<.01), number of chair stand ($\beta$=0.10, p<.05), scores of self-efficacy ($\beta$=0.16, p<.001) and the lower number of disease ($\beta$=-0.44, p<.001) show better self-rated health. Conclusion: Self-rated health is the most commonly used indicators in social epidemiology and geriatric research because it has been known as the good predictor of mortality and reflects health related disability. The finding suggested that daily walking habits, lower body strength, physical self-efficacy should be considered to improve the senior's self-perception of health. The community-based intervention associate increase these factors should be considered.

• Tuberculosis and Respiratory Diseases
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• 제60권2호
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• pp.205-214
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• 2006

배 경 : 만성폐쇄성폐질환의 급성 악화는 주요한 사회경제적 부담이다. 이 질환의 높은 사망률이 잘 알려져 있지만, 아직까지 급성악화로 입원했던 환자의 장기 예후에 대해서는 잘 알려져 있지 않다. 본 연구의 목적은 만성폐쇄성폐질환의 급성악화로 입원했던 환자에서 장기간 사망의 예측인자를 알아보기 위함이다. 방 법 : 2000년부터 2004년 사이에 만성폐쇄성폐질환의 급성 악화로 입원한 환자를 대상으로 후향적으로 조사하였다. 입원 중 또는 퇴원 후 6개월 이내에 사망하거나 흉부 X-선 촬영에서 결핵반흔, 흉막비후나 기관지확장증이 동반된 경우, 추적기간 중 악성종양을 진단받은 환자는 제외하였다. 결 과 : 평균 연령은 69.5세였고, 추적기간은 49개월이었으며, 평균 $FEV_1$은 1.00L(예측치의 46%)였다. 사망률은 35%(17/48)였다. 다중 Cox 회귀분석 결과 분당 100회 이상의 빈맥과(p=0.003; 상대위험도, 11.99; 95% 신뢰구간, 2.34-61.44) 35mmHg이상의 우심실수축기압이(p=0.019; 상대위험도, 6.85; 95% 신뢰구간, 1.38-34.02) 사망 위험을 높이는 독립적인 예측인자였다. 결 론 : 만성폐쇄성폐질환의 급성악화로 입원했던 환자의 장기간 사망 위험을 예측하는 데 안정시 심장박동수와 우심실수축기압이 유용할 것이다.

• 한국인구학
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• 제31권1호
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• pp.127-146
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• 2008

본 연구는 아프리카 국가들의 인구변천 유형과 특징을 검토하는데 그 목적이 있다. 이를 위해 본 연구는 아프리카의 인구변천 유형을 제시하고 있다. 그 다음으로 아프리카 국가들의 출산력과 사망력이 지난 40년간 어떻게 변화되어 왔는지를 다양한 지표를 활용하여 검토하고 있다. 분석결과 출산력의 경우 아프리카 지역은 최근까지도 비교적 높은 출산율을 보여 인구변천의 제2단계에 돌입한 것으로 보인다. 이 지역은 또한 알제리, 리비아, 모로코 등 아프리카 북부 지역의 국가와 나머지 국가들이 인구변천 과정에서 뚜렷한 차이를 보인다. 사망력의 경우에도 국가별로 큰 차이를 보인다. 우선 영아사망율의 경우 리비아는 17로 가장 낮은 수준을 보이는 데 반해 말리와 소말리아는 각각 142와 133으로 매우 높은 수준임을 알 수 있다. 평균수명도 국가별로 큰 차이를 보인다. 리비아와 알제리가 각각 71.5와 70.5로 가장 높은 수준이며 르완다는 39.9세에 머물고 있는 실정이다. 또한 대부분의 아프리카의 평균수명은 낮은 수준에 있다. 아프리카의 평균수명이 낮은 것은 여러 가지 설명이 가능하나 최근에 크게 확산되고 있는 에이즈의 영향이 가장 클 것으로 판단된다. 사회경제지표와 사망력 및 출산력의 관계는 대부분 예상했던 방향으로 나타나고 있으나, 그 관계의 유의성은 시기에 따라 약간의 차이를 보이고 있다. 사회경제지표 중 문맹률은 영아사망율과 양의 관계를 보이고 있으나, 통계적 유의성은 시기에 따라 다르게 나타나고 있다. 도시화율이 출산력에 미치는 영향은 음의 관계를 보이고 있으며, 1970년을 제외하고는 통계적 유의성도 잘 드러나고 있다. 연구모형에서 중요한 매개변인으로 설정된 영아사망률은 출산력에 중요한 영향을 미치고 있는 것으로 나타나고 있으며, 사회경제적 변인들이 영아사망률을 통하여 출산력에 미치는 간접적인 영향도 비교적 잘 드러나고 있다.