Journal of Preventive Medicine and Public Health

Original Articles

Validity of Self-reported Stroke and Myocardial Infarction in Korea: The Health Examinees (HEXA) Study: Sunho Choe, Joonki Lee, Jeeyoo Lee, Daehee Kang, Jong-Koo Lee, Aesun Shin; J Prev Med Public Health. 2019;52(6):377-383. Published online November 12, 2019; DOI: https://doi.org/10.3961/jpmph.19.089

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Objectives
Self-reported disease history is often used in epidemiological studies. In this study, we acquired the hospital records of subjects who self-reported stroke or myocardial infarction (MI) and evaluated the validity of the participants’ self-reported disease history. We also determined the level of agreement between specialists and non-specialists.
Methods
Among the participants in the Health Examinees study, 1488 subjects self-reported stroke or MI during 2012-2017, and medical records were acquired for the 429 subjects (28.8%) who agreed to share their medical information. Each record was independently assigned to 2 medical doctors for review. The records were classified as ‘definite,’ ‘possible,’ or ‘not’ stroke or MI. If the doctors did not agree, a third doctor made the final decision. The positive predictive value (PPV) of self-reporting was calculated with the doctors’ review as the gold standard. Kappa statistics were used to compare the results between general doctors and neurologists or cardiologists.
Results
Medical records from 208 patients with self-reported stroke and 221 patients with self-reported MI were reviewed. The PPV of self-reported disease history was 51.4% for stroke and 32.6% for MI. If cases classified as ‘possible’ were counted as positive diagnoses, the PPV was 59.1% for stroke and 33.5% for MI. Kappa statistics showed moderate levels of agreement between specialists and non-specialists for both stroke and MI.
Conclusions
The validity of self-reported disease was lower than expected, especially in those who reported having been diagnosed with MI. Proper consideration is needed when using these self-reported data in further studies.

Summary

Citations

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What Explains Socioeconomic Inequality in Health-related Quality of Life in Iran? A Blinder-Oaxaca Decomposition: Satar Rezaei, Mohammad Hajizadeh, Yahya Salimi, Ghobad Moradi, Bijan Nouri; J Prev Med Public Health. 2018;51(5):219-226. Published online August 7, 2018; DOI: https://doi.org/10.3961/jpmph.18.012

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Abstract PDF

Objectives
This study aimed to explain the health-related quality of life (HRQoL) gap between the poorest and the wealthiest quintiles in the capitals of Kermanshah and Kurdistan Provinces (Kermanshah and Sanandaj), in western Iran.
Methods
This was a cross-sectional study conducted among 1772 adults. Data on socio-demographic characteristics, socioeconomic status (SES), lifestyle factors, body mass index, and HRQoL of participants were collected using a self-administered questionnaire. The slope and relative indices of inequality (SII and RII, respectively) were employed to examine socioeconomic inequality in poor HRQoL. Blinder-Oaxaca (BO) decomposition was used to quantify the contribution of explanatory variables to the gap in the prevalence of poor HRQoL between the wealthiest and the poorest groups.
Results
The overall crude and age-adjusted prevalence of poor HRQoL among adults was 32.0 and 41.8%, respectively. The SII and RII indicated that poor HRQoL was mainly concentrated among individuals with lower SES. The absolute difference (%) in the prevalence of poor HRQoL between the highest and lowest SES groups was 28.4. The BO results indicated that 49.9% of the difference was explained by different distributions of age, smoking behavior, physical inactivity, chronic health conditions, and obesity between the highest and lowest SES groups, while the remaining half of the gap was explained by the response effect.
Conclusions
We observed a pro-rich distribution of poor HRQoL among adults in the capitals of Kermanshah and Kurdistan Provinces. Policies and strategies aimed at preventing and reducing smoking, physical inactivity, chronic health conditions, and obesity among the poor may reduce the gap in poor HRQoL between the highest and lowest SES groups in Iran.

Summary

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Chris Mweemba, Wilbroad Mutale, Felix Masiye, Peter Hangoma
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Health-related quality of life variation by socioeconomic status: Evidence from an Iranian population-based study
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Exploratory Study of Dimensions of Health-related Quality of Life in the General Population of South Korea: Seon-Ha Kim, Min-Woo Jo, Minsu Ock, Sang-il Lee; J Prev Med Public Health. 2017;50(6):361-368. Published online November 2, 2017; DOI: https://doi.org/10.3961/jpmph.16.076

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Abstract PDF Supplementary Material

Objectives
This study aimed to explore dimensions in addition to the 5 dimensions of the 5-level EQ-5D version (EQ-5D-5L) that could satisfactorily explain variation in health-related quality of life (HRQoL) in the general population of South Korea.
Methods
Domains related to HRQoL were searched through a review of existing HRQoL instruments. Among the 28 potential dimensions, the 5 dimensions of the EQ-5D-5L and 7 additional dimensions (vision, hearing, communication, cognitive function, social relationships, vitality, and sleep) were included. A representative sample of 600 subjects was selected for the survey, which was administered through face-to-face interviews. Subjects were asked to report problems in 12 health dimensions at 5 levels, as well as their self-rated health status using the EuroQol visual analogue scale (EQ-VAS) and a 5-point Likert scale. Among subjects who reported no problems for any of the parameters in the EQ-5D-5L, we analyzed the frequencies of problems in the additional dimensions. A linear regression model with the EQ-VAS as the dependent variable was performed to identify additional significant dimensions.
Results
Among respondents who reported full health on the EQ-5D-5L (n=365), 32% reported a problem for at least 1 additional dimension, and 14% reported worse than moderate self-rated health. Regression analysis revealed a R2 of 0.228 for the original EQ-5D-5L dimensions, 0.200 for the new dimensions, and 0.263 for the 12 dimensions together. Among the added dimensions, vitality and sleep were significantly associated with EQ-VAS scores.
Conclusions
This study identified significant dimensions for assessing self-rated health among members of the general public, in addition to the 5 dimensions of the EQ-5D-5L. These dimensions could be considered for inclusion in a new preference-based instrument or for developing a country-specific HRQoL instrument.

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Level of Agreement and Factors Associated With Discrepancies Between Nationwide Medical History Questionnaires and Hospital Claims Data: Yeon-Yong Kim, Jong Heon Park, Hee-Jin Kang, Eun Joo Lee, Seongjun Ha, Soon-Ae Shin; J Prev Med Public Health. 2017;50(5):294-302. Published online July 20, 2017; DOI: https://doi.org/10.3961/jpmph.17.024

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Abstract PDF

Objectives
The objectives of this study were to investigate the agreement between medical history questionnaire data and claims data and to identify the factors that were associated with discrepancies between these data types. Methods: Data from self-reported questionnaires that assessed an individual’s history of hypertension, diabetes mellitus, dyslipidemia, stroke, heart disease, and pulmonary tuberculosis were collected from a general health screening database for 2014. Data for these diseases were collected from a healthcare utilization claims database between 2009 and 2014. Overall agreement, sensitivity, specificity, and kappa values were calculated. Multiple logistic regression analysis was performed to identify factors associated with discrepancies and was adjusted for age, gender, insurance type, insurance contribution, residential area, and comorbidities. Results: Agreement was highest between questionnaire data and claims data based on primary codes up to 1 year before the completion of self-reported questionnaires and was lowest for claims data based on primary and secondary codes up to 5 years before the completion of self-reported questionnaires. When comparing data based on primary codes up to 1 year before the completion of self-reported questionnaires, the overall agreement, sensitivity, specificity, and kappa values ranged from 93.2 to 98.8%, 26.2 to 84.3%, 95.7 to 99.6%, and 0.09 to 0.78, respectively. Agreement was excellent for hypertension and diabetes, fair to good for stroke and heart disease, and poor for pulmonary tuberculosis and dyslipidemia. Women, younger individuals, and employed individuals were most likely to under-report disease. Conclusions: Detailed patient characteristics that had an impact on information bias were identified through the differing levels of agreement.

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Validation Studies

Validity of Expired Carbon Monoxide and Urine Cotinine Using Dipstick Method to Assess Smoking Status.: Su San Park, Ju Yul Lee, Sung Il Cho; J Prev Med Public Health. 2007;40(4):297-304.; DOI: https://doi.org/10.3961/jpmph.2007.40.4.297

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Abstract PDF

OBJECTIVES
We investigated the validity of the dipstick method (Mossman Associates Inc. USA) and the expired CO method to distinguish between smokers and nonsmokers. We also elucidated the related factors of the two methods. METHODS: This study included 244 smokers and 50 exsmokers, recruited from smoking cessation clinics at 4 local public health centers, who had quit for over 4 weeks. We calculated the sensitivity, specificity and Kappa coefficient of each method for validity. We obtained ROC curve, predictive value and agreement to determine the cutoff of expired air CO method. Finally, we elucidated the related factors and compared their effect powers using the standardized regression coefficient. RESULTS: The dipstick method showed a sensitivity of 92.6%, specificity of 96.0% and Kappa coefficient of 0.79. The best cutoff value to distinguish smokers was 5-6ppm. At 5 ppm, the expired CO method showed a sensitivity of 94.3%, specificity of 82.0% and Kappa coefficient of 0.73. And at 6 ppm, sensitivity, specificity and Kappa coefficient were 88.5%, 86.0% and 0.64, respectively. Therefore, the dipstick method had higher sensitivity and specificity than the expired CO method. The dipstick and expired CO methods were significantly increased with increasing smoking amount. With longer time since the last smoking, expired CO showed a rapid decrease after 4 hours, whereas the dipstick method showed relatively stable levels for more than 4 hours. CONCLUSIONS: The dipstick and expired CO methods were both good indicators for assessing smoking status. However, the former showed higher sensitivity and specificity and stable levels over longer hours after smoking, compared to the expired CO method.

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English Abstract

Does Non-standard Work Affect Health?.: Il Ho Kim, Do myung Paek, Sung Il Cho; J Prev Med Public Health. 2005;38(3):337-344.

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Abstract PDF: OBJECTIVE
Job insecurity, such as non-standard work, is reported to have an adverse impact on health, regardless of health behaviors. The aim of this study was to examine the relationship between non-standard employment and health in Korea. METHODS: We analyzed a representative weighted sample, which consisted of 2, 112 men and 1, 237 women, aged 15-64, from the 1998 Korea National Health and Nutrition Examination Survey. Non-standard employment included part-time permanent, short time temporary and daily workers. Self-reported health was used as a health indicator. RESULTS: This study indicated that women were more likely to report poorer health than men with standard jobs. Of all employees, 20.3% were female manual workers. After adjusting for potential confounders, such as age, education, equivalent income, marital, social and selfreported economic status and health behavior factors, nonstandard employment was found to be significantly associated with poor health among female manual workers (OR, 1.86; 95% CI, 1.24 to 2.79). No significant association was found in other working groups. CONCLUSIONS: Among female manual workers, nonstandard employees reported significantly poorer health compared with standard workers. This result raises concern as there are increasing numbers of non-standard workers, particularly females.; Summary

Original Article

Agreement between Smoking Self-report and Urine Cotinine among Adolescents.: Ihn Sook Jeong, No Rai Park, Jinkyung Ham; J Prev Med Public Health. 2004;37(2):127-132.

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Abstract PDF: OBJECTIONS: Cotinine, the major metabolite of nicotine, is a useful marker of exposure to tobacco smoke and self-reporting of smoking status is thought not to be reliable. This study aimed to evaluate the agreement between the smoking self-report among adolescents and the urinary cotinine test. METHODS: The study subjects were 1226 middle and high school students in Hanam city, who were selected by stratified random sampling. The self-report about smoking behavior was compared with urine cotinine value measured with PBM AccuSignRfi Nicotine (Princeton BioMeditech Corporation, USA). The percentage agreement, kappa and 95% confidence interval (CI) were calculated. RESULTS: The overall percentage agreement was 88.6%, and those for boys, girls, middle school, general school and vocational school students were 87.3%, 90.1%, 93.7%, 85, 5%, 90.7%, and 78.4%, respectively. The overall kappa index was 0.46 (95% CI=0.39-0.54) for overall, and those for boys, girls, middle school, general school and vocational school students were 0.56 (95% CI=0.48-0.65), 0.20 (95% CI=0.07-0.32), 0.21 (95% CI=0.09-0.34), 0.55 (95% CI=0.47-0.64), 0.42 (95% CI=0.33-0.52), and 0.48 (95% CI=0.36-0.60), respectively. CONCLUSION: The percentage agreement was relatively high but the kappa values very low for girls, and middle school students. Though the prevalence bias can be influenced by these results, the selfreport was not a sufficient tool for the evaluation of adolescents' smoking status, especially in girls or middle school students.; Summary

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