• Asian Pacific Journal of Cancer Prevention
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• v.16 no.18
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• pp.8541-8551
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• 2016

Background: The coverage of breast and cervical cancer screening has only slightly increased in the past decade in Thailand, and these cancers remain leading causes of death among women. This study identified socioeconomic and contextual factors contributing to the variation in screening uptake and coverage. Materials and Methods: Secondary data from two nationally representative household surveys, the Health and Welfare Survey (HWS) 2007 and the Reproductive Health Survey (RHS) 2009 conducted by the National Statistical Office were used. The study samples comprised 26,951 women aged 30-59 in the 2009 RHS, and 14,619 women aged 35 years and older in the 2007 HWS were analyzed. Households of women were grouped into wealth quintiles, by asset index derived from Principal components analysis. Descriptive and logistic regression analyses were performed. Results: Screening rates for cervical and breast cancers increased between 2007 and 2009. Education and health insurance coverage including wealth were factors contributing to screening uptake. Lower or non-educated and poor women had lower uptake of screenings, as were young, unmarried, and non-Buddhist women. Coverage of the Civil Servant Medical Benefit Scheme increased the propensity of having both screenings, while the universal coverage scheme increased the probability of cervical screening among the poor. Lack of awareness and knowledge contributed to non-use of both screenings. Women were put off from screening, especially Muslim women on cervical screening, because of embarrassment, fear of pain and other reasons. Conclusions: Although cervical screening is covered by the benefit package of three main public health insurance schemes, free of charge to all eligible women, the low coverage of cervical screening should be addressed by increasing awareness and strengthening the supply side. As mammography was not cost effective and not covered by any scheme, awareness and practice of breast self examination and effective clinical breast examination are recommended. Removal of cultural barriers is essential.

• Journal of Preventive Medicine and Public Health
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• v.48 no.6
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• pp.287-300
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• 2015

Objectives: Self-rated health is a measure of perceived health widely used in epidemiological studies. Our study investigated the determinants of poor self-rated health in middle-aged Korean adults with diabetes. Methods: A cross-sectional study was conducted based on the Health Examinees Study. A total of 9759 adults aged 40 to 69 years who reported having physician-diagnosed diabetes were analyzed with regard to a range of health determinants, including sociodemographic, lifestyle, psychosocial, and physical variables, in association with self-rated health status using multivariate logistic regression models. A p-value <0.05 was considered to indicate statistical significance. Results: We found that negative psychosocial conditions, including frequent stress events and severe distress according to the psychosocial well-being index, were most strongly associated with poor self-rated health (odds ratio $[OR]_{\text{Frequent stress events}}$, 5.40; 95% confidence interval [CI], 4.63 to 6.29; $OR_{\text{Severe distress}}$, 11.08; 95% CI, 8.77 to 14.00). Moreover, younger age and being underweight or obese were shown to be associated with poor self-rated health. Physical factors relating to participants' medical history of diabetes, such as a younger age at diagnosis, a longer duration of diabetes, insulin therapy, hemoglobin A1c levels of 6.5% or more, and comorbidities, were other correlates of poor reported health. Conclusions: Our findings suggest that, in addition to medical variables, unfavorable socioeconomic factors, and adverse lifestyle behaviors, younger age, being underweight or obese, and psychosocial stress could be distinc factors in predicting negative perceived health status in Korean adults with diabetes.

• Journal of Preventive Medicine and Public Health
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• v.42 no.5
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• pp.275-282
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• 2009

Objectives : This study aimed to verify the association between wealth or income level and health status after adjusting for other socio-economic position (SEP) indicators among Korean adults aged 45 and over. Methods : Data were obtained from the 1st wave of Korean Longitudinal Study of Ageing (households: 6,171, persons: 10,254). We used self-rated health status and activities of daily living (ADLs) as dependent variables. Explanatory variables included both net wealth measured by savings, immovables, the other valuated assets and total income including pay, transfer, property and so on. Binary logistic regression was conducted to examine the relationships. Also, in order to determine the relative health inequality across economic groups, we estimated the relative index of inequality (RII). Results : The inequality of health status was evident among various wealth and income groups. The wealthiest group (5th quintile) was much healthier than the poorest group, and this differential increased with age. Likewise, higher income was associated with better health status among the elderly. However, these effects, as measured by the odds ratio and RII, showed that wealth was more important in determining health status of elderly people. Conclusions : This study suggests that economic capability plays a significant role in determining the health status and other health-related problems among the elderly. Particularly, our results show that health status of the aged is related more closely to the individual s wealth than income.

• Women's Health Nursing
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• v.7 no.4
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• pp.473-485
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• 2001

This cross-sectional design was to identify the age at menopause of Korean women and the levels of bothersome menopausal symptoms. In addition, examining relationships between the levels of bothersome menopausal symptoms and sociodemographic factors, body mass index, menopause-related factors, and life-style behavior factors including smoking, alcohol use, physical activity, and diet was done. Two thousand eight hundred seven naturally postmenopausal women aged between 41-65 years were recruited by self-selection from 7 metropolitans and 6 provinces in Korea from Dec. 20, 1998 to April 30, 1999. The age at menopause of Korean women was 49.2 years(mean) and 50.0 years (median). The menopausal age of Korean women has slightly increased compared to a previous study. Based on the demographic factors, residential area and socioeconomic status were associated with the bothersome levels of climacteric symptoms. In the case of the life-style behaviors analysis, only alcohol use and a preference for wheat were associated with the bothersome levels of climacteric symptoms, especially physical symptoms.

• Journal of Nutrition and Health
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• v.32 no.4
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• pp.407-418
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• 1999

The purpose of this study was to identify dietary factors related to the incidence of diabetes mellitus in Korea. The study consisted of 165 diabetic patients, male and female, aged 30 to 70 years and 198 healthy persons as controls. Diabetic patients who had been diagnosed with diabetes mellitus for less than five years before the study period were recruited from eight different hospitals located in Seoul, Korea. Socioeconomic status, state of illness, physical activity, food habits and food intake were assessed. Food intake was assessed by food frequency questionnaire method using a 105-food frequency questionnaire developed for diabetic patients. The stress and activity indices of diabetic patients were not significantly different from control, but alcohol consumption and smoking levels were higher in diabetics than controls. Other diseases of male diabetic patients included liver diseases, digestive system diseases, and hypertension, while those of female diabetics were hypertension, neuralgia, arthritis and digestive system diseases. These disease patterns are different from Western countries whose most common complications are hypertension and hyperlipidemia. More irregular and less varied meals were found in the diabetic group compared to the control group, suggesting that diabetic patients have generally undesirable food habits. Otherwise, food and nutrient intake of diabetics did not differ greatly from the control group. It was found that diabetic patients consumed more cereals and less fruit than the control group, and also that male diabetics consumed more alcohol. The carbohydrate : protein : fat energy distribution ratio was 61.7 : 15.8 : 22.5 in male patients and 65.1 : 14.9 : 19.7 in female patients. Discriminant analysis showed that diabetes risk factors differed with sex. In male patients, the important factors were body mass index(BMI), vitamin C intake, family diabetic history and vegetable intake, while in female patients they were BMI, cereals intake, carbohydrate intake, vitamin C intake, stress, food habits and Ca intake. These results show that excessive intake of energy and fat are not the major causal factors in Korean NIDDM. Therefore, the diabetes risk factors of Western countries may not directly apply to Koreans. Mors study is needed to clarify the risk factors of Korean NIDDM.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.17 no.8
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• pp.84-93
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• 2016

This study was conducted to determine family factors related to obesity of high school students. A descriptive correlational study was conducted with 384 high school students in I metropolitan city. Data were collected from February to April of 2015 using self-report structured questionnaires. Questionnaires included weight, height, individual characteristics of subjects and their familial characteristics. Collected data were analyzed by multiple logistic regression. Logistic regression analysis revealed that male gender (aOR = 4.37; 95% CI [1.26, 15.16]), having a non-regular paternal job (aOR = 3.10; 95% CI [1.15, 8.40]), and not being in a two parent family (aOR = 3.52; 95% CI [1.29, 9.61]) were statistically significant contributors to obesity. These results indicate that it is necessary to improve social awareness regarding the obesity risk of male adolescents. Health care providers should recognize the importance of family factors such as parental socioeconomic status and family structures.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.18 no.4
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• pp.217-223
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• 2015

The obesity epidemic is a worldwide problem. Factors predisposing to obesity include genetics, race, socioeconomic conditions, birth by cesarean section, and perinatal antibiotic use. High protein (HP) content in infant formulas has been identified as a potential culprit predisposing to rapid weight gain in the first few months of life and leading to later obesity. In a large multicountry study the effects of lower protein (LP) formula (1.77 and 2.2 g protein/100 kcal, before and after the 5th month, respectively) were compared to those of higher protein (2.9 and 4.4 g protein/100 kcal, respectively). Results indicated that at 24 months, the weight-for-length z score of infants in the LP formula group was 0.20 (0.06, 0.34) lower than that of the HP group and was similar to that of the breastfed reference group. The authors concluded that a HP content of infant formula is associated with higher weight in the first 2 years of life but has no effect on length. LP intake in infancy might diminish the later risk of overweight and obesity. At 6 years of age HP children had a significantly higher body mass index (by 0.51; 95% confidence interval [CI], 0.13-0.90; p=0.009) and a 2.43 (95% CI, 1.12-5.27; p=0.024) fold greater risk of becoming obese than those who received the LP. In conclusion, several factors may influence development of metabolic syndrome and obesity. Breastfeeding should always be encouraged. An overall reduction of protein intake in formula non breastfed infants seems to be an additional way to prevent obesity.

• Journal of Preventive Medicine and Public Health
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• v.38 no.4
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• pp.443-448
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• 2005

Objectives : This study was done to evaluate the reliability of education and occupational class between using the health survey and the death certificate data. Methods : The 1998 National Health and Nutrition Examination Survey (NHANES) was conducted on a cross-sectional probability sample of South Korean households, and it contained unique 13-digit personal identification numbers that were linked to the data on mortality from the Korean National Statistical Office. The data from 263 deaths were used to estimate the agreement rates and the Kappa indices of the education and occupational class between using the NHANES data and the death certificate data. Results : The simple and weighted Kappa indices for education were 0.60 (95% CI=0.53-0.68) and 0.73 (95% CI=0.67-0.79) respectively, if the educational level was grouped into five categories: no-formal-education, elementary-school, middle-school, high-school and college or over. The overall agreement rate was 71.9% for these educational groups. The magnitude of reliability, as measured by the overall agreement rates and Kappa indices, tended to increase with a decrease in the educational class. The number of non-educated people with using the death certificate data was smaller than that with using the NHANES data. For the occupational class (manual workers, non-manual workers and others), the Kappa index was 0.40 (95% CI=0.30-0.51), which was relatively lower than that for the educational class. Compared with the NHANES, the number of non-manual workers for the deceased who were aged 30-64 tended to be increased (8 to 12) when using the death certificate data, whereas the number of manual workers tended to be decreased (59 to 41). Conclusions : The socioeconomic inequalities in the mortality rates that were based on the previous unlinked studies in South Korea were not due to a numerator/denominator bias. The mortality rates for the manual workers and the no-education groups might have been underestimated.

• Health Policy and Management
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• v.21 no.1
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• pp.23-43
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• 2011

Access to health care is complicated to define. It is a multidimensional process. In addition to the matters of quality of care, geographical accessibility and availability of the right type of care, finance, and acceptability are all involved. The purposes of this paper are to measure the geographic distances between patient residency locations and health service organizations in which the patients hadvisited, and to investigate the association between geographical distance measures and variables involved in health service utilization. The study used the first and the second wave of the 2008 Korea Health Panel Survey. The samples of analyses were patients who had visited outpatient or used ambulatory health services, and the total observations (visit numbers) analyzed were 229,128. We divided the samples into a frequent-visit illness group (Group 1) and a non-frequent visit illness group (Group 2) based on over 5,000 total visit numbers. We exploited three level analyses using xtmixed of STATA${\Box}$ 11.1 command with/without interaction terms among age, sex, and occupation. Geographical distances were measured using the Haversine method. Group 1 was tended to older and lower equivalent income than those of Group 2, but the geographic difference were not observed in terms of area deprivation index and standard mortality ratios. Amongst group 1, diabetes mellitus patients travelled far to visit health care organizations, and arthritis patients were more deprived in terms of the personal and areal characteristics. The study revealed that residents in rural areas traveled about 10 times more long distances than those whom lived in larger cities after adjusting for various variables, which we used for analyses. This study contributed to the practical understanding of health service utilizations using empirical analyses, and found that the types of diseases and socioeconomic characteristics of patients tended to define the amount of travel distance to healthcare organizations.

• Health Policy and Management
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• v.23 no.3
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• pp.233-243
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• 2013

Background: This study was conducted to evaluate the individual and community level factors which were influencing the severe injury patients' death and transfer at discharge. Methods: Analysis data is based on Korean National Hospital Discharge In-depth Survey Data released by the Korea Center for Disease Control and Prevention from 2006 to 2008. Study subjects was 11,026 inpatients with of severe injury. For multi-level analysis, socio-demographic characteristics, injury related characteristics, hospitalization related characteristics were used as individual level factors, and socio-environmental characteristics and health care resource characteristics were used as community level factors. Results: As to community level factors affecting mortality of severe injury, the possibility of death was also high in cases of less numbers of surgeons per a population of 100,000 and more number of operation beds. As to community level factors affecting transfer of severe injury, vulnerable areas with higher social deprivation index and low population density had higher possibility of transfer. Conclusion: Both individual level factors and community level factors affected clinical outcomes of treatment for severe injury. In particular, since there happened higher death and transfer of severe injury in socioeconomic and medical vulnerable areas, special efforts for establishing preventive policy and care system for injury in national and area level should be directed toward such areas.