[Socioeconomic inequity in self-rated health status and contribution of health behavioral factors in Korea]

Regularity of cervical cancer screening in Korea: analysis using national public data for 12 years

OBJECTIVE

To assess the frequency of regular uptake of national cervical cancer screening (CCS) program and identify associated factors among Korean women.

METHODS

This study is a fundamental investigation that employs openly accessible public data of Korea through secondary data analysis. A cohort of 4,663 women from the 2007-2012 Korean National Health and Nutrition Examination Survey, was followed up for up to 12 years (2007-2018) to obtain the frequency of national CCS. Compliance level with CCS was categorized, and an ordinal logistic regression model was employed to investigate the contributing factors.

RESULTS

The regular uptake of CCS in South Korea was low at 18.9%. The trend of regular screening showed significant association with various factors, including age (40-59 years), household income (100%-150% bracket), occupation (service workers), place of residence (small to medium sized cities), education level (middle school graduates), marital status (married), and possession of private insurance. Moreover, individuals with a history of non-cervical cancer or carcinoma in situ of the cervix, a family history of cervical cancer, or a higher frequency of general check-ups demonstrated a stronger adherence to regular CCS uptake.

CONCLUSION

Our findings revealed that regular participation in CCS in Korea was lower than anticipated, with factors such as socioeconomic status, personal history of gynecologic issue, and frequency of general health check-ups playing influential roles. However, further research, including an exploration of unexamined psychological barriers to screening, is necessary to gain a better understanding the reasons behind the reduced rates of regular CCS among Korean women.

Socio-economic factors and medical conditions affecting regular stomach cancer screening in Korea: a retrospective longitudinal study using national public health data for 11 years

OBJECTIVE

This study aimed to explore socio-economic factors and medical conditions that affect regular stomach cancer (SC) screening among Korean adults.

STUDY DESIGN

This was a retrospective observational study.

METHODS

Study subjects were 5545 adults aged ≥40 years who participated in the 2007-2012 Korean National Health and Nutrition Examination Survey and were followed up to year 2017 based on data linking to the Korean National Health Insurance Service and Korean Health Insurance Review and Assessment. Socio-economic factors included sex, age, residential area, education, occupation, marital status, disability, public and private health insurance, service through local public health organizations, history of cancer except for SC, and family history of SC. Medical factors included six gastric lesions with the possibility of facilitating SC screening, including benign gastric neoplasm, chronic atrophic gastritis, gastric polyp, Helicobacter pylori infection, intestinal metaplasia, and peptic ulcers. The outcome was adherence to SC screening, which was divided into non-adherence, irregular adherence, and regular adherence.

RESULTS

After adjusting for the effects of socio-economic factors, multivariate ordinal logistic regression revealed that participants with a history of four types of gastric lesions were more likely to regularly participate in SC screening: chronic atrophic gastritis (odds ratio [OR] 1.567; 95% confidence interval [CI] = 1.276-1.923), gastric polyps (OR 1.565; 95% CI = 1.223-2.003), H. pylori infection (OR 1.637; 95% CI = 1.338-2.003), and peptic ulcer (OR 2.226; 95% CI 1.750-2.831).

CONCLUSIONS

To improve participation in SC screening, it is necessary to implement personalized strategies for individuals at risk for gastric cancer in addition to population-based strategies for vulnerable groups.

Factors Affecting Adherence to National Colorectal Cancer Screening: A 12-Year Longitudinal Study Using Multi-Institutional Pooled Data in Korea

BACKGROUND

Consistent uptake of colorectal cancer (CRC) screening is important to reduce the incidence and mortality from advanced-stage CRC and increase the survival rate of the patients. We conducted a longitudinal study to determine the factors affecting CRC screening compliance in Korean adults using individual-level linked data from the Korean National Health and Nutrition Examination Survey, Korean National Health Insurance Service, and Korean Health Insurance Review and Assessment Service.

METHODS

We selected 3,464 adults aged 50-79 years as the study population and followed them for 12 years (January 2007-December 2018). The outcome variable was the level of adherence to CRC screening, categorized as nonadherent, intermittently adherent, and consistently adherent. An ordinal logistic regression model was designed to determine the socioeconomic factors, family history of CRC, and medical conditions that could facilitate the consistent uptake of CRC screening.

RESULTS

The results showed a significant and positive association between consistent uptake of CRC screening and the 100-150% income category (odds ratio [OR], 1.710; 95% confidence interval [CI], 1.401-2.088); clerical, sales and service job category (OR, 1.962; 95% CI, 1.582-2.433); residency at medium-sized cities (OR, 1.295; 95% CI, 1.094-1.532); high-school graduation (OR, 1.440; 95% CI, 1.210-1.713); married status (OR, 2.281; 95% CI, 1.946-2.674); use of employment-based national health insurance (OR, 1.820; 95% CI, 1.261-2.626); use of private insurance (OR, 2.259; 95% CI, 1.970-2.589); no disability (OR, 1.428; 95% CI, 1.175-1.737); family history of CRC (OR, 2.027; 95% CI, 1.514-2.714); and history of colorectal neoplasm (OR, 1.216; 95% CI; 1.039-1.422).

CONCLUSION

The lack of regular participation in CRC screening programs in the Republic of Korea was found to be an issue that requires attention. Policies on CRC screening must place increased emphasis on strengthening educational and public relations initiatives.

The Sequential Mediating Effects of Dietary Behavior and Perceived Stress on the Relationship between Subjective Socioeconomic Status and Multicultural Adolescent Health

Studies have examined the impact of social determinants of health on the health behaviors and health statuses of ethnic minority adolescents. This study examines the subjective health of this population by examining the direct effects of multicultural adolescents’ subjective socioeconomic status (SES) and the sequential mediating effects of their dietary behaviors and perceived stress. We utilized secondary data of 500 middle school students from multicultural families who participated in the 15th Korean Youth Health Behavior Survey, 2019. Information about SES, perceived stress, subjective health status, and dietary behavior (measured by the breakfast intake frequency during the prior week) were utilized. For the relationship between the SES and the subjective health status, we confirmed the sequential mediating effects of breakfast frequency and perceived stress using SPSS 25.0 and PROCESS macro with bootstrapping. The results showed that SES had a direct effect on subjective health status and indirectly influenced subjective health status through the sequential mediating effect of breakfast frequency and perceived stress. However, SES had no direct effects on perceived stress. These findings emphasize that broadening the community-health lens to consider the upstream factor of SES when preparing health promotion interventions is essential to achieving health equity for vulnerable populations.

Changes in poor self-rated health status among elderly Koreans over 10 years: Community Health Survey 2008-2017

AIM

This study investigated the change in self-rated health (SRH) status among elderly Koreans and sought influential factors affecting SRH by reference to data collected during the Korean Community Health Survey 2008-2017.

METHODS

We obtained raw data from the Korea Community Health Survey for 10 years (2008-2017), which included sociodemographic and health information on Koreans aged ≥65 years (242 552 men and 349 586 women). SRH was measured using the SRH scale and divided into not-poor and poor. Logistic regression analyses of poor SRH were performed using a weighted sampling method and interaction models (year × variables) to represent the entire Korean elderly population and estimate the changes in poor SRH over time.

RESULTS

The proportion of elderly subjects in the population increased over 10 years. After adjusting for all confounding variables, the weighted adjusted odds ratios for poor SRH decreased consistently between 2008 and 2017 (men: 0.64, 95% confidence interval 0.50-0.81; women: 0.62, 0.46-0.83). The odds ratios for poor SRH were markedly higher in subjects who reported being stressed (men: 7.02, 5.89-8.38; women 6.14, 5.33-7.08) and those who lacked formal education (men: 2.42, 2.18-2.69; women 3.12, 2.59-3.75) over times.

CONCLUSIONS

Despite the increase in the proportion of the elderly, poor SRH among elderly Koreans decreased over the past 10 years. Poor SRH was associated with high-level perceived stress and a lower educational level in both elderly men and women. Geriatr Gerontol Int 2020; 20: 1190-1195.

Factors Associated with the Health Literacy on Social Determinants of Health: A Focus on Socioeconomic Position and Work Environment

Though impressive progress has been made in healthcare worldwide, many people still experience disproportionate health burdens and inequities in healthcare services. For establishing sustainable development goals, health literacy on social determinants of health (HL-SDH) has been recognized as a key to creating better social and physical environments. In particular, low levels of health literacy among industrial workers are considered as a major barrier to benefitting from the progress made in healthcare. This study aimed to describe levels of HL-SDH and to examine the relationships among socioeconomic status, working environment, and HL-SDH among workers in Korea. A total of 660 workers from an online panel participated in Korea from 30 May to 7 June 2018. The Korean version of HL-SDH instrument consisted of 33 items and four dimensions: access, understand, appraise, and apply. Descriptive statistics, a t-test, ANOVA, and multiple regression analysis were conducted. The mean score of HL-SDH was 2.48. Perceived mental health status, annual income, and the number of employees per worksite were found to be statistically significant factors related to HL-SDH (F = 3.64, p = <0.001). The HL-SDH score was considerably higher, indicating that nursing interventions to enhance HL-SDH are required for health promotion, especially among workers in poor social and working environments.

Comparison of Health Status in Primary Care Underserved Area Residents and the General Population in Korea

Background

This study compared chronic diseases and health-related quality of life (HRQoL) in between primary care underserved areas residents and the general population.

Methods

Underserved areas were identified according to accessibility and the time relevance index for primary care. Overall, 279 participants aged ≥60 years from four counties enrolled voluntarily. A total of 1,873 individuals were assigned in the control group using the Korea National Health and Nutrition Examination Survey database. We assessed the differences in prevalence, awareness, and control of hypertension and diabetes and HRQoL using both subjective health status and the Korean version of the EuroQol-5D (EQ-5D) questionnaire using multivariate logistic regression analysis between the two groups.

Results

For hypertension, prevalence did not differ significantly between the two groups, whereas awareness and control were lower in the underserved areas than that in the general population; the adjusted odds ratios (95% confidence interval) were 0.40 (0.25–0.64) and 0.27 (0.18–0.41), respectively. For diabetes, differences in prevalence, awareness, and control were statistically insignificant. The proportion reporting poor subjective health status and problems in four EQ-5D indexes (ability to exercise, daily activities, pain/discomfort, anxiety/depression) was higher in the underserved areas, which also had a lower EQ-5D index, than that in the general population.

Conclusion

Primary care underserved area residents were underdiagnosed and under-controlled for hypertension and reported poorer subjective health and HRQoL compared to the general population. Primary care is the attributable factor to awareness and control of chronic diseases and subjective health and QoL in communities.

Associations Between Preschool Education Experiences and Adulthood Self-rated Health

Objectives

This study aimed to examine the association between preschool education experiences and adulthood self-rated health using representative data from a national population-based survey.

Methods

Data from the Korean Labor and Income Panel Study in 2006 and 2012 were used. A total of 2391 men and women 21-41 years of age were analyzed. Log-binomial regression analyses were conducted to examine the associations between preschool education experience and self-rated health in adulthood. Parental socioeconomic position (SEP) indicators were considered as confounders of the association between preschool education experience and adulthood subjective health, while current SEP indicators were analyzed as mediators. Age-adjusted prevalence ratios (PRs) and the associated 95% confidence intervals (CIs) were estimated.

Results

Compared with men without any experience of preschool education, those with both kindergarten and other preschool education experiences showed a lower prevalence of self-rated poor health (PR, 0.65; 95% CI, 0.47 to 0.89). In women, however, such an association was not evident. The relationship of preschool education experiences with self-rated poor health in adulthood among men was confounded by parental SEP indicators and was also mediated by current SEP indicators. After adjustment for parental and current SEP indicators, the magnitude of the associations between preschool education experiences and adulthood subjective health was attenuated in men.

Conclusions

Preschool education experience was associated with adulthood self-rated health in men. However, this association was explained by parental and current SEP indicators. Further investigations employing a larger sample size and objective health outcomes are warranted in the future.

Neo-Marxian social class inequalities in self-rated health among the employed in South Korea: the role of material, behavioral, psychosocial, and workplace environmental factors

BACKGROUND

The aim of this study was to examine the pattern of social inequality in self-rated health among the employed using the Wright's social class location indicator, and to assess the roles of material, behavioral, psychosocial, and workplace environmental factors as mediating factors in explaining the social class inequality in self-rated health in South Korea.

METHODS

This study used data from the 4th Korea National Health and Nutrition Examination Survey from 2007 to 2009. Study subjects included the employed population of 4392 men and 3309 women aged 19-64 years. Subjects were classified into twelve social class positions based on the Wright's social class map. The health outcome was self-rated health. Material, psychosocial, behavioral, and workplace environmental factors were considered as potential mediators in explaining social class health inequality. We calculated prevalence ratios of poor self-rated health according to social class, adjusted for age and mediating factors using Poisson regression models.

RESULTS

Nonskilled workers and petty bourgeoisie reported worse self-rated health than other social classes among men. The age-adjusted prevalence of petty bourgeoisie and nonskilled workers were about four-fold greater than that of managers. Expert supervisors in the contradictory class location had a greater prevalence of poor self-rated health than experts in men. In women, the prevalence of poor self-rated health was greater in most social classes than their male counterparts, while the differences among social classes within women were not statistically significant. Workplace environmental factors explained the social class inequality by from 24 to 31% in nonskilled and skilled workers and nonskilled supervisors, respectively, and material factors showed an explanatory ability of about 8% for both nonskilled workers and petty bourgeoisie in men.

CONCLUSIONS

We showed the inequality in self-rated health according to the Wright's social class in an industrialized Asian country. Policy efforts to improve workplace environments in nonskilled and skilled workers and nonskilled supervisors would have a moderate effect on reducing the magnitude of social class inequality in self-rated health. Furthermore, the means to improve power relations in the workplace should be devised to further reduce the social class inequalities in health.

Factors Associated with Perceived Depression of Korean Adults: Secondary Data from the Korean Community Health Survey

This study was aimed to identify factors related with Korean adults' depression in a community population using secondary data from the Korean Community Health Survey. The results showed factors associated with the Korean adults' perceived depression were subjective health, alcohol drinking, smoking, hypertension, diabetes mellitus, hours of sleep, activity impairments, and stress. Result of this study proposes that community mental health services are required to the population who has problems of activity impairment due to acute or chronic health status, which suggests having mental health problems such as alcohol drinking, smoking, depression, or stress.

Income gaps in self-rated poor health and its association with life expectancy in 245 districts of Korea

OBJECTIVES

To examine the income gaps associated with self-rated poor health at the district level in Korea and to identify the geographical correlations between self-rated poor health, life expectancy, and the associated income gaps.

METHODS

We analyzed data for 1,578,189 participants from the Community Health Survey of Korea collected between 2008 and 2014. The age-standardized prevalence of self-rated poor health and the associated income gaps were calculated. Previously released data on life expectancy and the associated income gaps were also used. We performed correlation and regression analyses for self-rated poor health, life expectancy, and associated income gaps.

RESULTS

Across 245 districts, the median prevalence of self-rated poor health was 15.7% (95% confidence interval [CI], 14.6 to 16.8%), with interquartile range (IQR) of 3.1 percentage points (%p). The median interquintile gaps in the prevalence of self-rated poor health was 11.1%p (95% CI, 8.1 to 14.5%p), with IQR of 3.6%p. Pro-rich inequalities in self-rated health were observed across all 245 districts of Korea. The correlation coefficients for the association between self-rated poor health and the associated income gaps, self-rated poor health and life expectancy, and income gaps associated with self-rated poor health and life expectancy were 0.59, 0.78 and 0.55 respectively.

CONCLUSIONS

Income gaps associated with self-rated poor health were evident across all districts in Korea. The magnitude of income gaps associated with self-rated poor health was larger in the districts with greater prevalence of self-rated poor health. A strong correlation between self-rated poor health and life expectancy was also observed.

Development and application of culturally appropriate decision aids for smoking cessation in Korea: a pragmatic clustered randomization crossover trial

INTRODUCTION

In Asian countries, reluctance to seek pharmacological intervention is a major barrier for smoking cessation. Culturally appropriate decision aids are expected to help people in the decision making for the use of smoking cessation medication.

OBJECTIVE

The aim of this study was to develop a culturally tailored decision aid for smoking cessation and evaluate its effect on the use of smoking cessation medication.

PATIENTS AND METHODS

A 7-minute video on smoking cessation information and options was developed. Physicians were randomized into intervention and control groups. The decision aid was provided to patients in the intervention group, and they watched it, while those in the control group were provided usual medical care for smoking cessation. The primary outcome was the proportion of smokers who were prescribed smoking cessation medication within 1 month after consultation. The secondary outcomes were abstinence rate and use of smoking cessation medication within 6 months. A logistic regression analysis was used to assess the effect of the decision aid on the outcomes.

RESULTS

In total, 414 current smokers (intervention group: 195; control group: 219) were enrolled. The mean age of the participants was 48.2 years, and 381 subjects (92%) were males. In total, 11.8% of the participants in the intervention group and 10.5% in the control group were prescribed smoking cessation medications within 1 month. The odds ratio was 1.02 (95% CI: 0.40-2.63) after adjustment for baseline characteristics. Within 6 months, 17.4% of the participants in the intervention group and 15% in the control group were prescribed medication (adjusted odds ratio 1.12, 95% CI: 0.59-2.13).

CONCLUSION

The culturally tailored smoking cessation decision aid developed in this study did not show a significant impact on the decision to use smoking cessation medication. Further research to develop more effective and more interactive interventions is expected.