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Shin H.,Korea Institute for Health and Social Affairs | Kim J.,Northern Illinois University
International Journal for Equity in Health | Year: 2010

Background. To better understand income-related inequalities in health care use, it is imperative to identify sources of inequalities and assess the extent to which health care use is still related to income after differences in need across the income distribution are accounted for. Little is known regarding rural-urban differences in income-related inequalities and subgroup variation in horizontal inequities in health care use. This study decomposes income-related inequalities in ambulatory care use into contributions of need and non-need factors and compares horizontal inequities of subgroups in rural and non-rural areas. Methods. This analysis used non-elderly adult samples from the 1998 to 2001 U.S. National Health Interview Survey data. The area of residence was categorized as rural for non-Metropolitan Statistical Area (MSA) and non-rural for MSA. Concentration indices of ambulatory care use were used to gauge income-related inequalities and decomposed into contributing factors. Horizontal inequities were measured using two methods and the results were compared. Results. Ambulatory care use was disproportionately concentrated in the poor before need adjustment. However, the results of decomposition and horizontal inequity analyses indicate that the pro-poor concentration of health care use was due to greater health care need in low-income groups. Adjusting for need, ambulatory care use was distributed favoring the better-off, to a larger degree in non-rural areas. Health-related variables were the major contributors to income-related inequalities. Non-need factors, including socioeconomic factors, health insurance, and usual source of care, also contributed to income-related inequalities. There were variation in determinants' contributions to income-related inequalities between rural and non-rural populations and subgroup differences in horizontal inequities. Horizontal inequities were greater within non-whites, high school graduates, individuals with private health insurance, and those without a usual source of care with some geographic variation. Conclusions. Our analysis shows that seemingly pro-poor income-related inequalities in ambulatory care use were largely due to greater health care need among low-income groups. The results demonstrate different contributions of determinants to income-related inequalities and variation in horizontal inequities by subgroup and locale. The findings of this study should help identify targets for policy intervention for each rural and non-rural area. © 2010 Shin and Kim; licensee BioMed Central Ltd.

Objective: We examined the risk of cardiovascular disease, stroke, ischaemic heart disease, and diabetes with the metabolic syndrome according to the new harmonised definition and its components using a national longitudinal data set from an Asian population. Methods: Data of 9791 men and women aged 20+ from 1998 and 2001 Korea National Health and Nutrition Examination Surveys were individually linked to national hospitalisation and mortality data using unique personal identification numbers. During a 5.8-year follow-up through 2005, 288 incident cardiovascular events (184 strokes and 122 cases of ischaemic heart disease) and 85 new diabetes cases have been detected. Results: Men and women with the metabolic syndrome had 48%, 39%, 64%, and 127% greater risks of cardiovascular disease, stroke, ischaemic heart disease, and diabetes, respectively, than those without the metabolic syndrome. The increased risks of cardiovascular disease, ischaemic heart disease, and diabetes remained significant after adjusting for health behaviours, bio-clinical factors, family history, and socio-demographic factors. Analysis results on population attributable risks showed that about a quarter of total diabetes occurrence and more than 10% of cardiovascular disease was attributable to the metabolic syndrome. The number of metabolic syndrome components was linearly associated with risks of outcomes. High blood pressure was significantly associated with all four outcomes while hypertriglyceridemia and hyperglycemia were also important for ischaemic heart disease and diabetes, respectively. Conclusions: Reduction of metabolic risk factors is necessary in South Korea to lower the burden of associated diseases, especially ever-increasing ischaemic heart disease and diabetes. © 2010 Elsevier Ireland Ltd.

Khang Y.-H.,University of Ulsan | Kim H.R.,Korea Institute for Health and Social Affairs
Journal of Women's Health | Year: 2010

Aims: We aimed to examine whether pain-inducing musculoskeletal disorders might explain the gender difference in the strength of the self-rated health (SRH)-mortality association. Methods: We pooled data from two National Health and Nutrition Examination Surveys (conducted in 1998 and 2001), which were linked to national mortality data of Korea using 13-digit unique personal identification numbers. There were 9,912 study participants, and 456 deaths were recorded (average length of follow-up=5.7 years). Using a checklist of chronic conditions, the prevalences of major pain-causing musculoskeletal disorders (arthritis, sciatica, and herniated intervertebral disc) were obtained. Results: The relative risk (RR) of mortality for the poor and very poor categories of SRH tended to be greater in men than in women. Compared with those without musculoskeletal disorders, the RR for those with musculoskeletal disorders was similar in men but lower in women. Women had a greater prevalence of musculoskeletal disorders than men, and women with musculoskeletal disorders reported poorer health than did men with these disorders. In individuals without major musculoskeletal disorders, the strength of the SRH-mortality association was reduced in men but increased in women. Similar patterns in RRs for SRH by gender were observed when sociodemographic characteristics (education and marital status), number of severe chronic illnesses, and health behaviors (cigarette smoking, alcohol consumption, and regular physical exercise) were additionally adjusted for. Conclusions: Nonfatal musculoskeletal disorders may explain gender differences in the SRH-mortality association. Larger prospective studies in different cultural settings may help advance our understanding of the role of pain and pain-inducing musculoskeletal disorders in explaining gender differences in the SRH-mortality association. Copyright 2010, Mary Ann Liebert, Inc.

Khang Y.-H.,University of Ulsan | Kim H.R.,Korea Institute for Health and Social Affairs
International Journal of Public Health | Year: 2010

Objectives: This study explored gender- and age-specific contributions of explanatory factors to the relationship between self-rated health (SRH) and all-cause mortality. Methods: We used mortality follow-up data from 1998 and 2001 National Health and Nutrition Examination Surveys of South Korea (n = 9,663). Explanatory factors included baseline health status, socioeconomic status, health behaviors, clinical risk factors, psychosocial factors, and family medical history. Results: The ability of explanatory factors to explain the SRH-mortality relationship differed with age. For those aged 30-64, most excess hazards were explained by all explanatory factors. However, a large part of the mortality differentials by SRH remained unexplained among elderly samples. Conclusions: A wide range of health-related factors could explain the SRH-mortality association in younger population but not in older population. Factors to explain a large part of mortality differentials by SRH among older population should be identified. © 2010 Swiss School of Public Health.

Kang E.,Korea Institute for Health and Social Affairs | Lee J.,Gachon University
Journal of Preventive Medicine and Public Health | Year: 2010

Objectives: The objective of this study was to analyze the causal relationship between smoking and depression using longitudinal data. Methods: Two waves of the Korea Welfare Panel collected in 2006 and 2007 were used. The sample consisted of 14 426 in 2006 and 13 052 in 2007 who were aged 20 and older. Smoking was measured by smoking amount (none/

Hong J.-S.,Health Insurance Review and Assessment Institute | Kang H.-C.,Korea Institute for Health and Social Affairs
Medical Care | Year: 2014

BACKGROUND:: Medication adherence is the most important factor in the proper management of patients with diabetes. Considering the importance of informational continuity in a changing world, it could be meaningful to improve institution-level continuity of care and its positive relationship with medication adherence. OBJECTIVES:: We examined the relationship between institution-level continuity of ambulatory care and medication adherence in adult patients with type 2 diabetes receiving a new hypoglycemic prescription and sought to determine whether an improvement in medication adherence could be achieved through an ongoing relationship between the patient and the medical care institution. RESEARCH DESIGN AND SUBJECTS:: This was a longitudinal study of 23,034 patients aged 20 years and older enrolled in the Korea National Health Insurance (KNHI) program and first diagnosed with type 2 diabetes in 2004. The patients were followed-up for 4 years using claims data to measure continuity of ambulatory care and adherence to oral antihyperglycemic medications. The Continuity of Care Index (COCI) was calculated on the institution level as a measure of continuity and the medication possession ratio (MPR) was used as a measure of adherence. RESULTS:: After adjusting for confounding variables, the odds of being medication adherent (MPR≥ 0.8) increased as the COCI increased [0.2≤COCI<0.4, odds ratio (OR)=2.20; 0.4≤COCI<0.6, OR=3.46; 0.6≤COCI<0.8, OR=4.76; 0.8≤COCI<1.0, OR=4.43; COCI=1.0, OR=7.24]. CONCLUSIONS:: Institution-level continuity of ambulatory care was positively associated with medication adherence, which suggested that a high concentration of ambulatory care visits, whether it's a physician or an institution, could facilitate delivery of proper medical services to and increases medication adherence among patients with type 2 diabetes, and that institution-level continuity of ambulatory care could be an effective index for assessing the quality of chronic care in the fragmented health care delivery system as in Korea.

Hong J.-S.,Health Insurance Review and Assessment Service | Kang H.-C.,Korea Institute for Health and Social Affairs
Acta Cardiologica | Year: 2014

Objective: Seasonal and monthly variation in the occurrence and case fatality rate (CFR) of acute myocardial infarction (AMI) have been reported. We examined the seasonal variation in hospital admissions and CFR in Korean patients with AMI, and analysed the influence of season on fatality risk for AMI.Methods: We used the 10-year administrative database of the Korean National Health Insurance covering the entire population of Korea. The data included 265,935 AMI events that occurred in 228,601 patients who were admitted to hospitals across Korea from 1997–2006.Results: Hospital admissions and CFR for AMI were highest in winter and lowest in summer. The fatality risk for AMI was significantly higher in spring (odds ratio [OR]: 1.06, confidence interval [CI]: 1.02–1.10), autumn (OR: 1.08, CI: 1.04–1.12), and winter (OR: 1.11, CI: 1.07–1.15) than in summer. Interestingly, among the summer months, the fatality risk for men was higher in August (OR: 1.10, CI: 1.01–1.19) than in June.Conclusions: Our findings support the hypothesis that AMI may be triggered by events external to atherosclerotic plaques. This seasonal evidence supports the idea that a disease forecast system may be developed using temperature information in Korea. © 2014, Acta Cardiologica. All rights reserved.

Hong J.-S.,Health Insurance Review and Assessment Service | Kang H.-C.,Korea Institute for Health and Social Affairs
Medicine (United States) | Year: 2014

Issues regarding healthcare disparity continue to increase in connection with access to quality care for acute myocardial infarction (AMI), even though the case-fatality rate (CFR) continues to decrease.We explored regional variation in AMI CFRs and examined whether the variation was due to disparities in access to quality medical services for AMI patients.A dataset was constructed from the Korea National Health Insurance Claims Database to conduct a retrospective cohort study of 95,616 patients who were admitted to a hospital in Korea from 2003 to 2007 with AMI. Each patient was followed in the claims database for information about treatment after admission or death.The procedure rate decreased as the region went "down" from Seoul to the county level, whereas the AMI CFR increased as the county level as a function of proximity to the county level (30-day AMI CFRs: Seoul, 16.4%; metropolitan areas, 16.2%, cities; 18.8%, counties, 39.4%). Even after adjusting for covariates, an identical regional variation in the odds of patients receiving treatment services and dying was identified. After adjusting for invasive and medical management variables in addition to earlier covariates, the death risk in the counties remained statistically significantly higher than in Seoul; however, the degree of the difference decreased greatly and the significant differences in metropolitan areas and cities disappeared.Policy interventions are needed to increase access to quality AMI care in county-level local areas because regional differences in the AMI CFR are likely caused by differences in the performance of medical and invasive management among the regions of Korea. Additionally, a public education program to increase the awareness of early symptoms and the necessity of visiting the hospital early should be established as the first priority to improve the outcome of AMI patents, especially in county-level local areas. Copyright © 2014 Wolters Kluwer Health / Lippincott Williams & Wilkins.

Yi S.-W.,Catholic Kwandong University | Han Y.-J.,Korea Institute for Health and Social Affairs | Ohrr H.,Yonsei University
European Journal of Clinical Nutrition | Year: 2013

Background/objectives: Maternal prepregnancy hemoglobin concentration has rarely been explored as a risk of poor birth outcomes. This study examined whether women with anemia before pregnancy would be at higher risk of preterm birth, low birth weight (LBW) and small-for-gestational-age (SGA) birth. Subjects/Methods: This retrospective cohort study was conducted on 70 895 Korean women who delivered a singleton in 1999, with their prepregnancy hemoglobin concentration measured at health examinations in 1997-1999. A logistic model was used to adjust for confounding variables and calculate odds ratios (ORs) and 95% confidence intervals (CIs).Results:In adjusted analysis, moderate-to-severe anemia (hemoglobin <100 g/l) before pregnancy was associated with preterm birth (OR, 1.53; 95% CI, 1.05-2.23; P=0.027), LBW (OR, 1.81; 95% CI, 1.24-2.64; P=0.002) and SGA (OR, 1.71; 95% CI, 1.35-2.17; P<0.001) when compared with prepregnancy hemoglobin of 120-149 g/l. Mild anemia (hemoglobin of 100-119 g/l) was also associated with LBW (OR, 1.21; 95% CI, 1.06-1.39; P=0.005) and SGA (OR, 1.15; 95% CI, 1.06-1.25; P=0.001). The risk of preterm birth, LBW and SGA across 11 prepregnancy hemoglobin groups depended on the severity of anemia (P for trend=0.042, 0.019, and 0.001, respectively). A high hemoglobin concentration (≥150 g/l), however, was not associated with adverse birth outcomes.Conclusions:Anemia, not high hemoglobin concentration, before pregnancy was associated with an elevated risk of preterm birth, LBW and SGA, and the risk increased with the severity of anemia in Korean women. © 2013 Macmillan Publishers Limited All rights reserved.

Ryu G.-C.,Korea Institute for Health and Social Affairs
Journal of Preventive Medicine and Public Health | Year: 2013

This study investigated the German experience in the transition to a unified health care system and suggests the following implications for Korea. First, Germany could have made use of the unification process better if there had been a good road map. Therefore Korea must develop a well prepared road map that considers all possible situations. Second, Germany saw an opportunity for the improvement of the health care system in the early stage of unification but could not take advantage of it because the situation changed dramatically and they had not sufficiently prepared for it. Korea should take into account the opportunity for improvement of the present health care system, such as the roles of public health and traditional medicine. Thirdly, the conditions f North Korea seem to be far worse than those of former East Germany and also worse than even those of other transition countries. Therefore Korea should design a long-term road map taking as many variables into account as possible, including the different rigid way of thinking and the interrelationship among the social sectors. Fourthly, during the German reunification unexpected factors changed the direction of the events. Korea should have a separate plan for the unexpected factors. Copyright © 2013 The Korean Society for Preventive Medicine.

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