Impact of economic crisis on cause-specific mortality in South Korea

Housing cost burden and external causes of mortality: Variations across housing regimes in high-income countries, 2010-2020

OBJECTIVES

While comparative studies reported that generous welfare state improves population health, they did not take into account the roles of housing as a cornerstone of welfare state. To reduce knowledge gaps, this study aims to estimate (a) the link between housing affordability stress and mortality rate due to external causes and (b) the moderating effects of housing regime on such association.

METHODS

Using country level panel data from the databases of the Organisation for Economic Co-operation and Development (OECD), fixed effects were performed to estimate the effects of housing costs to income ratio on mortality rates due to external causes (accidents, intentional self-harm, and assault). Also, we tested whether housing regimes moderate the association between housing cost burden and mortality rate.

RESULTS

An increased level of housing cost burden predicted mortality rates due to accidents and intentional self-harm. Such association was pronounced for countries with higher rates of homeownership and limited access to market self-help. In addition, when homeownership rates and debt-to-income ratios are taken into account as time-varying variables, the elevated mortality risks associated with both increased housing cost burden and higher homeownership are mitigated in countries where debt relative to income increases.

CONCLUSION

Our findings suggest that different housing systems shape divergent patterns of mortality risks associated with housing affordability stress. Future studies may wish to incorporate housing in macro comparative studies on population health.

Is a change in economic status associated with anxiety, depression and suicide ideation during the COVID-19 pandemic in South Korean adults?

BACKGROUND

Coronavirus disease 2019 (COVID-19) affected global economic changes and mental health outcomes. However, sex differences are unclear regarding the relationship between economic status change and mental health outcomes during the pandemic. Therefore, we investigated whether change in economic status is associated with depression, anxiety and suicidal ideation, based on sex.

METHODS

We used data from the COVID-19 National Mental Health Survey 2021 in South Korea. We used the Generalized Anxiety Disorder (GAD) 7-item scale for measuring anxiety, the Patient Health Questionnaire-9 scale for measuring depression and self-reported questionnaires for investigating suicidal ideation and COVID-19-related suicidal ideation.

RESULTS

Among 2000 participants, those with a worse economic status change had a 2.7-fold higher risk of GAD (prevalence ratio [PR], 2.70; 95% confidence interval [CI], 2.07-3.51); 2.5-fold higher depression risk (PR, 2.55; 95%CI, 2.05-3.18); 2.1-fold higher risk of suicidal ideation (PR, 2.09; 95%CI, 1.72-2.53); and 4.0-fold higher risk of COVID-19-related suicidal ideation (PR, 4.03; 95%CI, 2.78-5.83). Women whose economic status worsened had a 3.5-fold higher risk of COVID-19-related suicidal ideation (PR, 3.49; 95%CI, 2.01-6.06).

CONCLUSION

Worse economic change is associated with negative mental health outcomes during the COVID-19 pandemic; particularly, women experiencing financial hardships during the pandemic had a higher risk of COVID-19-related suicidal ideation.

The impact of national and international financial crises on mental health and well-being: a systematic review

BACKGROUND

Evidence suggests that financial crises and poor mental health are reciprocally related, but no systematic review has been conducted to synthesise the existing literature on the impact of national and international financial crises on population-level mental health and well-being.

AIMS

The aim of this study was to systematically review the available literature on the global impact of financial crises on mental health and well-being outcomes.

METHODS

After registration on PROSPERO, a systematic search was conducted in PsycINFO, MEDLINE, Wiley, and Web of Science for papers published until 21 November 2022. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement, 98 papers were identified as meeting eligibility criteria. Included studies were assessed using the Mixed Methods Appraisal Tool (MMAT) and results were presented in a formal narrative synthesis.

RESULTS

Our findings show that financial crises are significantly associated with well-being and occurrence of psychological conditions. Several socio-demographic, cultural, and country-specific characteristics played a crucial role in the prevention of population mental health decline in periods of financial crises.

CONCLUSIONS

Based on the findings of this review, evidence-based recommendations were developed to guide the design of policy actions that protect population mental health during and after financial crises.

A sustainable economic revival plan for post-COVID-19 using machine learning approach – a case study in developing economy context

Purpose

The impact of COVID-19 has caused a recession in economies all over the world. In this context, the current study aims to analyze the prevailing economic scenario using a machine learning approach and suggest sustainable measures to recover the global economy taking the case of Make in India (MII) initiative of developing the economy as a base for the study.

Design/methodology/approach

A well-known topic modeling technique – Latent Dirichlet allocation (LDA) algorithm has been employed to extract useful information characterizing the existing state of selected sectors under the MII initiative alongside catalytic policies that have been implemented for the same. The textual data acts as the base of the study upon which suggestions are provided.

Findings

The findings obtained suggest that digital transformation will play a key role in concerned sectors to optimize the performance of manufacturing organizations. Additionally, inter-relationship between Key Performance Indicators for the economy's revival is crucial for effective utilization of foreign direct investment resources.

Practical implications

The novel efforts to utilize MII initiative as a case present crucial information which can be used by policy makers and various other stakeholders across the globe to enhance decision-making and draft legislation across different sectors to empower the economy.

Originality/value

The study presents a novel approach to utilize the MII initiative by identifying important measures for crucial sectors and associated policies that have been presented by employing a text mining approach which in itself makes it unique in its contribution to research literature.

Spatio-Temporal Variation of Lung Cancer in Crete, 1992-2013. Economic or Health Crisis?

(1) Background: This is the first population-based study in Greece, with the aim to measure the changing trends of lung cancer (LC) and the associated risk factors before and after the economic crisis. Among the main objectives were the identification of LC hot spots and high-risk areas; (2) Methods: The study was conducted in Crete, the biggest island in Greece. Data (5057 LC cases) were collected from the Cancer Registry of Crete (CRC). The age-standardized incidence and mortality rates (ASIR, ASMR/100,000/year) were estimated, while additional indexes were used, including the adjusted Charlson's comorbidity index (CCI%), the deprivation index (HPI-2), and the exposure to outdoor air pollution (OAP). The analysis was performed for two time periods (Period A: 1992-2008; Period B: 2009-2013); (3) Results: ASIR presented a significant increase during the economic crisis, while an even higher increase was observed in ASMR (Period A: ASMR = 30.5/100,000/year; Period B: ASMR = 43.8/100,000/year; p < 0.001). After 2009, a significant increase in the observed LC hot spots was identified in several sub-regions in Crete (p = 0.04). The risk of LC mortality increased even more for smokers (RR = 5.7; 95%CI = 5.2-6.3) and those living in highly deprived geographical regions (RR = 5.4; 95%CI = 5.1-5.8) during the austerity period. The multiple effect of LC predictors resulted in adjusted RRs ranging from 0.7 to 5.7 within the island (p < 0.05); (4) Conclusions: The increased LC burden after the onset of the economic crisis, along with a changing pattern of LC predictors stressed the urgent need of geographically oriented interventions and cancer control programs focusing on the most deprived or vulnerable population groups.

Trends and disparities in avoidable, treatable, and preventable mortalities in South Korea, 2001-2020: comparison of capital and non-capital areas

OBJECTIVES

This study aimed to describe the regional avoidable mortality trends in Korea and examine the trends in avoidable mortality disparities between the Seoul Capital Area and non-Seoul-Capital areas, thereby exploring the underlying reasons for the trend changes.

METHODS

Age-standardized mortality rates from avoidable causes between 2001-2020 were calculated by region. Regional disparities in avoidable mortality were quantified on both absolute and relative scales. Trends and disparities in avoidable mortality were analyzed using joinpoint regression models.

RESULTS

Avoidable, treatable, and preventable mortalities in Korea decreased at different rates over time by region. The largest decreases were in the non-Seoul-Capital non-metropolitan area for avoidable and preventable mortality rates and the non-Seoul- Capital metropolitan area for treatable mortality rates, despite the largest decline being in the Seoul Capital Area prior to around 2009. Absolute and relative regional disparities in avoidable and preventable mortalities generally decreased. Relative disparities in treatable mortality between areas widened. Regional disparities in all types of mortalities tended to improve after around 2009, especially among males. In females, disparities in avoidable, treatable, and preventable mortalities between areas improved less or even worsened.

CONCLUSIONS

Trends and disparities in avoidable mortality across areas in Korea seem to have varied under the influence of diverse social changes. Enhancing health services to underserved areas and strengthening gender-oriented policies are needed to reduce regional disparities in avoidable mortality.

Economic Uncertainty During COVID-19 Pandemic in Latin America and Asia

The purpose of this article is to analyze the impact of COVID-19 pandemic on inflation and exchange rate volatility and to study the government measures implemented in order to support economies. Based on monthly data from January to September 2020 for 10 countries, the dynamic panel data model is used to study the effect of COVID-19 spread. The results reveal that high infections negatively affect exchange rate and inflation; the responses of governments increase inflation and result in a lower exchange rate. In fact, providing health protocols which entered the countries into a new economic and financial crisis since economic agents could not freely engage in economic activities. Therefore, policy makers in both regions should invest in health infrastructure to improve the capacity of the national health system to resist the epidemic of contagious diseases.

The impact of macroeconomic factors on suicide in 175 countries over 27 years

BACKGROUND

Every year, more than 800,000 people die by suicide, three-quarters of which are males. Economic factors influence suicide rates, but a worldwide perspective of their impact according to age and sex is lacking.

METHOD

We queried publicly available datasets on economic factors and on suicide rates stratified according to sex and age, from 1991 to 2017, for 175 countries. Thus, we analyzed approximately 21 million deaths by suicide using a multivariable regression model approach.

RESULTS

Every 1% increase in global unemployment rates is associated with a 1% upsurge in male deaths by suicide (Relative risk (RR) = 1.01 [CI 95% 1.00-1.01] with respect to females) or 5000 excess male deaths. A 1% higher unemployment rate also exerts age-specific effects on suicide rates, since, among adults aged 30-59, the suicide rate is increased by 2-3%. Lastly, for every 1000 US dollar increase in the GDP per capita, suicide rates are reduced by 2% (RR = 0.98 [0.98-0.98]), corresponding to a reduction of 14,000-15,000 suicide deaths per year globally.

CONCLUSIONS

Males who have lost their jobs in adulthood are those at higher risk of suicide and to whom financial support measures should be delivered in a timely manner.

Are Wealthier Times Healthier in Cities? Economic Fluctuations and Mortality in Urban Areas of Latin America

Objective: To analyze the relationship between economic conditions and mortality in cities of Latin America. Methods: We analyzed data from 340 urban areas in ten countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Guatemala, Mexico, Panama, Peru, and El Salvador. We used panel models adjusted for space-invariant and time-invariant factors to examine whether changes in area gross domestic product (GDP) per capita were associated with changes in mortality. Results: We find procyclical oscillations in mortality (i.e., higher mortality with higher GDP per capita) for total mortality, female population, populations of 0-9 and 45+ years, mortality due to cardiovascular diseases, malignant neoplasms, diabetes mellitus, respiratory infections and road traffic injuries. Homicides appear countercyclical, with higher levels at lower GDP per capita. Conclusions: Our results reveal large heterogeneity, but in our sample of cities, for specific population groups and causes of death, mortality oscillates procyclically, increasing when GDP per capita increases. In contrast we find few instances of countercyclical mortality.

Educational inequalities in suicide in the highly volatile economy of Argentina

PURPOSE

Little is known about how economic fluctuations affect educational inequalities in mortality in low- or middle-income countries. The objective of this study is to analyze the temporal variations in educational differentials in suicide in four Argentinian provinces.

METHODS

Data on suicides for ages 25 years and over and three age groups (25-44, 45-64, and 65 +) in four Argentinian provinces during the period 1999-2013 were linked to population data and information on the educational level of the deceased. Regression models were estimated using age, sex, year, province of residence, educational level, and economic character of the year (expansion or recession) as explanatory variables.

RESULTS

The educational gap in suicide mortality widened since the expansion following the crisis of 1999-2002, and then only decreased in 2005 and 2011. For ages 45-64, the confidence intervals of the suicide rate overlapped each year, and the suicide rate of the middle-high education population exceeded the suicide rate of the low-education population in 2 recession years, 1999 and 2002. Considering the years of economic expansion or recession as a dichotomous variable, at ages 45-64 differences in suicide rates by educational level disappeared during years of recession, while they were present in years of expansion.

CONCLUSION

Suicides rise during economic downturns but these periods could reduce the educational gaps of suicide mortality by increasing the vulnerability of adults of high educational level to changes in the economy.

Long-term impact of the 2008 economic crisis in Spain on road traffic collisions mortality by socioeconomic position

We aimed to assess the effect of the 2008 crisis on road traffic collision (RTC) mortality in Spain, by socioeconomic position (SEP) and type of road use. This prospective, country-wide study covered all adults living in Spain and aged ≥30 years in November 2001. The long-term effect of the crisis was assessed by measuring the monthly percentage change (MPC) in RTC mortality between the pre-crisis (2002-2007) and crisis period (2008-2011). During the recession, RTC mortality fell more in people with low compared to high SEP, so MPCs difference between periods were of a higher magnitude in the low compared to high SEP groups, especially among men motorcyclists. RTC mortality trends were favorable following the 2008 crisis, particularly among low-SEP groups. In men motorcyclists, the upward trend of the pre-crisis period reversed course.

Big Events theory and measures may help explain emerging long-term effects of current crises

Big Events are periods during which abnormal large-scale events like war, economic collapse, revolts, or pandemics disrupt daily life and expectations about the future. They can lead to rapid change in health-related norms, beliefs, social networks and behavioural practices. The world is undergoing such Big Events through the interaction of COVID-19, a large economic downturn, massive social unrest in many countries, and ever-worsening effects of global climate change. Previous research, mainly on HIV/AIDS, suggests that the health effects of Big Events can be profound, but are contingent: Sometimes Big Events led to enormous outbreaks of HIV and associated diseases and conditions such as injection drug use, sex trading, and tuberculosis, but in other circumstances, Big Events did not do so. This paper discusses and presents hypotheses about pathways through which the current Big Events might lead to better or worse short and long term outcomes for various health conditions and diseases; considers how pre-existing societal conditions and changing 'pathway' variables can influence the impact of Big Events; discusses how to measure these pathways; and suggests ways in which research and surveillance might be conducted to improve human capacity to prevent or mitigate the effects of Big Events on human health.

Threshold Effect of the Government Intervention in the Relationship Between Business Cycle and Population Health: Evidence From China

China is an emerging country, and government intervention is always considered as an important part of the solutions when people facing challenges in China. Under the impact of the coronavirus disease 2019 (COVID-19) epidemic and the global economic downturn, the Chinese government quickly brought the epidemic under control and restored the positive economic growth through strong intervention. Based on the panel data of provincial level in China and the government intervention as the threshold variable, this paper empirically analyzed the non-linear effect of business cycle on population health by using the panel threshold regression model. The empirical results show that the impact of the business cycle on population health is significantly negative, and government intervention has a single threshold effect on the relationship between business cycle and population health. When the government intervention is below the threshold value, the business cycle has a significant negative effect on the improvement of the population health level; when the level of government intervention exceeds the threshold value, the relationship between business cycle and population health becomes significantly positive. To some extent, the conclusions of this paper can guide the formulation and revision of government health policy and help to adjust the direction and intensity of government intervention. The Chinese government and other governments of emerging countries should do more to harness the power of state intervention in their response to the business cycle.

Age-Period-Cohort Analysis of Trends in Infectious Disease Mortality in South Korea from 1983 to 2017

We aimed to describe the infectious disease (ID) mortality trends and evaluate age-period-cohort (APC) effects on ID mortality in Korea. Using cause-of-death and census population estimates data from 1983-2017, age-standardized ID mortality trends were investigated by joinpoint regression analysis. The APC effects on ID mortality were estimated using intrinsic estimator models. The age effect showed a J-shaped concave upward curve. Old age, especially ≥70 years, was a critical factor for ID deaths. Similar to the W-shaped period curve, ID mortality rapidly decreased due to economic development and the expansion of health coverage in the 1980s, decelerated with increasing inequality, surged due to the 1997 economic crisis, and has gradually increased since the mid-2000s. The cohort effect showed an inverted U-shape. The increasing cohort effect due to the deterioration of living standards led to a decreasing trend after the independence of Korea. Notwithstanding the slowdown during the 1950-1953 Korean War, educational expansion, economic growth, fertility reduction, and the improvement of ID-related policies might have led to a continued decline among the cohorts born since the 1960s. Diverse socioeconomic events may have influenced ID mortality trends in Korea via period and cohort effects. Policies to reduce the growing burden of ID deaths should be further improved.

Homicide committed by individuals with severe mental illnesses: A comparative study before and after the Tunisian revolution of January 14th, 2011

BACKGROUND

Many studies have established a correlation between the increase of homicide rates, and economic crises and rapid social changes following historical events. We propose to analyse the impact of the Tunisian Revolution on homicide rates in Tunisia in a clinical population.

METHODS

We conducted a retrospective comparative study of all individuals who commited an homicide and were admitted, at least once, to the forensic psychiatry unit in Razi Hospital between January 1st, 2004 and December 31st, 2018 after a decision of irresponsibility by reason of insanity.

RESULTS

The number of homicides committed by the individuals with mental illness included in our study was multiplied by a factor of 1.3 after the revolution, with a prevalence of 11.0% between 2004 and 2011, compared to a prevalence of 14.7% during the period 2011-2018. No significant difference was noted between the two groups regarding the socio-demographic characteristics or the characteristics of the act committed.

CONCLUSION

Our results highlighted that political and socio-economic crises following the Tunisian revolution significantly contributed to an increase of homicide rates in people with severe mental illness. Thus, macro-level socioeconomic determinants would be important to consider in homicide prevention strategies.

What has contributed to the large sex differentials in lifespan variation and life expectancy in South Korea?

To date, research on sex differentials in lifespan variation and life expectancy has mainly been conducted in Western countries and there is a dearth of data from South Korea. This study aimed to further the understanding of mortality transition and life expectancy in South Korea, and the associated trajectories of age-at-death variation, through an analysis of life disparity by gender. Using complete life tables for South Korea for 1970-2015, sex differentials (female-male differences) in life disparity and life expectancy at birth were estimated, and sex differentials in life expectancy were decomposed by age and cause of death. The results showed that sex differentials in life expectancy at birth have not reduced significantly in the last 45 years (1970: 7.1 years; 2015: 6.2 years). Life disparity has reduced more rapidly for females than males, and the difference increased from -0.1 year in 1981 to -1.6 years in 2015. Sex differentials in life expectancy and life disparity in South Korea were higher during 1970-2015 than in several Western countries with high life expectancy. The elderly age group (60 and above) contributed 50% of the total sex difference in life expectancy at birth in 1970, and this increased to 70% in 2015. The contribution of the age group 15-59 years reduced significantly over the period. Decomposition of life expectancy at birth by cause revealed that diseases of the circulatory system (2.2 years), followed by external causes (1.3 years), were the most important causes of the sex differences in life expectancy at birth in 1983, and in 2015 neoplasms (2.2 years) and external causes (1.1 years) explained half of the total sex differences. There has been a significant shift in the age-specific pattern of the contribution towards each cause of death. Overall, sex differentials in life disparity and life expectancy at birth have remained significant in South Korea in the last 45 years.

The Monetary Value of Human Lives Lost to Suicide in the African Continent: Beating the African War Drums

Background: Suicide is an important public health problem in the African continent whose economic burden remains largely unknown. This study estimated the monetary value of human lives lost due to suicide in the African continent in 2017. Methods: The human capital approach was applied to monetarily value the years of life lost due to premature mortality from suicide deaths (SD) among 54 African countries. A 3% discount rate was used to convert future losses into their present values. The sensitivity of monetary value of human lives lost to changes in discount rate and average life expectancy was tested. Results: The 75,505 human lives lost from suicide had a grand total monetary value of International Dollars (Int$) 6,989,963,325; and an average present value of Int$ 92,576 per SD. About 31.1% of the total monetary value of SD was borne by high-income and upper-middle-income countries (Group 1); 54.4% by lower-middle-income countries (Group 2); and 14.5% by low-income countries (Group 3). The average monetary value per human life lost from SD was Int$ 234,244 for Group 1, Int$ 109,545 for Group 2 and Int$ 32,223 for Group 3. Conclusions: Evidence shows that suicide imposes a substantive economic burden on African economies. The evidence reinforces the case for increased investments to ensure universal coverage of promotive, preventive, curative and rehabilitative mental health services.

Factors associated with the suicide rates in Korea

The suicide rate in the Republic of Korea remains among the highest in the world, which needs to be examined in various aspects. This study investigated factors associated with the suicide rates in Korea. The suicide rates of 251 districts in Korea in 2015 and their relationships with the prevalence of heavy drinking, health care provision, and religion as well as demographic characteristics were examined with a Pearson correlations and a multiple linear regression analysis. The suicide rate in Korea was 26.5 per 100,000 persons in 2015. The regression analysis showed that the income level of the region, as represented by the average national health insurance premium, had a negative association with the suicide rate and that the prevalence of heavy drinking and the percentage of the population aged 65 and above had positive associations with the suicide rate. While the unemployment rate and the proportion of Catholics showed negative relationships with the suicide rate in the correlation matrix, the association was statistically insignificant in the regression analysis. Special attention should be given to excessive drinking and socio-economically disadvantaged conditions in taking measures to prevent suicide.

Trends in mortality from road traffic injuries in South Korea, 1983-2017: Joinpoint regression and age-period-cohort analyses

Although mortality trends can be influenced by different ages, periods, and cohorts, few studies have demonstrated the age-period-cohort (APC) effect on road traffic injury (RTI) mortality. Moreover, APC effects in Korea have never been documented despite the high mortality rates from RTIs. This study aimed to describe the trends in mortality from RTIs and examine APC effects on RTI mortality in Korea. Using the national death certificate and census mid-year population estimates data during 1983-2017, trends in age-standardized mortality rates from RTIs were analyzed using Joinpoint regression. Intrinsic estimator regression models were used to estimate APC effects on RTI mortality. Consistent with the trend in period effects, RTI mortality increased sharply with the economic growth in the 1980s, decelerated after the implementation of road safety policies in the early 1990s, plummeted owing to the 1997-1998 financial crisis, and gradually decreased from the early 2000s. A J-shaped age effect indicated that the relative risk of road traffic death surged in people aged ≥65 years. Educational expansion from the mid-1950s turned an increasing birth cohort effect into a continuously decreasing trend after peaking around the 1938-1943 birth cohorts. The risk of road traffic death was relatively high among the Korean Generation Y, i.e., those born in 1978-1983. RTI mortality trends in Korea have been affected by diverse socioeconomic changes through cohort and period effects. Despite the recent favorable trend, RTI mortality remains high, especially among older people. Road safety policies to address the burden of RTIs require further improvement.

Internalized transphobia and mental health among transgender adults: A nationwide cross-sectional survey in South Korea

Introduction: Transgender people are stigmatized in South Korea (hereafter Korea), where cultural expectations of a biologically-based, binary sex and gender system present fundamental challenges to those whose gender identity does not align with their birth-assigned sex. A growing international body of literature implicates gender minority stress as a key contributor to transgender mental health disparities, but little research has been conducted on this topic in Korea. As in other cultural settings, depression and suicidality are urgent public health concerns for transgender people in Korea, primarily for those who have not initiated gender affirming medical treatment (GAMT), such as cross-sex hormone therapy. In the current study, an international and interdisciplinary team of authors apply the lens of gender minority stress to elucidate the relationships between a key facet of gender minority stress, internalized transphobia (ITP), and outcomes of depressive symptoms and suicidality. Methods: Based on a cross-sectional survey of 207 Korean transgender adults, the current study evaluates the relationships between ITP and depressive symptoms, suicidal ideation, and suicide attempts. ITP was measured with an eight-item, Korean-language questionnaire adapted from the Gender Minority Stress and Resilience Measure through a translation and back-translation process. Results: Korean trans women and trans men mean (mean age = 26.4) were included in the analysis, most of whom had at least one experience of any GAMT. The findings of this study show that Korean transgender adults face similar public health concerns such as high prevalence of depressive symptoms, suicidal ideation, and suicide attempts. As predicted, ITP was significantly related to depressive symptoms, suicidal ideation, and suicide attempts. Conclusion: The authors suggest potential clinical, policy, and research applications, including institutional interventions, to address structural and cultural barriers to optimal mental health and GAMT as well as mental health interventions to reduce Korean transgender people's internalized negative beliefs about their gender identity.

How Does Economic Inequality Affect Infanticide Rates? An Analysis of 15 Years of Death Records and Representative Economic Data

Background: Is there a relationship between economic inequality and infanticide rates? Few studies have examined the socioeconomic factors that trigger infanticide. This study aims to statistically analyze the effect of these factors on infanticide rates. Methods: This study used infant death records in South Korea from 2003 to 2017 to assess the impact of unemployment rates and various statistical indicators (e.g., GDP and income inequality index) on the rate of infanticide. A generalized additive model and a quasi-Poisson regression were used for statistical analyses. Results: A time-trend analysis shows that the infanticide rate tended to grow despite a decreasing trend in the quarterly infant mortality rate. A 1% increase in the unemployment rate is associated with a significant rise in the relative risk of infanticide after a lag of two quarters. Relative risks increased significantly three and four quarters after a 0.1 rise in the p80/p20 ratio (income inequality index). Conclusions: Policymakers should pay attention to socioeconomic factors while formulating healthcare regulations to protect potential infanticide victims, including vulnerable infants and their parents.

Avoidable, amenable, and preventable mortalities in South Korea, 2000-2017: Age-period-cohort trends and impact on life expectancy at birth

This study aimed to estimate age-period-cohort effects on avoidable mortality and quantify the impact of avoidable mortality changes on life expectancy (LE) at birth in the South Korean population aged 0-74 years. Using death certificate and resident population data from 2000 to 2017, trends in age-standardized avoidable mortality rates were analyzed with joinpoint regression. Intrinsic estimator regression analysis was conducted to estimate age-period-cohort effects on avoidable mortality. Arriaga's method was used to measure the contributions of avoidable causes to changes in LE gaps between adjacent three-year periods by age and avoidable cause of death groups. Avoidable mortality decreased annually by 4.6% between 2000 and 2017. There were strong age and cohort effects and a weak period effect on avoidable mortality. In the overall decreasing trend, avoidable mortality declined less in cohorts born after the 1950-1953 Korean War and economic recession in the 1970s, with further reductions in cohorts born after the 1987 democratic reform and 1997-1998 economic crisis. Avoidable mortality was reduced after implementation of major health policies, but the decrease stagnated during the 2008-2009 financial crisis. Avoidable mortality reduction resulted in LE gains of 3.1 years, which accounted for 80% of total LE gains. Contribution to LE gains by causes of death was the largest for cerebrovascular disease. Major social changes and health policies influenced the avoidable mortality trend through cohort and period effects. Health care and public health policies implemented since the 2000s might have contributed substantially to gains in LE.

Mortality inequalities by occupational class among men in Japan, South Korea and eight European countries: a national register-based study, 1990-2015

BACKGROUND

We compared mortality inequalities by occupational class in Japan and South Korea with those in European countries, in order to determine whether patterns are similar.

METHODS

National register-based data from Japan, South Korea and eight European countries (Finland, Denmark, England/Wales, France, Switzerland, Italy (Turin), Estonia, Lithuania) covering the period between 1990 and 2015 were collected and harmonised. We calculated age-standardised all-cause and cause-specific mortality among men aged 35-64 by occupational class and measured the magnitude of inequality with rate differences, rate ratios and the average inter-group difference.

RESULTS

Clear gradients in mortality were found in all European countries throughout the study period: manual workers had 1.6-2.5 times higher mortality than upper non-manual workers. However, in the most recent time-period, upper non-manual workers had higher mortality than manual workers in Japan and South Korea. This pattern emerged as a result of a rise in mortality among the upper non-manual group in Japan during the late 1990s, and in South Korea during the late 2000s, due to rising mortality from cancer and external causes (including suicide), in addition to strong mortality declines among lower non-manual and manual workers.

CONCLUSION

Patterns of mortality by occupational class are remarkably different between European countries and Japan and South Korea. The recently observed patterns in the latter two countries may be related to a larger impact on the higher occupational classes of the economic crisis of the late 1990s and the late 2000s, respectively, and show that a high socioeconomic position does not guarantee better health.

Trends in inequality in life expectancy at birth between 2004 and 2017 and projections for 2030 in Korea: multiyear cross-sectional differences by income from national health insurance data

OBJECTIVES

The current status, time trends and future projections of a national health equity target are crucial elements of national health equity surveillance. This study examined time trends in inequality by income in life expectancy (LE) at birth between 2004 and 2017 and made future projections for the year 2030 in Korea.

DESIGN

Using individually linked mortality data, time trends in inequality by income in LE at birth were examined. The LE projection was made with the Lee-Carter model.

SETTING

Total Korean population and death data derived from the National Health Information Database of the National Health Insurance Service.

PARTICIPANTS

A total of 685 773 157 subjects and 3 486 893 deaths between 2004 and 2017 were analysed.

PRIMARY AND SECONDARY OUTCOME MEASURES

Annual LE and the magnitude of inequality by income in LE between 2004 and 2030.

RESULTS

Inequality by income in LE among the total Korean population increased during the past 14 years, and this inequality is projected to become even greater in the future. In 2030, the magnitude of inequality by income in LE is projected to increase by 0.25 years in comparison to the magnitude in 2017. The increase in LE inequality was projected to be more prominent among women, with a projected 1.08 year increase in LE inequality between 2017 and 2030.

CONCLUSION

Aggressive policies should be developed to close the increasing LE gap in Korea. LE inequalities by income should be considered as a measurable target for health equity in the process of establishing the National Health Plan 2030 in Korea.

Age, period, cohort trends of suicide in Japan and Korea (1986-2015): A tale of two countries

Japan and South Korea have among the highest suicide rates in the world. However, the age, gender, and time trends in each country differ substantially. Age-Period-Cohort (APC) analysis of suicide rates was conducted to better understand these differences. Using age- and gender-specific data on suicide between 1986 and 2015 in Japan and Korea, we implemented APC analysis to decompose the country-specific trends into age, calendar period, and birth cohort effects. APC analysis revealed three trends: (1) there was a sharp increase in suicide around retirement age in Korea but not in Japan (age effect); (2) there was a dramatic increase in suicide during the three decades of observation in Korea (period effect) whereas rates were more stable in Japan; and (3) the post-War generation in Japan (including baby boomer) had lower rates of suicide compared to generations born before 1916 or after 1961 (birth cohort effect), whereas suicide rate has increased linearly in each generation in Korea. Although Japan & Korea share high suicide rates, our APC analysis suggests divergent causes underlying these trends. Japanese suicide rates plateaued among the cohorts who experienced the post-War rapid economic growth (women born in 1951-1956 and men born in 1916-1961) (birth cohort effect) due to a strong social safety net for this cohort, while suicide rates in Korea continue to rise with each generation and is particularly elevated in post-retirement age. Japan and Korea need to pay more attention to suicide prevention in more recent birth cohorts.

Social selection in historical time: The case of tuberculosis in South Korea after the East Asian financial crisis

The perspectives of social selection and causation have long been debated. Social selection theory is as "social" as social causation theory, since all diseases are social and no biological process occurs outside society. To identify the social selection pathway and historical juncture affected by socioeconomic and political changes, we investigated the reciprocal impact of suffering from tuberculosis (TB) on the current socioeconomic position (SEP), stratified by childhood SEP. We also examined the extent to which the social consequences of ill health changed since the East Asian economic downturn. Data were collected for 2007-2012 from the Korea National Health and Nutritional Examination Survey. To identify associations between TB history and current household income (HHI), we constructed an ordinal logistic regression model adjusted for covariates, including age, gender, educational attainment, and job status. We adopted a recursive regression model to examine trend changes in this association from 1980-2012 to 2003-2012. Of 28,136 participants, 936 had experienced TB. In the first ordinal logistic regression, the TB group was more likely to have lower HHI than the non-TB group. The odds ratios (ORs) increased from 1.30 (1980-2012) to 1.86 (2003-2012) for the TB group, increasing their probability of having low HHI. Among the low childhood SEP group, the TB group's probability of having low HHI was 1.35 (95% confidence interval [CI]: 1.16-1.57) during 1980-2012, which increased to 2.01 (95% CI: 1.37-2.95) during 2003-2012. For the high childhood SEP group, the TB group's OR range fluctuated, similar to that for the non-TB group. The results support the social selection pathway from TB history to adverse impact on current SEP. Our study identified downward social mobility due to TB history among the low childhood SEP group. Moreover, negative social consequences deteriorated since the East Asian economic crisis.

Effect of the Great Recession on regional mortality trends in Europe

Previous studies have consistently shown the recurrent relationship between macroeconomic cycles and changes in mortality trends, so that recessions are generally associated with periods of faster life expectancy rise, and periods of economic growth with slower reductions or even increases in mortality trends. Here we analyze the link between annual per capita estimates of gross domestic product and daily atmospheric temperatures and standardized death rates for a large ensemble of European regions to describe the effect of the Great Recession on annual and seasonal changes in all-cause human mortality trends. Results show that the countries and regions with the largest (smallest) economic slowdown were also those with the largest (smallest) strengthening of the declining mortality trend. This procyclical evolution of mortality rates is found to be stronger during the cold part of the year, showing that it also depends on the seasonal timing of the underlying causes of death.

Age, Period, and Cohort Effects on Suicide Mortality in South Korea, 1992⁻2015

Although the effects of age, period, and cohort (APC) on suicide are important, previous work in this area may have been invalid because of an identification problem. We analyzed these effects under three different scenarios to identify vulnerable groups and thus overcame the identification problem. We extracted the annual numbers of suicides from the National Death Register of Korea (1992⁻2015) and estimated the APC effects. The annual average suicide rates in 1992⁻2015 were 31.5 and 14.7 per 100,000 males and females, respectively. The APC effects on suicide were similar in both sexes. The age effect was clearly higher in older subjects, in contrast to the minimal changes apparent during earlier adulthood. The birth cohort effect showed an inverted U shape; a higher cohort effect was evident in females born in the early 1980s when period drift was larger than 3.7%/year. Period effect increased sharply during the early 1990s and 2000s. We found that elderly and young females may be at a particularly high risk of suicide in Korea.

Factors associated with continued smoking after the diagnosis of type 2 diabetes: a retrospective study in the Korean cohort

OBJECTIVE

To investigate the factors associated with continued smoking in patients newly diagnosed with type 2 diabetes.

DESIGN

Retrospective study using the Korean National Health Insurance Service-National Health Screening Cohort (2002-2013) database.

PARTICIPANTS

Male patients newly diagnosed with type 2 diabetes between 1 January 2004 and 31 December 2011.

MEASUREMENT

Change in smoking behaviour after the diabetes diagnosis was assessed using a self-reported questionnaire, which was administered before and after the diagnosis. To identify the factors associated with continued smoking after diabetes diagnosis, a multivariate-adjusted logistic regression was conducted using only the variables with statistical significance from the univariate analyses.

RESULTS

Younger age, lower economic status, heavier smoking habit, lower Charlson Comorbidity Index and comorbid hypertension were identified as factors associated with continued smoking after the diagnosis of type 2 diabetes. Older patients (adjusted OR (aOR) 0.71, 95% CI 0.63 to 0.79) and patients with longer diabetic duration (1-2 years OR 0.88, 95% CI 0.80 to 0.98, ≥3 years OR 0.63, 95% CI 0.55 to 0.73) were more likely to quit smoking. Contrastingly, smokers in the lower economic status (aOR 1.29, 95% CI 1.18 to 1.42) and heavier smoking habit (moderate: aOR 1.53, 95% CI 1.35 to 1.72; heavy: aOR 1.90, 95% CI 1.67 to 2.17) categories were more likely to continue smoking after the diagnosis.

CONCLUSIONS

It is important to identify the factors associated with smoking behaviour in patients with type 2 diabetes. Recognising the factors that contribute to the vulnerability of patients to continued smoking will be helpful in developing policies and intervention strategies in future. Vulnerable patients may require intensive education and encouragement to quit smoking. We recommend physicians to take a more proactive approach, such as encouraging frequent clinical sessions for behavioural counselling and even early pharmacological interventions, when they encounter patients with the factors outlined in this study.

Effects of smoking habit change on all-cause mortality and cardiovascular diseases among patients with newly diagnosed diabetes in Korea

This study aimed to investigate the effects of smoking habit change on the risks of all-cause mortality and cardiovascular diseases (CVDs) among patients with newly diagnosed diabetes using the Korean National Sample Cohort data. Survival regression analyses for the risks of all-cause mortality and CVDs were performed. Quitters without body mass index (BMI) change (adjusted hazard ratio [aHR], 0.68; 95% confidence interval [CI], 0.46-1.00) and quitters with BMI loss (aHR, 1.76; 95% CI, 1.13-2.73) showed significantly reduced and substantially the increased risk of all-cause mortality, respectively, compared with sustained smokers. Smoking reduction after diabetes diagnosis may have potential positive effects. However, definite benefits on the health outcomes were not identified in this study. Participants who started smoking after diabetes diagnosis had higher risks of all-cause mortality and CVDs than those who were never smokers or ex-smokers, although not statistically significant. In conclusion, smoking cessation after diabetes diagnosis could reduce the risks of all-cause mortality and cardiovascular events among patients with newly diagnosed diabetes when accompanied by proper weight management. Therefore, physicians should advice patients with newly diagnosed type 2 diabetes on the importance of smoking cessation in combination with long-term weight management to maximize the benefits of smoking cessation.

Cross-national comparisons of increasing suicidal mortality rates for Koreans in the Republic of Korea and Korean Americans in the USA, 2003-2012

AIMS

Korea has the highest suicide rate of developed countries, two times higher than the USA. Suicide trends among Koreans Americans living in the USA during the same period have not yet been described. We report suicide mortality rates and trends for four groups: (1) Korean Americans, (2) non-Hispanic White (NHW) Americans, (3) selected Asian American subgroups and (4) Koreans living in the Republic of Korea.

METHODS

We used US national (n = 18 113 585) and World Health Organization (WHO) (n = 232 919 253) mortality records for Korea from 2003 to 2012 to calculate suicide rates, all expressed per 100 000 persons. We assessed temporal trends and differences in age, gender and race/ethnicity using binomial regression.

RESULTS

Suicide rates are highest in Koreans living in the Republic of Korea (32.4 for men and 14.8 for women). Suicide rates in Korean Americans (13.9 for men and 6.5 for women) have nearly doubled from 2003 to 2012 and exceed rates for all other Asian American subgroups (5.4-10.7 for men and 1.6-4.2 for women). Suicide rates among NHWs (21.0 for men and 5.6 for women) remain high. Among elders, suicide in Korean Americans (32.9 for men and 15.4 for women) is the highest of all examined racial/ethnic groups in the USA.

CONCLUSIONS

Suicide in Korean Americans is higher than for other Asian Americans and follows temporal patterns more similar to Korea than the USA. Interventions to prevent suicide in Korean American populations, particularly among the elderly, are needed.

Economic Conditions May Contribute to Increased Violence toward Children: A Nationwide Population-Based Analysis of Pediatric Injuries in Taiwanese Emergency Departments

Childhood injuries are unfortunately common. Analysis procedures may assist professionals who work with children with developing preventive measures for protecting children’s wellness. This study explores the causes of pediatric injuries presenting to an emergency department in Taiwan. This nationwide, population-based study was conducted using data from the National Health Insurance Research Database of Taiwan (NHIRD). Patients aged <18 years were identified from approximately one million individuals listed in the NHIRD. We followed up with these patients for nine years and analyzed the causes of injuries requiring presentation to an emergency department. Variables of interest were age, sex, injury mechanisms, and temporal trends. A total of 274,028 children were identified in our study. Between 2001 and 2009, the leading causes of pediatric injuries treated in emergency departments were motor vehicle injuries, falls, and homicide. The overall incidence of injuries declined over the course of the study because of reductions in motor vehicle accidents and falls. The incidence of homicide increased during the study period, particularly between 2007 and 2009. A moderately inverse correlation between homicide rate and economic growth was observed (correlation coefficient: −0.613, p = 0.041). There was a general decline in pediatric injuries between 2001 and 2009. Public policy changes, including motorcycle helmet laws and increases in alcohol taxes, may have contributed to this decline. Unfortunately, the incidence of homicide increased over the course of the study. Ongoing financial crises may have contributed to this increase. Multidisciplinary efforts are required to reduce homicide and reinforce the importance of measures that protect children against violence.

Income disparity and mortality among patients with alcohol use disorder in South Korea

Problems related to alcohol consumption, particularly alcohol disorders, occur frequently in South Korea and are gradually increasing due to the drinking culture and social atmosphere. We analyzed the relationship between mortality and income among patients with alcohol disorders. We used data from the National Sampling Claim Data 2003-2013, which included medical claims filed for 10,593 patients newly diagnosed with alcohol disorders. We performed survival analyses using a Cox proportional hazards model. 12.79% died during the study period. Patients with lower incomes were more positively associated with the risk of mortality than those with higher incomes (0-30 percentile: hazard ratio [HR] = 1.432, 95% confidence interval [CI] = 1.155-1.777; 31-60 percentile: HR = 1.318, 95% CI = 1.065-1.633; 61-90 percentile: HR = 1.352, 95% CI = 1.097-1.665; 91-100 percentile: ref). Such associations were significant in males, patients with mild conditions, or those who lived in metropolitan areas. In conclusion, we found that income disparity was related to mortality among patients diagnosed with disorders due to alcohol use. Thus, healthcare professionals need to provide active intervention in the early phase of alcohol disorders, and consider policy that would improve healthcare accessibility for low-income populations in order to reduce income disparity.

Population health and the economy: Mortality and the Great Recession in Europe

We analyze the evolution of mortality-based health indicators in 27 European countries before and after the start of the Great Recession. We find that in the countries where the crisis has been particularly severe, mortality reductions in 2007-2010 were considerably bigger than in 2004-2007. Panel models adjusted for space-invariant and time-invariant factors show that an increase of 1 percentage point in the national unemployment rate is associated with a reduction of 0.5% (p < .001) in the rate of age-adjusted mortality. The pattern of mortality oscillating procyclically is found for total and sex-specific mortality, cause-specific mortality due to major causes of death, and mortality for ages 30-44 and 75 and over, but not for ages 0-14. Suicides appear increasing when the economy decelerates-countercyclically-but the evidence is weak. Results are robust to using different weights in the regression, applying nonlinear methods for detrending, expanding the sample, and using as business cycle indicator gross domestic product per capita or employment-to-population ratios rather than the unemployment rate. We conclude that in the European experience of the past 20 years, recessions, on average, have beneficial short-term effects on mortality of the adult population.

Suicide Trends According to Age, Gender, and Marital Status in South Korea

The purpose of this study is to examine suicide trends in South Korea, which has one of the highest suicide rates in the world. The results show that the male suicide rate outweighs that of females, the likelihood of committing suicide increases with age, and that, in regard to marital status, nonmarried people are the most at risk. In addition, several methods of reducing suicide rates are identified: the wider use of social networks to reduce social burden, the development of a social atmosphere where aging is accepted as a natural process, and the development of protection factors within families.

Forty years of economic growth and plummeting mortality: the mortality experience of the poorly educated in South Korea

BACKGROUND

South Korea has experienced rapid economic development and a substantial increase in life expectancy in an extremely short period. Whether this rapid development has been able to adequately address inequalities in health in South Korea may have important policy implications. This paper explores long-term trends in inequalities in mortality related to education in South Korea between 1970 and 2010.

METHODS

We used secondary data on population size and deaths in 1970 and 1980 from a previously published study, and census and death certificate data from Statistics Korea from 1990, 1995, 2000, 2005 and 2010. Trends in age-standardised mortality rates for men and women aged 25-64 according to education, as well as the rate ratio (RR), rate difference (RD), relative index of inequality (RII) and slope index of inequality (SII), were examined over the period 1970-2010.

RESULTS

Despite overall mortality declines of 70-80% in the past 4 decades, educational inequalities have increased or been stagnant. There was minimal decline in mortality since 1970 in South Koreans with only a primary or lower level of education. The RR and RD between tertiary education and primary or lower education increased over the study period, while the RII and the SII in both genders remained stable.

CONCLUSIONS

The South Korean experience over the past 40 years suggests that plummeting mortality rates and huge advances in education at the population level do not translate into reduced educational inequalities in mortality.

A nationwide study of patients hospitalised for poisoning in Korea based on Korea National Hospital Discharge In-Depth Injury Survey data from 2005 to 2009

OBJECTIVES

In light of the need to develop an integrated database on poisoning incidents in Korea, this study seeks to determine the characteristics of poisoning incidents in Korea by age, gender, location of incident, causative substance and patient prognosis.

DATA SOURCES

The Korea National Hospital Discharge In-Depth Injury Survey results (2005-2009) from the Korea Centers for Disease Control and Prevention were used.

PARTICIPANTS

3826 participants in the survey who had been hospitalised for poisoning incidents.

RESULTS

The poisoning hospitalisation rate per 100,000 population was higher in women (1.735) than in men (1.372) and increased with age: the rate was 0.458 among individuals aged ≤9 years, 0.481 among those aged 10-19 years, 1.584 among those aged 20-64 years and 4.053 among those aged ≥65 years. The intentional poisoning hospitalisation rate differed by gender and age group. Women aged ≤19 years and 20-64 years showed a higher hospitalisation rate than men, while men aged ≥65 years showed a higher hospitalisation rate than women in the same age group. The most common poisoning substance was pesticides (33.6%), while antiepileptic, sedative-hypnotic and antiparkinsonism drugs and psychotropic drugs, not elsewhere classified were also very common. Poisoning in those aged ≤9 years usually involved other drugs, while pesticides were the most common substances in those aged 20-64 years and ≥65 years.

CONCLUSIONS

This study analysed poisoning incidents in Korea from 2005 to 2009, by age and gender, causative substance, and characteristics. The results of this study may serve as evidence for new strategies in Korea to prevent poisoning.

No effect of unemployment on intimate partner-related femicide during the financial crisis: a longitudinal ecological study in Spain

Background

Spain’s financial crisis has been characterized by an increase in unemployment. This increase could have produced an increase in deaths of women due to intimate partner-related femicides (IPF). This study aims to determine whether the increase in unemployment among both sexes in different regions in Spain is related to an increase in the rates of IPF during the current financial crisis period.

Methods

An ecological longitudinal study was carried out in Spain’s 17 regions. Two study periods were defined: pre-crisis period (2005–2007) and crisis period (2008–2013). IPF rates adjusted by age and unemployment rates for men and women were calculated. We fitted multilevel linear regression models in which observations at level 1 were nested within regions according to a repeated measurements design.

Results

Rates of unemployment have progressively increased in Spain, rising above 20 % from 2008 to 2013 in some regions. IPF rates decreased in some regions during crisis period with respect to pre-crisis period. The multilevel analysis does not support the existence of a significant relationship between the increase in unemployment in men and women and the decrease in IPF since 2008.

Discussion

The increase in unemployment in men and women in Spain does not appear to have an effect on IPF. The results of the multilevel analysis discard the hypothesis that the increase in the rates of unemployment in women and men are related to an increase in IPF rates.

Conclusions

The decline in IPF since 2008 might be interpreted as the result of exposure to other factors such as the lower frequency of divorces in recent years or the medium term effects of the integral protection measures of the law on gender violence that began in 2005.

[Lessons from abroad. Current and previous crisis in other countries. SESPAS report 2014]

The evidence available on the impact of previous crises on health reveals different patterns attributable to study designs, the characteristics of each crisis, and other factors related to the socioeconomic and political context. There is greater consensus on the mediating role of government policy responses to financial crises. These responses may magnify or mitigate the adverse effects of crises on population health. Some studies have shown a significant deterioration in some health indicators in the context of the current crisis, mainly in relation to mental health and communicable diseases. Alcohol and tobacco use have also declined in some European countries. In addition, this crisis is being used by some governments to push reforms aimed at privatizing health services, thereby restricting the right to health and healthcare. Specifically, action is being taken on the three axes that determine health system financing: the population covered, the scope of services, and the share of the costs covered. These measures are often arbitrarily implemented based on ideological decisions rather than on the available evidence and therefore adverse consequences are to be expected in terms of financial protection, efficiency, and equity.

Ten-year trends in the prevalence and correlates of major depressive disorder in Korean near-elderly adults: a comparison of repeated nationwide cross-sectional studies from 2001 and 2011

PURPOSE

Near-elderly adults go through many changes in socioeconomic status, such as retirement, which may affect their mental health differently according to when they live. We aimed to compare the prevalence of major depressive disorder (MDD) and its changes according to sociodemographic factors using nationally representative surveys of Korean near-elderly adults conducted 10 years apart.

METHODS

Nationwide community samples of individuals aged 55-64 years living in 2001 (n = 1256) and 2011 (n = 1066) were compared. Face-to-face interviews were conducted using the Korean version of the Composite International Diagnostic Interview to diagnose MDD. Sociodemographic data were collected using self-reported questionnaires including questions on employment and economic status. We examined differences in MDD prevalence and its association with sociodemographic factors over time by calculating 2011-to-2001 odds ratios (ORs) using multivariable logistic regression models.

RESULTS

Among near-elderly people, MDD tended to be more prevalent in 2011 than in 2001. However, only near-elderly men in 2011 showed a higher risk of MDD compared with those in 2001 (2011-to-2001 OR 4.19), while women did not. The prevalence ratio by gender decreased from 7.04 in 2001 to 2.34 in 2011. Among vulnerable sociodemographic groups, a significant increase in MDD was observed in unemployed men (adjusted OR 8.35), but not in unemployed women or other vulnerable groups.

CONCLUSION

This study provides evidence of a substantial increase in MDD in Korean near-elderly men and suggests that unemployment should be considered as an important correlate of MDD in this group.

Effects of the 2008 Global Economic Crisis on National Health Indicators: Results from the Korean National Health and Nutrition Examination Survey

Background

The relationship between economics and health has been of great interest throughout the years. The accumulated data is not sufficient enough to carry out long-term studies from the viewpoint of morbidity, although Korea National Health and Nutrition Examination Survey (KNHANES) was carried out yearly since 1998 in Korea. Thus, we investigated the effect of the 2008 global economic crisis on health indicators of Korea.

Methods

Health indicators were selected by paired t-test based on 2007 and 2009 KNHANES data. Age, gender, body mass index (BMI), smoking, drinking, exercise, education, income, working status, and stress were used as confounding factors, which were analyzed with logistic and probit analyses. Validation was done by comparing gross domestic product (GDP) growth rates and probit analyses results of 2007-2012 KNHANES data.

Results

Among several health indicators, the prevalence of hypertension and stress perception was higher after the economic crisis. Factors related with higher hypertension prevalence include older age, male gender, higher BMI, no current tobacco use, recent drinking, lower education levels, and stress perception. Factors related with more stress perception were younger age, female gender, current smoking, lower education levels, and lower income. GDP growth rates, a macroeconomic indicator, are inversely associated with hypertension prevalence with a one-year lag, and also inversely associated with stress perception without time lag.

Conclusion

The economic crisis increased the prevalence of hypertension and stress perception. In the case of GDP growth rate change, hypertension was an inversely lagging indicator and stress perception was an inversely-related coincident indicator.

Systematic review of suicide in economic recession

AIM: To provide a systematic update of the evidence concerning the relationship between economic recession and suicide.

METHODS: A keyword search of Ovid Medline, Embase, Embase Classic, PsycINFO and PsycARTICLES was performed to identify studies that had investigated the association between economic recession and suicide.

RESULTS: Thirty-eight studies met predetermined selection criteria and 31 of them found a positive association between economic recession and increased suicide rates. Two studies reported a negative association, two articles failed to find such an association, and three studies were inconclusive.

CONCLUSION: Economic recession periods appear to increase overall suicide rates, although further research is warranted in this area, particularly in low income countries.