Journal of Preventive Medicine and Public Health

Original Article

Changes in Adolescent Health Behavior and the Exacerbation of Economic Hardship During the COVID-19 Pandemic: A Cross-sectional Study From the Korea Youth Risk Behavior Survey: Chaeeun Kim, Haeun Lee, Kyunghee Jung-Choi, Hyesook Park; J Prev Med Public Health. 2024;57(1):18-27. Published online November 11, 2023; DOI: https://doi.org/10.3961/jpmph.23.306

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Abstract Summary PDF Supplementary Material

Objectives
This study investigated the association between exacerbated economic hardship during the coronavirus disease 2019 (COVID-19) pandemic and changes in the health behaviors of Korean adolescents.
Methods
We analyzed data from the 2021 Korea Youth Risk Behavior Survey and included 44 908 students (22 823 boys and 22 085 girls) as study subjects. The dependent variables included changes in health behaviors (breakfast habits, physical activity, and alcohol use) that occurred during the COVID-19 pandemic. The aggravation of economic hardship by COVID-19 and the subjective economic status of the family were used as exposure variables. Multiple logistic regression analysis was utilized to calculate the prevalence odds ratios (PORs).
Results
Severe exacerbation of a family’s economic hardship due to COVID-19 was negatively associated with the health behaviors of adolescents, including increased breakfast skipping (POR, 1.85; 95% confidence interval [CI], 1.55 to 2.21 for boys and POR, 1.56; 95% CI, 1.27 to 1.92 for girls) and decreased physical activity (POR, 1.37; 95% CI, 1.19 to 1.57 for boys and POR, 1.38; 95% CI, 1.19 to 1.60 for girls). These negative changes in health behaviors were further amplified when combined with a low subjective family economic status.
Conclusions
The experience of worsening household hardship can lead to negative changes in health behavior among adolescents. It is crucial to implement measures that address the economic challenges that arise from stressful events such as COVID-19 and to strive to improve the lifestyles of adolescents under such circumstances.

Summary

Korean summary
이 연구는 코로나바이러스감염증-19 (COVID-19) 대유행 기간 악화된 가구의 경제적 상황과 청소년의 건강 행태 변화의 관련성을 청소년건강행태조사를 이용하여 분석하였다. 가구의 경제적 상황이 COVID-19로 인해 심각하게 악화된 경우, 청소년 건강 행태의 부정적인 변화와 연관성이 관찰되었다. 가구의 경제적 상황이 악화되는 경험은 청소년들의 건강 행태에 부정적인 변화를 초래할 수 있다. COVID-19와 같은 사회적 사건으로 인해 발생하는 경제적 어려움에 대응하는 조치를 마련하고, 이러한 상황에서 청소년들의 건강 행태를 개선하기 위한 개입이 필요하다.

Key Message
This study investigated the association between exacerbated economic hardship during the coronavirus disease 2019 (COVID-19) pandemic and changes in the health behaviors of Korean adolescents using the 2021 Korea Youth Risk Behavior Survey. Severe exacerbation of a family’s economic hardship due to COVID-19 was negatively associated with the health behaviors of adolescents. The experience of worsening household hardship can lead to negative changes in health behavior among adolescents. It is crucial to implement measures that address the economic challenges that arise from stressful events such as COVID-19 and to strive to improve the lifestyles of adolescents under such circumstances.

Citations

Citations to this article as recorded by

Family Dynamics, Socioeconomic Hardships, and Health Risk Behaviours of Bulgarian Adolescents during the COVID-19 Pandemic
Elitsa Dimitrova, Anna Alexandrova-Karamanova
Children.2024; 11(8): 1016. CrossRef

Special Articles

Well-being Index Scores and Subjective Health Status of Korean Healthcare Workers: Yoonhee Shin, Bohyun Park, Nam-eun Kim, Eun Jeong Choi, Minsu Ock, Sun Ha Jee, Sue K. Park, Hyeong Sik Ahn, Hyesook Park; J Prev Med Public Health. 2022;55(3):226-233. Published online May 31, 2022; DOI: https://doi.org/10.3961/jpmph.22.114

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Abstract Summary PDF: Objectives
The aim of this study was to evaluate the subjective level of health-related quality of life of Korean healthcare workers using various quality-of-life instruments.
Methods
This study included 992 participants, who were doctors and nurses. A survey was conducted between November 28 and December 4, 2019. Data from 954 participants divided into 3 groups (physicians, residents, and nurses) were analyzed. Four measurement tools (29 questions) were used in the survey to evaluate subjective health status and well-being.
Results
In the Mayo Well-being Index, burnout during work (88.5%) and emotional difficulties caused by work (84.0%) were frequently cited by the respondents. Regarding questions on burnout and emotional difficulties, residents and nurses had the highest scores (91.0 and 89.6%, respectively). Emotional problems, such as anxiety, depression, and irritability, accounted for a high percentage (73.1%) of the total, while 82.2% of respondents reported that their work schedules interfered with their leisure and family time. There was no significant difference among the groups in subjective health status. However, 10.1% of the residents experienced very low quality of life, which was a higher proportion than that of physicians (2.7%) and nurses (5.2%).
Conclusions
The level of well-being that Korean medical workers experienced in relation to work was lower than the results of the United States healthcare workers surveyed using the same tool. This study was unique in that it conducted a subjective quality-of-life survey on Korean healthcare workers.; Summary

Korean summary
본 연구의 목적은 다양한 삶의 질 도구를 사용하여 한국 의료종사자들의 건강과 관련된 삶의 질에 대한 주관적인 수준을 평가하는 것이다. 피로와 정서적 어려움, 업무로 인한 일상생활의 방해 등 한국 의료종사자의 일부 삶의 질 점수가 낮았다. 의료 종사자의 소진 경험이 환자의 치료에 부정적인 영향을 미친다는 것을 고려할 때 의료 종사자들의 삶의 질을 향상시키는 정책이 마련되어야하며, 건강과 관련된 직업적 위험요인 연구도 추가적으로 필요하다.

Adjustment for Multimorbidity in Estimations of the Burden of Diseases Using Korean NHIS Data: Yoonhee Shin, Eun Jeong Choi, Bomi Park, Hye Ah Lee, Eun-Kyung Lee, Hyesook Park; J Prev Med Public Health. 2022;55(1):28-36. Published online January 31, 2022; DOI: https://doi.org/10.3961/jpmph.21.583

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Abstract Summary PDF Supplementary Material: The current multimorbidity correction method in the Global Burden of Disease studies assumes the independent occurrence of diseases. Those studies use Monte-Carlo simulations to adjust for the presence of multiple disease conditions for all diseases. The present study investigated whether the above-mentioned assumption is reasonable based on the prevalence confirmed from actual data. This study compared multimorbidity-adjusted years of lived with disability (YLD) obtained by Monte-Carlo simulations and multimorbidity-adjusted YLD using multimorbidity prevalence derived from National Health Insurance Service data. The 5 most common diseases by sex and age groups were selected as diseases of interest. No significant differences were found between YLD estimations made using actual data and Monte-Carlo simulations, even though assumptions about the independent occurrence of diseases should be carefully applied. The prevalence was not well reflected according to disease characteristics in those under the age of 30, among whom there was a difference in YLD between the 2 methods. Therefore, when calculating the burden of diseases for Koreans over the age of 30, it is possible to calculate the YLD with correction for multimorbidity through Monte-Carlo simulation, but care should be taken with under-30s. It is useful to apply the efficiency and suitability of calibration for multiplicative methods using Monte-Carlo simulations in research on the domestic disease burden, especially in adults in their 30s and older. Further research should be carried out on multimorbidity correction methodology according to the characteristics of multiple diseases by sex and age.; Summary

Korean summary
질병부담 산출 시 몬테카를로 시뮬레이션을 통한 복합질환 보정 방법에 대해 다빈도 질환 실제 데이터 기반으로 검증해 봄으로써 30세 이상 연령에서 추정값에 큰 차이가 없음을 확인하였다. 하지만 30세 미만에서는 포함되는 질환 종류에 따라 실제 데이터 기반으로 복합질환을 보정하는 것이 불가능하거나 시뮬레이션으로 구한 값이 부정확하였다. 따라서, 질환 특성을 반영한 복합질환 보정방법론 개발이 필요함을 제안하며 본 연구 결과는 한국인 질병부담 연구에서 몬테카를로 시뮬레이션을 이용한 복합질환 보정 방법의 활용근거로 사용될 수 있을 것이다.

Measuring the Burden of Disease in Korea, 2008-2018: Yoon-Sun Jung, Young-Eun Kim, Hyesook Park, In-Hwan Oh, Min-Woo Jo, Minsu Ock, Dun-Sol Go, Seok-Jun Yoon; J Prev Med Public Health. 2021;54(5):293-300. Published online September 30, 2021; DOI: https://doi.org/10.3961/jpmph.21.478

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Abstract Summary PDF Supplementary Material

The study aims to examine the current status and differences in the burden of disease in Korea during 2008-2018. We calculated the burden of disease for Koreans from 2008 to 2018 using an incidence-based approach. Disability adjusted life years (DALYs) were expressed in units per 100 000 population by adding years of life lost (YLLs) and years lived with disability (YLDs). DALY calculation results were presented by gender, age group, disease, region, and income level. To explore differences in DALYs by region and income level, we used administrative district and insurance premium information from the National Health Insurance Service claims data. The burden of disease among Koreans showed an increasing trend from 2008 to 2018. By 2017, the burden of disease among men was higher than that among women. Diabetes mellitus, low back pain, and chronic lower respiratory disease were ranked high in the burden of disease; the sum of DALY rates for these diseases accounted for 18.4% of the total burden of disease among Koreans in 2018. The top leading causes associated with a high burden of disease differed slightly according to gender, age group, and income level. In this study, we measured the health status of Koreans and differences in the population health level according to gender, age group, region, and income level. This data can be used as an indicator of health equity, and the results derived from this study can be used to guide community-centered (or customized) health promotion policies and projects, and for setting national health policy goals.

Summary

Korean summary
이 논문에서는 장애보정생존년수라는 지표를 활용하여 2008-2018년 한국인의 질병부담 산출결과를 제시하였으며, 성별·연령군별·질환별 질병부담 수준의 차이 뿐만 아니라 지역 및 소득수준의 사회경제적 수준에 따른 질병부담의 격차도 함께 제시하였다.

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Original Article

Factors Influencing Vaccination in Korea: Findings From Focus Group Interviews: Bomi Park, Eun Jeong Choi, Bohyun Park, Hyejin Han, Su Jin Cho, Hee Jung Choi, Seonhwa Lee, Hyesook Park; J Prev Med Public Health. 2018;51(4):173-180. Published online May 25, 2018; DOI: https://doi.org/10.3961/jpmph.18.063

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Abstract PDF

Objectives
Immunization is considered one of the most successful and cost-effective public health interventions protecting communities from preventable infectious diseases. The Korean government set up a dedicated workforce for national immunization in 2003, and since then has made strides in improving vaccination coverage across the nation. However, some groups remain relatively vulnerable and require intervention, and it is necessary to address unmet needs to prevent outbreaks of communicable diseases. This study was conducted to characterize persistent challenges to vaccination.
Methods
The study adopted a qualitative method in accordance with the Consolidated Criteria for Reporting Qualitative Research checklist. Three focus group interviews were conducted with 15 professionals in charge of vaccination-related duties. The interviews were conducted according to a semi-structured guideline, and thematic analysis was carried out. Data saturation was confirmed when the researchers agreed that no more new codes could be found.
Results
A total of 4 main topics and 11 subtopics were introduced regarding barriers to vaccination. The main topics were vaccine hesitancy, personal circumstances, lack of information, and misclassification. Among them, vaccine hesitancy was confirmed to be the most significant factor impeding vaccination. It was also found that the factors hindering vaccination had changed over time and disproportionately affected certain groups.
Conclusions
The study identified ongoing unmet needs and barriers to vaccination despite the accomplishments of the National Immunization Program. The results have implications for establishing tailored interventions that target context- and group-specific barriers to improve timely and complete vaccination coverage.

Summary

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Brief Report

The Pyramid of Injury: Estimation of the Scale of Adolescent Injuries According to Severity: Hyejin Han, Bomi Park, Bohyun Park, Namsoo Park, Ju Ok Park, Ki Ok Ahn, Yang Ju Tak, Hye Ah Lee, Hyesook Park; J Prev Med Public Health. 2018;51(3):163-168. Published online May 23, 2018; DOI: https://doi.org/10.3961/jpmph.18.027

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Abstract PDF

Objectives
Due to their developmental characteristics, adolescents have a higher probability than other age groups of experiencing injuries caused by accidents, violence, and intentional self-harm. The severity and characteristics of injuries vary by the intentionality and mechanism of injury; therefore, there is a need for a national-level estimate of the scale and the severity of injuries in adolescents that takes these factors into account.
Methods
By using data from the Emergency Department-based Injury In-depth Surveillance Data, National Emergency Department Information System, the Korean National Hospital Discharge In-depth Injury Survey, and cause of death statistics, we calculated the emergency department (ED) visit rate, hospitalization rate, and death rate of injuries per 100 000 adolescents for each injury mechanism. The calculated rates were used to generate the injury pyramid ratio (ratio of death rate to hospitalization rate to ED visit rate) to visualize the scale and the severity of the injury.
Results
The mortality rate in adolescents due to injury was 10/100 000; the corresponding rates for hospitalization and ED visits were 1623 and 4923, respectively, resulting in an injury pyramid ratio with the general pyramid form, with a 1:162:492 ratio of deaths to hospitalizations to ED visits. The mortality rate due to suicide/intentional self-harm was 5/100 000, while 35 were hospitalized for this reason and 74 made ED visits. The pyramid ratio of 1:7:15 for intentional self-harm/suicide showed a steep pyramidal form, indicating considerable lethality. The mortality rate due to motor vehicle collisions (MVCs) was 3/100 000; 586 were hospitalized for this reason, while 1023 made ED visits. The pyramid ratio of 1:195:341 for MVCs showed a gradual pyramid form, indicating that the lethality was low and the scale of injury was high.
Conclusions
The main categories of injuries in adolescents were visualized in pyramid form, contributing to an understanding of the scale of each injury by mechanism in terms of levels of death, hospitalization, and ED visits. These findings will be helpful for understanding how to prioritize injuries in adolescents.

Summary

Citations

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Burden of Childhood Injuries in India and Possible Public Health Interventions: A Systematic Review
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Special Article

Overview of Noncommunicable Diseases in Korean Children and Adolescents: Focus on Obesity and Its Effect on Metabolic Syndrome: Hye Ah Lee, Hyesook Park; J Prev Med Public Health. 2013;46(4):173-182. Published online July 31, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.4.173

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Abstract PDF

Obesity during childhood is a dominant risk factor for noncommunicable diseases (NCDs), and is itself considered a disease that needs to be treated. Recently, the growth in childhood obesity in Korea has become stagnant; however, two in every ten children are still overweight. In addition, 60% or more of overweight children have at least one metabolic syndrome risk factor. Thus, childhood obesity should be controlled through lifestyle modification. This paper reviews studies of the modifiable risk factors of obesity in Korean children. According to the life-course approach, preschool-aged children (<5 years) are influenced by their parents rather than individual habits because they are under mostly parental care. Elementary school-aged children (6 to 11 years) are affected by overlapping individual and parental effects. This may mean that the establishment of individual behavior patterns begins during this period. The conditions of poor eating habits such as skipping meals, eating out, and high fat intake, along with low physical activity, facilitate increased obesity among adolescents (12 to 18 years). Notably, adolescent girls show high rates of both underweight and obesity, which may lead to the development of NCDs in their offspring. Therefore, the problem of NCDs is no longer limited to adults, but is also prevalent among children. In addition, early intervention offers cost-effective opportunities for preventing NCDs. Thus, children need primary consideration, adequate monitoring, diagnosis, and treatment to reduce the burden of NCDs later in adulthood.

Summary

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Brief Report

Trends in Ischemic Heart Disease Mortality in Korea, 1985-2009: An Age-period-cohort Analysis: Hye Ah Lee, Hyesook Park; J Prev Med Public Health. 2012;45(5):323-328. Published online September 28, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.5.323

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Abstract PDF

Objectives

Economic growth and development of medical technology help to improve the average life expectancy, but the western diet and rapid conversions to poor lifestyles lead an increasing risk of major chronic diseases. Coronary heart disease mortality in Korea has been on the increase, while showing a steady decline in the other industrialized countries. An age-period-cohort analysis can help understand the trends in mortality and predict the near future.

Methods

We analyzed the time trends of ischemic heart disease mortality, which is on the increase, from 1985 to 2009 using an age-period-cohort model to characterize the effects of ischemic heart disease on changes in the mortality rate over time.

Results

All three effects on total ischemic heart disease mortality were statistically significant. Regarding the period effect, the mortality rate was decreased slightly in 2000 to 2004, after it had continuously increased since the late 1980s that trend was similar in both sexes. The expected age effect was noticeable, starting from the mid-60's. In addition, the age effect in women was more remarkable than that in men. Women born from the early 1900s to 1925 observed an increase in ischemic heart mortality. That cohort effect showed significance only in women.

Conclusions

The future cohort effect might have a lasting impact on the risk of ischemic heart disease in women with the increasing elderly population, and a national prevention policy is need to establish management of high risk by considering the age-period-cohort effect.

Summary

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Original Articles

Effect of Preexisting Musculoskeletal Diseases on the 1-Year Incidence of Fall-related Injuries: Won Kyung Lee, Kyoung Ae Kong, Hyesook Park; J Prev Med Public Health. 2012;45(5):283-290. Published online September 28, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.5.283

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Abstract PDF

Objectives

People who have chronic diseases, as well as gait imbalance or psychiatric drug use, may be susceptible to injuries from falls and slips. The purpose of this study was to evaluate the effect of musculoskeletal diseases on incidental fall-related injuries among adults in Korea.

Methods

We analyzed data from the 4th Korea National Health and Nutrition Examination Survey (2007-2009), which are national data obtained by a rolling survey sampling method. The 1-year incidence of fall-related injuries was defined by health service utilization within the last year due to injury occurring after a slip and fall, and musculoskeletal diseases included osteoarthritis, rheumatoid arthritis, osteoporosis, and back pain. To evaluate the effects of preexisting musculoskeletal diseases, adults diagnosed before the last year were considered the exposed group, and adults who had never been diagnosed were the unexposed group.

Results

The weighted lifetime prevalence of musculoskeletal disease was 32 540 per 100 000 persons. Musculoskeletal diseases were associated with a higher risk of fall-related injury after adjustment for sex, age, residence, household income, education, occupation, visual disturbance, paralysis due to stroke, and medication for depression (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.03 to 1.93). As the number of comorbid musculoskeletal diseases increased, the risk of fall-induced injuries increased (p-value for trend <0.001). In particular, patients who had any musculoskeletal condition were at much higher risk of recurrent fall-related injuries (OR, 6.20; 95% CI, 1.06 to 36.08).

Conclusions

One must take into account the risk of fall-related injuries and provide prevention strategies among adults who have musculoskeletal diseases.

Summary

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The Effect of Eating Behavior on Being Overweight or Obese During Preadolescence: Hye Ah Lee, Won Kyung Lee, Kyoung-Ae Kong, Namsoo Chang, Eun-Hee Ha, Young Sun Hong, Hyesook Park; J Prev Med Public Health. 2011;44(5):226-233. Published online September 28, 2010; DOI: https://doi.org/10.3961/jpmph.2011.44.5.226

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Abstract PDF

Objectives

Being overweight or obese is central to metabolic syndrome, and these characteristics constitute dominant risk factors for chronic diseases. Although behavioral factors, including eating habits and sedentary lifestyles, are considered to be determinants of obesity, the specific childhood factors that contribute to this condition have not been clearly defined.

Methods

The subjects consisted of 261 children aged 7-9 years who were recruited from an elementary school during October 2003. Information was obtained from their parents using a questionnaire focused on eating behaviors and lifestyle factors, additional data were also collected via anthropometric measurements and biochemical examinations, including blood tests.

Results

A total of 48 (18.4%) of the 261 children were overweight, and 34 (70.8%) had at least one other component of metabolic syndrome. Eating behaviors emerged as significant lifestyle-related risk factors for being overweight or obese. Those who engaged in overeating more than twice per week had three times the risk of being overweight (odds ratio [OR], 3.10, 95% confidence interval [CI], 1.39 to 6.92), and those who ate rapidly had three times the risk of being overweight (OR, 3.28; 95% CI, 1.68 to 6.41). Those who had fewer family meals (fewer than 2-3/month) had a nine times higher risk of being overweight than those who had family meals more frequently (at least 1/day) (OR, 9.51; 95% CI, 1.21 to 74.82).

Conclusions

This study showed that being overweight or obese during preadolescence is associated with a higher risk of metabolic syndrome and is related to unhealthy eating behaviors. Thus, weight-control strategies and healthy eating behaviors should be developed early in life to reduce the risk for metabolic syndrome.

Summary

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Comparative Study

Body Weight at Birth and at Age Three and Respiratory Illness in Preschool Children.: Yoolwon Jeong, Kyunghee Jung-Choi, Jin Hwa Lee, Hwa Young Lee, Eun Ae Park, Young Ju Kim, Eunhee Ha, Se Young Oh, Hyesook Park; J Prev Med Public Health. 2010;43(5):369-376.; DOI: https://doi.org/10.3961/jpmph.2010.43.5.369

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Abstract PDF

OBJECTIVES
The purpose of this study was to examine the associations of current body weight and body mass index (BMI) at age three and birth weight in developing chronic respiratory illness in childhood and identify possible interaction underlying its mechanism. METHODS: The study was carried out with 422 children who were enrolled in a hospital-based birth cohort. Birth related anthropometric data were collected at birth. At age 3 years, the presence of respiratory symptoms was evaluated by using the Korean version of core questionnaire for wheezing and asthma from the International Study of Asthma and Allergies in Childhood (ISAAC). Physical examination was carried out to measure the child's weight and height. RESULTS: Children in the lowest birth weight tertile (aOR = 3.97, 95% CI = 0.94-16.68) or highest BMI tertile (aOR = 3.68, 95% CI = 1.24-10.95) at three years of age were at an increased risk of chronic respiratory illness. Children who were initially in the lowest birth weight tertile but now belong in the highest weight tertile had higher risk of chronic respiratory illness compared to those who had remained in the middle tertile (OR=16.35, 95% CI=1.66-160.57). CONCLUSIONS: Children with lower birth weight or higher BMI were at an increased risk of chronic respiratory illness. In addition, children who were initially in the lowest birth weight tertile but are now in the highest weight tertile had higher risk of chronic respiratory illness compared to those who remained in the middle tertile.

Summary

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English Abstracts

Clustering of Metabolic Risk Factors and Its Related Risk Factors in Young Schoolchildren.: Kyoung Ae Kong, Bo Hyun Park, Jung Won Min, Juhee Hong, Young Sun Hong, Bo Eun Lee, Namsoo Chang, Sun Hwa Lee, Eun Hee Ha, Hyesook Park; J Prev Med Public Health. 2006;39(3):235-242.

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Abstract PDF: OBJECTIVES
We wanted to determine the distribution of the clustering of the metabolic risk factors and we wanted to evaluate the related factors in young schoolchildren. METHODS: A cross-sectional study of metabolic syndrome was conducted in an elementary school in Seoul, Korea. We evaluated fasting glucose, triglyceride, HDL cholesterol, blood pressures and the body mass index, and we used parent-reported questionnaires to assess the potential risk factors in 261 children (136 boys, 125 girls). We defined the metabolic risk factors as obesity or at risk for obesity (> or = 85th percentile for age and gender), a systolic or diastolic blood pressure at > or = 90th percentile for age and gender, fasting glucose at > or = 110 mg/dl, triglyceride at > or = 110 mg/dl and HDL cholesterol at @40 mg/dl. RESULTS: There were 15.7% of the subjects who showed clustering of two or more metabolic risk factors, 2.3% of the subjects who showed clustering for three or more risk factors, and 0.8% of the subjects who showed clustering for four or more risk factors. A multivariate analysis revealed that a father smoking more than 20 cigarettes per day, a mother with a body mass index of = 25 kg/m2, and the child eating precooked or frozen food more than once per day were associated with clustering of two or more components, with the odds ratios of 3.61 (95% CI=1.24-10.48), 5.50 (95% CI=1.39-21.73) and 8.04 (95% CI=1.67-38.81), respectively. CONCLUSIONS: This study shows that clustering of the metabolic risk factors is present in young schoolchildren in Korea, with the clustering being associated with parental smoking and obesity as well as the child's eating behavior. These results suggest that evaluation of metabolic risk factors and intervention for lifestyle factors may be needed in both young Korean children and their parents.; Summary

Relationship of Socioeconomic Factors with Medical Utilization for Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia in a South Korean Community.: Han Hae Kim, Kyoung Ae Kong, Hun Jae Lee, Hana Yoon, Bo Eun Lee, Ok Ryun Moon, Hyesook Park; J Prev Med Public Health. 2006;39(2):141-148.

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Abstract PDF: OBJECTIVES
We wanted to evaluate the medical underutilization for benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) among Korean elderly men and we wanted to determine their associated factors. METHODS: This study was conducted on 239 men with LUTS and 116 men with BPH who were compatible with the diagnostic criteria from a total of 641 participants. These participants were over 50 years old and they were randomly chosen in a community-based study for estimating the prevalence of BPH. Using a self-reported questionnaire, we surveyed the sociodemographics, health status, quality of life, lower urinary tract symptoms, medical utilization and reasons for not seeking treatment. RESULTS: Only 27.6% of the men with LUTS and 31.0% of the men with BPH reported having visited a doctor for urinary symptoms. The reasons for not visiting a doctor were, in order of responses from the group with LUTS: 'considered the symptoms as a part of the normal ageing process', 'not enough time to visit a doctor', 'financial difficulty' and 'the symptoms were not severe or bothersome'. Regarding BPH, the responses were the same as those of the group with LUTS however, 'financial difficulty' placed second. Among the men with experience of visiting a doctor for urinary symptoms, 33.3% of those with LUTS and 28.1% of those with BPH were not treated. The most common reason in both groups was 'the symptoms were not severe to be treated'. On a multiple logistic regression analysis, the larger size household (odds ratio (OR) 3.03, 95% confidence interval (CI)=1.40-6.54) and an unsatisfactory quality of life related with urinary symptoms (OR 2.98, 95% CI=1.23-7.21) were associated with medical utilization in the group of LUTS. For BPH, the current employment status was related with the medical utilization (OR 2.80, 95% CI=1.10-7.11), in addition to the larger size household (OR 3.24, 95% CI=1.14-9.21). CONCLUSIONS: Many men with urinary symptoms do not visit a doctor. This medical underutilization for people with LUTS and BPH may be associated with economic status in Korea.; Summary

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