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Original Articles
From Rich to Poor: A Decomposition Analysis of Socioeconomic Inequality in Health-related Quality of Life in Iran
Satar Rezaei
J Prev Med Public Health. 2025;58(5):538-547.   Published online August 20, 2025
DOI: https://doi.org/10.3961/jpmph.25.383
  • 3,399 View
  • 215 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
Socioeconomic status (SES) is a well-established predictor of health outcomes across an individual’s lifespan. People from lower socioeconomic backgrounds generally have shorter life expectancies and lower levels of health-related quality of life (HRQoL) compared with those from higher-income groups. This study aimed to quantify income-related inequalities in HRQoL among adults in Iran.
Methods
A total of 3518 adults aged 18 years and older were selected using a convenience sampling method across 9 provinces in Iran. HRQoL was assessed with the EuroQoL 5-Dimension 5-Level (EQ-5D-5L) instrument, which evaluates 5 dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. The concentration index (CI) approach was used to measure income-related inequality in worse HRQoL (disutility=1–utility value) and to identify the socioeconomic factors contributing to the observed inequality.
Results
The CI for worse HRQoL was -0.116, while the CI for the EuroQol visual analogue scale (EQ-VAS) score was 0.027. The CIs for reporting any problems in the EQ-5D-5L dimensions were: mobility (-0.122), self-care (-0.070), usual activities (-0.074), pain/discomfort (-0.139), and anxiety/depression (-0.139). Decomposition analysis showed that income (38.00%), educational level (31.53%), age (8.05%), and physical activity (7.30%) were the main factors contributing to socioeconomic inequality in poorer HRQoL in Iran.
Conclusions
This study identified a pro-poor distribution of poorer HRQoL and reported problems across all dimensions of the EQ-5D-5L in Iran. Targeted interventions should focus on reducing disparities in income, education, and physical activity levels.
Summary
Key Message
The study of 3518 adults across 9 Iranian provinces revealed significant pro-poor socioeconomic inequality in health-related quality of life (HRQoL), with worse HRQoL concentrated among lower-income groups (concentration index: -0.116). Income (38%) and education level (31.53%) were the largest contributors to this inequality, followed by age (8.05%) and physical activity (7.30%) based on decomposition analysis. All five EQ-5D-5L health dimensions showed more reported problems in lower socioeconomic groups, emphasizing the need for targeted interventions addressing income, education, and lifestyle factors to reduce HRQoL disparities in Iran.
Inequality in Private Health Care Expenditures: A 36-Year Trend Study of Iranian Households
Ehsan Aghapour, Mehdi Basakha, Seyed Hossein Mohaqeqi Kamal, Abolghasem Pourreza
J Prev Med Public Health. 2022;55(4):379-388.   Published online June 27, 2022
DOI: https://doi.org/10.3961/jpmph.22.123
  • 7,973 View
  • 102 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract PDF
Objectives
Throughout history, societies have been impacted by inequality. Many studies have been conducted on the topic more broadly, but only a few have investigated inequalities in out-of-pocket health payments (OHP). This study measures OHP inequality trends among the Iranian households.
Methods
This study used data from the Iranian Statistics Center on Iranian household income and expenditures. The analysis included a total of 995 300 households during the 36 years from 1984 to 2019. The Gini coefficient, Atkinson index, and Theil index were calculated for Iranian OHP.
Results
Average Iranian household OHP increased from 33 US dollar (USD) in 1984 to 47 USD in 2019. During this 36-year span, the average±standard deviation Gini coefficient for OHP was 0.73±0.04, and the Atkinson and Theil indexes were 0.68±0.05 and 1.14±0.29, respectively. The Gini coefficients for the subcategories of OHP of outpatient diagnostic services, medical assistant accessories, hospital inpatient services, and addiction cessation were 0.70, 0.61, 0.84, and 0.64, respectively.
Conclusions
In this study, we scrutinized trends of inequality in the OHP of Iranian households. Inequality in OHP decreased slightly over the past four decades. An analysis of trends among different subgroups revealed that affluent households, such as households with insurance coverage and households in higher income deciles, experienced higher inequality. Therefore, lower inequality in health care expenditures may be related to restricted access to health care services in Iran.
Summary

Citations

Citations to this article as recorded by  
  • Unequal benefits: the effects of health insurance integration on consumption inequality in rural China
    Linlin Han
    Frontiers in Public Health.2025;[Epub]     CrossRef
  • Decomposition of Healthcare Utilization Inequality in Iran: The Prominent Role of Health Literacy and Neighborhood Characteristics
    Neda Soleimanvandiazar, Seyed Hossein Mohaqeqi Kamal, Mehdi Basakha, Salah Eddin Karimi, Sina Ahmadi, Gholamreza Ghaedamini Harouni, Homeira Sajjadi, Ameneh Setareh Forouzan
    INQUIRY: The Journal of Health Care Organization, Provision, and Financing.2024;[Epub]     CrossRef
Analysis of Differences in Preterm Birth Rates According to Household Occupation in Japan From 2007 to 2019
Tasuku Okui, Naoki Nakashima
J Prev Med Public Health. 2022;55(4):371-378.   Published online June 20, 2022
DOI: https://doi.org/10.3961/jpmph.22.178
  • 8,275 View
  • 125 Download
  • 5 Web of Science
  • 6 Crossref
AbstractAbstract PDF
Objectives
No studies have examined the association between preterm birth rates and socioeconomic factors in Japan using nationwide statistical data. We analyzed the association between preterm birth rates and household occupation using Vital Statistics data.
Methods
Aggregated Vital Statistics data from Japan from 2007 to 2019 were obtained from the Ministry of Health, Labour and Welfare. From the data, the number of births according to year, age group, gestational period, number of pregnancies, and household occupation were used in this study. Crude preterm birth rates and preterm birth rates adjusted by maternal age according to household occupation were calculated for each year. Poisson regression analysis was conducted to evaluate the association between household occupation and preterm births.
Results
Unemployed households had the highest preterm birth rate, and households with an occupation classification of “full-time worker 2” (an employee at a large company, civil servant, or board member) had the lowest preterm birth rate throughout each period. Poisson regression analysis revealed that unemployed households were statistically significantly associated with a high preterm birth risk. In contrast, the preterm birth rate adjusted by maternal age remained stable throughout each period regardless of household occupation, and preterm birth rates were found not to have increased in recent years in Japan.
Conclusions
Unemployed households had higher preterm birth rates than other household occupations. Further studies investigating the characteristics of unemployed households are needed to identify the reasons for this disparity.
Summary

Citations

Citations to this article as recorded by  
  • Maternal occupation and risk of adverse fetal outcomes in Tanzania: A hospital-based cross-sectional study
    Baldwina Tita Olirk, Aiwerasia Vera Ngowi, Furaha August, Ezra Jonathan Mrema, Jovine Bachwenkizi, Simon Henry Mamuya, Kahsu Gebrekidan
    PLOS ONE.2025; 20(3): e0319653.     CrossRef
  • Shotgun metagenomics of the vaginal microbiome in cervical shortening and preterm birth risk
    Keun-Young Lee, Seung-Ho Shin, Goeun Park, Shin-Hae Kang, Hyun-Jung Kang, Jiye Kim, Jae Jun Lee, Ga-Hyun Son, Ji Young Hong
    Scientific Reports.2025;[Epub]     CrossRef
  • Establishment and validation of clinical prediction models for preterm birth in patients with intrahepatic cholestasis of pregnancy: Single-center retrospective observational study
    Min Wen, Wenfei Zheng, Mengmeng Yu
    Medicine.2025; 104(52): e46848.     CrossRef
  • Analysis of an Association between Preterm Birth and Parental Educational Level in Japan Using National Data
    Tasuku Okui
    Children.2023; 10(2): 342.     CrossRef
  • Association of maternal nationality with preterm birth and low birth weight rates: analysis of nationwide data in Japan from 2016 to 2020
    Tasuku Okui, Yoko Sato, Seiichi Morokuma, Naoki Nakashima
    Maternal Health, Neonatology and Perinatology.2023;[Epub]     CrossRef
  • Does the father’s job matter? Parental occupation and preterm birth in Korea
    Taemi Kim, Eunseon Gwak, Bolormaa Erdenetuya, Jeong-Won Oh, Jung-won Yoon, Myoung-Hee Kim, Jia Ryu, Seung-Ah Choe
    Epidemiology and Health.2023; 45: e2023078.     CrossRef
Decomposition of Socioeconomic Inequality in Cardiovascular Disease Prevalence in the Adult Population: A Cohort-based Cross-sectional Study in Northwest Iran
Farhad Pourfarzi, Telma Zahirian Moghadam, Hamed Zandian
J Prev Med Public Health. 2022;55(3):297-306.   Published online May 3, 2022
DOI: https://doi.org/10.3961/jpmph.22.051
  • 8,082 View
  • 127 Download
  • 4 Web of Science
  • 3 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
The incidence of cardiovascular disease (CVD) mortality is increasing in developing countries. This study aimed to decompose the socioeconomic inequality of CVD in Iran.
Methods
This cross-sectional population-based study was conducted on 20 519 adults who enrolled in the Ardabil Non-Communicable Disease cohort study. Principal component analysis and multivariable logistic regression were used, respectively, to estimate socioeconomic status and to describe the relationships between CVD prevalence and the explanatory variables. The relative concentration index, concentration curve, and Blinder-Oaxaca decomposition model were used to measure and decompose the socioeconomic inequality.
Results
The overall age-adjusted prevalence of CVD was 8.4% in northwest Iran. Multivariable logistic regression showed that older adults, overweight or obese adults, and people with hypertension and diabetes were more likely to have CVD. Moreover, people with low economic status were 38% more likely to have CVD than people with high economic status. The prevalence of CVD was mainly concentrated among the poor (concentration index, -0.077: 95% confidence interval, -0.103 to -0.060), and 78.66% of the gap between the poorest and richest groups was attributed to differences in the distribution of the explanatory variables included in the model.
Conclusions
The most important factors affecting inequality in CVD were old age, chronic illness (hypertension and diabetes), marital status, and socioeconomic status. This study documented stark inequality in the prevalence of CVD, wherein the poor were more affected than the rich. Therefore, it is necessary to implement policies to monitor, screen, and control CVD in poor people living in northwest Iran.
Summary

Citations

Citations to this article as recorded by  
  • Relationship between social determinants of health and stroke, and the moderating and mediating effect of depression
    YongYing Zhang, Bin Zhang, Honghua Zhuang, Yushan Yin
    Journal of Affective Disorders.2026; 394: 120469.     CrossRef
  • Impact of Social Determinants of Health on Cardiovascular Disease
    George Bazoukis, Joseph Loscalzo, Jennifer L. Hall, Sandeep Chandra Bollepalli, Jagmeet P. Singh, Antonis A. Armoundas
    Journal of the American Heart Association.2025;[Epub]     CrossRef
  • A Global Perspective on Socioeconomic Determinants of Cardiovascular Health
    Bart Wilder, Alejandro Pinedo, Salaheldin Abusin, David Ansell, Adrian Matias Bacong, James Calvin, Sung Whoy Cha, Rami Doukky, Faisal Hasan, Shengyuan Luo, Ahmet Afşin Oktay, Latha Palaniappan, Natasha Rana, Frederick Berro Rivera, Basmah Fayaz, Ahmed Al
    Canadian Journal of Cardiology.2024;[Epub]     CrossRef
Socioeconomic Predictors of Diabetes Mortality in Japan: An Ecological Study Using Municipality-specific Data
Tasuku Okui
J Prev Med Public Health. 2021;54(5):352-359.   Published online August 14, 2021
DOI: https://doi.org/10.3961/jpmph.21.215
  • 9,409 View
  • 174 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
The aim of this study was to examine the geographic distribution of diabetes mortality in Japan and identify socioeconomic factors affecting differences in municipality-specific diabetes mortality.
Methods
Diabetes mortality data by year and municipality from 2013 to 2017 were extracted from Japanese Vital Statistics, and the socioeconomic characteristics of municipalities were obtained from government statistics. We calculated the standardized mortality ratio (SMR) of diabetes for each municipality using the empirical Bayes method and represented geographic differences in SMRs in a map of Japan. Multiple linear regression was conducted to identify the socioeconomic factors affecting differences in SMR. Statistically significant socioeconomic factors were further assessed by calculating the relative risk of mortality of quintiles of municipalities classified according to the degree of each socioeconomic factor using Poisson regression analysis.
Results
The geographic distribution of diabetes mortality differed by gender. Of the municipality-specific socioeconomic factors, high rates of single-person households and unemployment and a high number of hospital beds were associated with a high SMR for men. High rates of fatherless households and blue-collar workers were associated with a high SMR for women, while high taxable income per-capita income and total population were associated with low SMR for women. Quintile analysis revealed a complex relationship between taxable income and mortality for women. The mortality risk of quintiles with the highest and lowest taxable per-capita income was significantly lower than that of the middle-income quintile.
Conclusions
Socioeconomic factors of municipalities in Japan were found to affect geographic differences in diabetes mortality.
Summary

Citations

Citations to this article as recorded by  
  • Worldwide burden and trends of diabetes among people aged 70 years and older, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019
    Shimin Jiang, Tianyu Yu, Dingxin Di, Ying Wang, Wenge Li
    Diabetes/Metabolism Research and Reviews.2024;[Epub]     CrossRef
  • The Effect of Neighborhood Deprivation on Mortality in Newly Diagnosed Diabetes Patients: A Countrywide Population-Based Korean Retrospective Cohort Study, 2002–2013
    Kyoung-Hee Cho, Juyeong Kim, Young Choi, Tae-Hyun Kim
    International Journal of Environmental Research and Public Health.2022; 19(7): 4324.     CrossRef
  • Depression, cognitive dysfunction and other factors associated with 5-year overall mortality in type 2 diabetes mellitus: a pilot prospective observational study
    E. G. Starostina, M. N. Volodina, I. V. Starostin
    Diabetes mellitus.2022; 25(4): 327.     CrossRef
COVID-19: Original Article
Did the Timing of State Mandated Lockdown Affect the Spread of COVID-19 Infection? A County-level Ecological Study in the United States
Megh M. Trivedi, Anirudha Das
J Prev Med Public Health. 2021;54(4):238-244.   Published online July 2, 2021
DOI: https://doi.org/10.3961/jpmph.21.071
  • 7,631 View
  • 130 Download
  • 8 Web of Science
  • 9 Crossref
AbstractAbstract PDF
Objectives
Previous pandemics have demonstrated that several demographic, geographic, and socioeconomic factors may play a role in increased infection risk. During this current coronavirus disease 2019 (COVID-19) pandemic, our aim was to examine the association of timing of lockdown at the county level and aforementioned risk factors with daily case rate (DCR) in the United States.
Methods
A cross-sectional study using publicly available data was performed including Americans with COVID-19 infection as of May 24, 2020. The United States counties with >100 000 population and >50 cases per 100 000 people were included. The independent variable was the days required from the declaration of lockdown to reach the target case rate (50/100 000 cases) while the dependent (outcome) variable was the DCR per 100 000 on the day of statistical calculation (May 24, 2020) after adjusting for multiple confounding socio-demographic, geographic, and health-related factors. Each independent factor was correlated with outcome variables and assessed for collinearity with each other. Subsequently, all factors with significant association to the outcome variable were included in multiple linear regression models using stepwise method. Models with best R2 value from the multiple regression were chosen.
Results
The timing of mandated lockdown order had the most significant association on the DCR per 100 000 after adjusting for multiple socio-demographic, geographic and health-related factors. Additional factors with significant association with increased DCR include rate of uninsured and unemployment.
Conclusions
The timing of lockdown order was significantly associated with the spread of COVID-19 at the county level in the United States.
Summary

Citations

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  • The Economic Power of Capital and the Spread of COVID-19 in the United States: An Empirical Study
    Junfu Zhao
    Review of Radical Political Economics.2025; 57(1): 30.     CrossRef
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    Gabriel McCarthy, Hana M. Dobrovolny
    Mathematical Biosciences and Engineering.2025; 22(3): 700.     CrossRef
  • Predisposing, Enabling, and Reinforcing Factors of COVID-19 Prevention Behavior in Indonesia: A Mixed-methods Study
    Putri Winda Lestari, Lina Agestika, Gusti Kumala Dewi
    Journal of Preventive Medicine and Public Health.2023; 56(1): 21.     CrossRef
  • Assessing the Impacts of COVID-19 and Social Isolation on Mental Health in the United States of America
    Alexander Fulk, Raul Saenz-Escarcega, Hiroko Kobayashi, Innocent Maposa, Folashade Agusto
    COVID.2023; 3(6): 807.     CrossRef
  • Understanding mental health trends during COVID-19 pandemic in the United States using network analysis
    Hiroko Kobayashi, Raul Saenz-Escarcega, Alexander Fulk, Folashade B. Agusto, Karina Cardoso Meira
    PLOS ONE.2023; 18(6): e0286857.     CrossRef
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    Adam Mayer, Stacia Ryder
    Socius: Sociological Research for a Dynamic World.2023;[Epub]     CrossRef
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    Philosophical Transactions of the Royal Society A: Mathematical, Physical and Engineering Sciences.2023;[Epub]     CrossRef
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    Long Chu, R. Quentin Grafton, Tom Kompas, Mary-Louise McLaws
    Sage Open.2023;[Epub]     CrossRef
  • Association mining based approach to analyze COVID-19 response and case growth in the United States
    Satya Katragadda, Raju Gottumukkala, Ravi Teja Bhupatiraju, Azmyin Md. Kamal, Vijay Raghavan, Henry Chu, Ramesh Kolluru, Ziad Ashkar
    Scientific Reports.2021;[Epub]     CrossRef
COVID-19: Brief Report
Association of Lower Socioeconomic Status and SARS-CoV-2 Positivity in Los Angeles, California
Lao-Tzu Allan-Blitz, Cameron Goldbeck, Fred Hertlein, Isaac Turner, Jeffrey D. Klausner
J Prev Med Public Health. 2021;54(3):161-165.   Published online April 13, 2021
DOI: https://doi.org/10.3961/jpmph.21.126
  • 7,396 View
  • 218 Download
  • 13 Web of Science
  • 19 Crossref
AbstractAbstract PDF
Objectives
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreads heterogeneously, disproportionately impacting poor and minority communities. The relationship between poverty and race is complex, with a diverse set of structural and systemic factors driving higher rates of poverty among minority populations. The factors that specifically contribute to the disproportionate rates of SARS-CoV-2 infection, however, are not clearly understood.
Methods
We evaluated SARS-CoV-2 test results from community-based testing sites in Los Angeles, California, between June and December, 2020. We used tester zip code data to link those results with United States Census report data on average annual household income, rates of healthcare coverage, and employment status by zip code.
Results
We analyzed 2 141 127 SARS-CoV-2 test results, of which 245 154 (11.4%) were positive. Multivariable modeling showed a higher likelihood of SARS-CoV-2 test positivity among Hispanic communities than among other races. We found an increased risk for SARS-CoV-2 positivity among individuals from zip codes with an average annual household income Conclusions
Residence in zip codes with lower average annual household income, lower rates of employment, or lower rates of health insurance was associated with SARS-CoV-2 positivity. Further research is needed into how those factors increase the spread of SARS-CoV-2 infection among populations of lower socioeconomic status in order to develop targeted public health interventions.
Summary

Citations

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    Rossybelle P. Amorrortu, Yayi Zhao, Robert J. Keenan, Scott M. Gilbert, Dana E. Rollison
    Journal of Racial and Ethnic Health Disparities.2025; 12(1): 107.     CrossRef
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    Anna F. Wang-Erickson, Xueyan Zhang, Klancie Dauer, Danielle M. Zerr, Amanda Adler, Janet A. Englund, Brian Lee, Jennifer E. Schuster, Rangaraj Selvarangan, Chelsea Rohlfs, Mary A. Staat, Leila C. Sahni, Julie A. Boom, G. K. Balasubramani, John V. William
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    Anna K. Porter, Sarah E. Kleinschmidt, Kara L. Andres, Courtney N. Reusch, Ryan M. Krisko, Oyebode A. Taiwo, Geary W. Olsen, Matthew P. Longnecker
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    Jingxin Lei, Ying MacNab
    Spatial and Spatio-temporal Epidemiology.2024; 49: 100658.     CrossRef
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Original Article
Effects of Socio-demographic Factors on the Decreasing Trend in the Sex Ratio at Birth in Korea, 1997-2017
Jisuk Bae
J Prev Med Public Health. 2020;53(5):371-380.   Published online August 7, 2020
DOI: https://doi.org/10.3961/jpmph.20.282
  • 8,106 View
  • 112 Download
AbstractAbstract PDFSupplementary Material
Objectives
This study investigated the effects of socio-demographic factors on the decreasing trend in the sex ratio at birth from 1997 to 2017 in Korea.
Methods
Data from 10 349 602 live births registered with Statistics Korea from 1997 to 2017 were analyzed. The secondary sex ratio (SSR), defined as the ratio of male to female live births, during the study period (1997-1999 [phase I], 2000-2002 [phase II], 2003-2005 [phase III], 2006-2008 [phase IV], 2009-2011 [phase V], 2012-2014 [phase VI], and 2015-2017 [phase VII]) was calculated according to selected socio-demographic factors, such as parental age, education, occupation, and birth order. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals for a male birth after adjusting for potential confounders.
Results
The SSR gradually decreased from 1.10 (in 1998-2000 and 2002) to 1.05 (in 2013-2016). While a decreasing trend in the SSR was not noted among first births, male-biased sex ratios were prominent among third and higher-order births, for which the highest SSR was 1.46 in 1998. Higher birth order was significantly associated with an excess of male births in phases I-VI (≥third vs. first, OR range, 1.03 to 1.35). Advanced maternal age was significantly associated with an excess of female births in phases II, III, and V (≥40 vs. 20-24 years, OR range, 0.92 to 0.95).
Conclusions
This study demonstrated that advanced maternal age and reduction of the artificially-biased SSR among third and higher-order births may partially explain the decreasing trend in the SSR from 1997 to 2017 in Korea.
Summary
Brief Report
Life Expectancy and Inequalities Therein by Income From 2016 to 2018 Across the 253 Electoral Constituencies of the National Assembly of the Korea
Jinwook Bahk, Hee-Yeon Kang, Young-Ho Khang
J Prev Med Public Health. 2020;53(2):143-148.   Published online March 5, 2020
DOI: https://doi.org/10.3961/jpmph.20.050
  • 6,871 View
  • 155 Download
  • 3 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
We calculated life expectancy and inequalities therein by income for the period of 2016-2018 across the 253 electoral constituencies of the 20th National Assembly election in Korea.
Methods
We obtained population and death data between 2016 and 2018 from the National Health Information Database and constructed abridged life tables using standard life table procedures according to gender and income quintiles for the electoral constituencies of the 20th National Assembly election held in 2016.
Results
Life expectancy across the 253 constituencies ranged from 80.51 years to 87.05 years, corresponding to a gap of 6.54 years. The life expectancy difference by income across the 253 constituencies ranged from 2.94 years to 10.67 years. In each province, the difference in life expectancy by income across electoral constituencies was generally greater than the inter-constituency differences. Constituencies in capital and metropolitan areas showed a higher life expectancy and a lower life expectancy difference by income than constituencies in rural areas.
Conclusions
Pro-rich inequalities in life expectancy by income existed in every electoral constituency in Korea. Both intra-constituency and inter-constituency socioeconomic inequalities in health should be highlighted in future policy-making in the National Assembly.
Summary
Korean summary
이 연구는 2016년 치뤄진 제20대 국회의원 선거구 253개에서 2016-2018년의 기대수명을 산출하고, 소득 상위 20%와 소득 하위 20% 간 기대수명 격차를 제시하였다. 연구 결과, 253개 모든 선거구에서 소득 상위 20%가 소득 하위 20%보다 기대수명이 높게 나타났으며, 선거구 내의 소득에 따른 기대수명 격차가 선거구들 간의 기대수명 차이보다 더 큰 경향을 보였다. 기대수명의 선거구 간 격차를 줄이고, 선거구 내의 소득 계층 간 기대수명 격차를 해소하기 위한 입법적 조치를 마련하는 데에 이 연구의 결과가 근거자료로 유용하게 사용되기를 기대한다.

Citations

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  • Spatio-temporal Analysis of District-level Life Expectancy from 2004 to 2017 in Korea
    Hwa-Kyung Lim, Hee-Yeon Kang, Ikhan Kim, Young-Ho Khang
    Journal of Korean Medical Science.2021;[Epub]     CrossRef
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    Eunjeong Noh, Hee-Yeon Kang, Jinwook Bahk, Ikhan Kim, Young-Ho Khang
    Journal of Korean Medical Science.2021;[Epub]     CrossRef
  • Income-Related Mortality Inequalities and Its Social Factors among Middle-Aged and Older Adults at the District Level in Aging Seoul: An Ecological Study Using Administrative Big Data
    Minhye Kim, Suzin You, Jong-sung You, Seung-Yun Kim, Jong Heon Park
    International Journal of Environmental Research and Public Health.2021; 19(1): 383.     CrossRef
Review
Measurement of Socioeconomic Position in Research on Cardiovascular Health Disparities in Korea: A Systematic Review
Chi-Young Lee, Yong-Hwan Lee
J Prev Med Public Health. 2019;52(5):281-291.   Published online August 14, 2019
DOI: https://doi.org/10.3961/jpmph.19.094
  • 10,780 View
  • 200 Download
  • 5 Crossref
AbstractAbstract PDF
Objectives
The validity of instruments measuring socioeconomic position (SEP) has been a major area of concern in research on cardiovascular health disparities. The purpose of this systematic review is to identify the current status of the methods used to measure SEP in research on cardiovascular health disparities in Korea and to provide directions for future research.
Methods
Relevant articles were obtained through electronic database searches with manual searches of reference lists and no restriction on the date of publication. SEP indicators were categorized into compositional, contextual, composite, and life-course measures.
Results
Forty-eight studies published from 2003 to 2018 satisfied the review criteria. Studies utilizing compositional measures mainly relied on a limited number of SEP parameters. In addition, these measures hardly addressed the time-varying and subjective features of SEP. Finding valid contextual measures at the organizational, community, and societal levels that are appropriate to Korea’s context remains a challenge, and these are rarely modeled simultaneously. Studies have rarely focused on composite and life-course measures.
Conclusions
Future studies should develop and utilize valid compositional and contextual measures and appraise social patterns that vary across time, place, and culture using such measures. Studies should also consider multilevel influences, adding a focus on the interactions between different levels of intertwined SEP factors to advance the design of research. More attention should be given to composite and life-course measures.
Summary

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Original Articles
Measuring and decomposing socioeconomic inequality in catastrophic healthcare expenditures in Iran
Satar Rezaei, Mohammad Hajizadeh
J Prev Med Public Health. 2019;52(4):214-223.   Published online June 14, 2019
DOI: https://doi.org/10.3961/jpmph.19.046
  • 10,719 View
  • 229 Download
  • 22 Crossref
AbstractAbstract PDF
Objectives
Equity in financial protection against healthcare expenditures is one the primary functions of health systems worldwide. This study aimed to quantify socioeconomic inequality in facing catastrophic healthcare expenditures (CHE) and to identify the main factors contributing to socioeconomic inequality in CHE in Iran.
Methods
A total of 37 860 households were drawn from the Households Income and Expenditure Survey, conducted by the Statistical Center of Iran in 2017. The prevalence of CHE was measured using a cut-off of spending at least 40% of the capacity to pay on healthcare services. The concentration curve and concentration index (C) were used to illustrate and measure the extent of socioeconomic inequality in CHE among Iranian households. The C was decomposed to identify the main factors explaining the observed socioeconomic inequality in CHE in Iran.
Results
The prevalence of CHE among Iranian households in 2017 was 5.26% (95% confidence interval [CI], 5.04 to 5.49). The value of C was -0.17 (95% CI, -0.19 to -0.13), suggesting that CHE was mainly concentrated among socioeconomically disadvantaged households in Iran. The decomposition analysis highlighted the household wealth index as explaining 71.7% of the concentration of CHE among the poor in Iran.
Conclusions
This study revealed that CHE is disproportionately concentrated among poor households in Iran. Health policies to reduce socioeconomic inequality in facing CHE in Iran should focus on socioeconomically disadvantaged households.
Summary

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    Abdoreza mousavi, Farhad lotfi, Samira Alipour, Aliakbar Fazaeli, Mohsen Bayati
    Journal of Preventive Medicine and Public Health.2024; 57(1): 65.     CrossRef
  • Household financial burden associated with out-of-pocket payments for healthcare in Iran: insights from a cross-sectional survey
    Satar Rezaei, Maryam Karimi, Shahin Soltani, Eshagh Barfar, Mohammad Ali Mohammadi Gharehghani, Abbas Badakhshan, Nasim Badiee, Mohsen Pakdaman, Heather Brown
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    Yongjian Xu, Yiting Zhou, Andi Pramono, Yazhuo Liu, Cong Jia
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  • Decomposition of Socioeconomic Inequality in Cardiovascular Disease Prevalence in the Adult Population: A Cohort-based Cross-sectional Study in Northwest Iran
    Farhad Pourfarzi, Telma Zahirian Moghadam, Hamed Zandian
    Journal of Preventive Medicine and Public Health.2022; 55(3): 297.     CrossRef
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    International Journal of Human Rights in Healthcare.2021; 14(5): 426.     CrossRef
  • The impact of out-of pocket payments of households for dental healthcare services on catastrophic healthcare expenditure in Iran
    Abraha Woldemichael, Satar Rezaei, Ali Kazemi Karyani, Mohammad Ebrahimi, Shahin Soltani, Abbas Aghaei
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    Akram Hernández-Vásquez, Carlos Rojas-Roque, Rodrigo Vargas-Fernández, Diego Rosselli
    Journal of Preventive Medicine and Public Health.2020; 53(4): 266.     CrossRef

  • Incidence and Intensity of Catastrophic Health-care Expenditure for Type 2 Diabetes Mellitus Care in Iran: Determinants and Inequality


    Bakhtiar Piroozi, Amjad Mohamadi-Bolbanabad, Ghobad Moradi, Hossein Safari, Shahnaz Ghafoori, Yadolah Zarezade, Farzam Bidarpour, Satar Rezaei
    Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy.2020; Volume 13: 2865.     CrossRef
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    Satar Rezaei, Abraha Woldemichael, Mohammad Ebrahimi, Sina Ahmadi
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    ClinicoEconomics and Outcomes Research.2020; Volume 12: 761.     CrossRef
Trends in Inequality in Cigarette Smoking Prevalence by Income According to Recent Anti-smoking Policies in Korea: Use of Three National Surveys
Youngs Chang, Sanghyun Cho, Ikhan Kim, Jinwook Bahk, Young-Ho Khang
J Prev Med Public Health. 2018;51(6):310-319.   Published online October 30, 2018
DOI: https://doi.org/10.3961/jpmph.18.225
  • 10,781 View
  • 167 Download
  • 10 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
This study examined trends in inequality in cigarette smoking prevalence by income according to recent anti-smoking policies in Korea.
Methods
The data used in this study were drawn from three nationally representative surveys, the Korea National Health and Nutrition Examination Survey, the Korea Community Health Survey, and the Social Survey of Statistics Korea. We calculated the age-standardized smoking prevalence, the slope index of inequality, and the relative index of inequality by income level as a socioeconomic position indicator.
Results
Smoking prevalence among men decreased during the study period, but the downward trend became especially pronounced in 2015, when the tobacco price was substantially increased. Inequalities in cigarette smoking by income were evident in both genders over the study period in all three national surveys examined. Absolute inequality tended to decrease between 2014 and 2015 among men. Absolute and relative inequality by income decreased between 2008 and 2016 in women aged 30-59, except between 2014 and 2015.
Conclusions
The recent anti-smoking policies in Korea resulted in a downward trend in smoking prevalence among men, but not in relative inequality, throughout the study period. Absolute inequality decreased over the study period among men aged 30-59. A more aggressive tax policy is warranted to further reduce socioeconomic inequalities in smoking in young adults in Korea.
Summary

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Measuring and Decomposing Socioeconomic Inequalities in Adult Obesity in Western Iran
Farid Najafi, Yahya Pasdar, Behrooz Hamzeh, Satar Rezaei, Mehdi Moradi Nazar, Moslem Soofi
J Prev Med Public Health. 2018;51(6):289-297.   Published online October 29, 2018
DOI: https://doi.org/10.3961/jpmph.18.062
  • 10,094 View
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  • 19 Crossref
AbstractAbstract PDF
Objectives
Obesity is a considerable and growing public health concern worldwide. The present study aimed to quantify socioeconomic inequalities in adult obesity in western Iran.
Methods
A total of 10 086 participants, aged 35-65 years, from the Ravansar Non-communicable Disease Cohort Study (2014-2016) were included in the study to examine socioeconomic inequalities in obesity. We defined obesity as a body mass index ≥30 kg/m2 . The concentration index and concentration curve were used to illustrate and measure wealth-related inequality in obesity. Additionally, we decomposed the concentration index to identify factors that explained wealth-related inequality in obesity.
Results
Overall, the prevalence of obesity in the total sample was 26.7%. The concentration index of obesity was 0.04; indicating that obesity was more concentrated among the rich (p<0.001). Decomposition analysis indicated that wealth, place of residence, and marital status were the main contributors to the observed inequality in obesity.
Conclusions
Socioeconomic-related inequalities in obesity among adults warrant more attention. Policies should be designed to reduce both the prevalence of obesity and inequalities in obesity by focusing on those with higher socioeconomic status, urban residents, and married individuals.
Summary

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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
  • 9,720 View
  • 213 Download
  • 6 Crossref
AbstractAbstract 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

Citations

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Factors Associated With Subjective Life Expectancy: Comparison With Actuarial Life Expectancy
Jaekyoung Bae, Yeon-Yong Kim, Jin-Seok Lee
J Prev Med Public Health. 2017;50(4):240-250.   Published online June 27, 2017
DOI: https://doi.org/10.3961/jpmph.17.036
  • 12,031 View
  • 179 Download
  • 19 Crossref
AbstractAbstract PDF
Objectives
Subjective life expectancy (SLE) has been found to show a significant association with mortality. In this study, we aimed to investigate the major factors affecting SLE. We also examined whether any differences existed between SLE and actuarial life expectancy (LE) in Korea. Methods: A cross-sectional survey of 1000 individuals in Korea aged 20-59 was conducted. Participants were asked about SLE via a self-reported questionnaire. LE from the National Health Insurance database in Korea was used to evaluate differences between SLE and actuarial LE. Age-adjusted least-squares means, correlations, and regression analyses were used to test the relationship of SLE with four categories of predictors: demographic factors, socioeconomic factors, health behaviors, and psychosocial factors. Results: Among the 1000 participants, women (mean SLE, 83.43 years; 95% confidence interval, 82.41 to 84.46 years; 48% of the total sample) had an expected LE 1.59 years longer than that of men. The socioeconomic factors of household income and housing arrangements were related to SLE. Among the health behaviors, smoking status, alcohol status, and physical activity were associated with SLE. Among the psychosocial factors, stress, self-rated health, and social connectedness were related to SLE. SLE had a positive correlation with actuarial estimates (r=0.61, p<0.001). Gender, household income, history of smoking, and distress were related to the presence of a gap between SLE and actuarial LE. Conclusions: Demographic factors, socioeconomic factors, health behaviors, and psychosocial factors showed significant associations with SLE, in the expected directions. Further studies are needed to determine the reasons for these results.
Summary

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Socioeconomic Inequality in Malnutrition in Under-5 Children in Iran: Evidence From the Multiple Indicator Demographic and Health Survey, 2010
Abdollah Almasian Kia, Aziz Rezapour, Ardeshir Khosravi, Vajiheh Afzali Abarghouei
J Prev Med Public Health. 2017;50(3):201-209.   Published online May 10, 2017
DOI: https://doi.org/10.3961/jpmph.17.028
  • 11,685 View
  • 290 Download
  • 18 Crossref
AbstractAbstract PDF
Objectives
The aim of this study was to assess the socioeconomic inequality in malnutrition in under-5 children in Iran in order to help policymakers reduce such inequality.
Methods
Data on 8443 under-5 children were extracted from the Iran Multiple Indicator Demographic and Health Survey. The wealth index was used as proxy for socioeconomic status. Socioeconomic inequality in stunting, underweight, and wasting was calculated using the concentration index. The concentration index was calculated for the whole sample, as well as for subcategories defined in terms of categories such as area of residence (urban and rural) and the sex of children.
Results
Stunting was observed to be more prevalent than underweight or wasting. The results of the concentration index at the national level, as well as in rural and urban areas and in terms of children’s sex, showed that inequality in stunting and underweight was statistically significant and that children in the lower quintiles were more malnourished. The wasting index was not sensitive to socioeconomic status, and its concentration index value was not statistically significant.
Conclusions
This study showed that it can be misleading to assess the mean levels of malnutrition at the national level without knowledge of the distribution of malnutrition among socioeconomic groups. Significant socioeconomic inequalities in stunting and underweight were observed at the national level and in both urban and rural areas. Regarding the influence of nutrition on the health and economic well-being of preschool-aged children, it is necessary for the government to focus on taking targeted measures to reduce malnutrition and to focus on poorer groups within society who bear a greater burden of malnutrition.
Summary

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    Maryam Sadat Kasaii, Sara Rodrigues, Morteza Abdollahi, Anahita Houshiar-Rad, Julian Perelman
    Nutrients.2025; 17(10): 1631.     CrossRef
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Associations Between Preschool Education Experiences and Adulthood Self-rated Health
Jeehye Lee, Jinwook Bahk, Young-Ho Khang
J Prev Med Public Health. 2017;50(4):228-239.   Published online May 10, 2017
DOI: https://doi.org/10.3961/jpmph.16.110
  • 10,068 View
  • 211 Download
  • 1 Crossref
AbstractAbstract PDFSupplementary Material
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.
Summary

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  • Self-rated health and its determinants in patients with hypertension in Isfahan in 2019
    Asieh Mansouri, Alireza Khosravi Farsani, Noushin Mohammadifard, Fatemeh Nouri, Mahnaz Jozan, Ghazaal Alavi Tabatabaei, Rezvan Salehidoost, Hamed Rafiee
    BMC Public Health.2024;[Epub]     CrossRef
Income Differences in Smoking Prevalences in 245 Districts of South Korea: Patterns by Area Deprivation and Urbanity, 2008-2014
Ikhan Kim, Jinwook Bahk, Tae-Ho Yoon, Sung-Cheol Yun, Young-Ho Khang
J Prev Med Public Health. 2017;50(2):100-126.   Published online February 9, 2017
DOI: https://doi.org/10.3961/jpmph.16.069
  • 17,873 View
  • 326 Download
  • 23 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
The aim of this study was to measure income differences in smoking prevalence at the district level and to investigate correlations among area deprivation, smoking prevalence, and income differences in smoking prevalence, stratified by urbanity.
Methods
Data were pooled from the Community Health Survey data of South Korea between 2008 and 2014. The age-standardized prevalence of smoking and its interquintile income differences were calculated. We conducted correlation analyses to investigate the association of the deprivation index with smoking prevalence and interquintile differences in smoking prevalence.
Results
Across 245 districts, the median prevalence of smoking in men was 45.9% (95% confidence interval [CI], 43.4 to 48.5%), with an interquartile range (IQR) of 4.6% points. In women, the median prevalence was 3.0% (95% CI, 2.4 to 3.6%) and IQR was 1.6% points. The median interquintile difference in smoking prevalence was 7.4% points (95% CI, 1.6 to 13.2% points) in men and 2.7% points (95% CI, 0.5 to 4.9% points) in women. The correlation coefficients for the association between the deprivation index and smoking prevalence was 0.58, 0.15, -0.22 in metropolitan, urban, and rural areas, respectively, among men, and 0.54, -0.33, -0.43 among women. No meaningful correlation was found between area deprivation and interquintile difference in smoking prevalence. The correlation between smoking prevalence and interquintile difference in smoking prevalence was more evident in women than in men.
Conclusions
This study provides evidence of geographical variations in smoking prevalence and interquintile difference in smoking prevalence. Neither smoking prevalence nor the deprivation index was closely correlated with interquintile income difference in smoking prevalence. Measuring inequalities in smoking prevalence is crucial to developing policies aimed at reducing inequalities in smoking.
Summary

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The Relationship of Socioeconomic and Behavioral Risk Factors With Trends of Overweight in Korea
Jin Hee Shin, Matthew E. Dupre, Truls Østbye, Gwen Murphy, Mina Silberberg
J Prev Med Public Health. 2015;48(6):310-318.   Published online November 17, 2015
DOI: https://doi.org/10.3961/jpmph.15.001
  • 11,316 View
  • 117 Download
  • 3 Crossref
AbstractAbstract PDF
Objectives
Previous studies have shown that overweight (including obesity) has increased significantly in Korea in recent decades. However, it remains unclear whether this change has been uniform among all Koreans and to what extent socioeconomic and behavioral factors have contributed to this increase.
Methods
Changes in overweight were estimated using data from the 1998, 2001, 2005, 2007-2009, and 2010-2012 Korea National Health and Nutrition Examination Survey (n=55 761).
Results
Overweight increased significantly among men but not among women between 1998 and 2012. Changes in socioeconomic and behavioral factors over the time period were not associated with overall trends for both men and women. However, we found significant differences in the prevalence of overweight relative to key risk factors. For men, overweight increased at a significantly greater rate among the non-exercising (predicted probability [PP] from 0.23 to 0.32] and high-calorie (PP from 0.18 to 0.37) groups compared to their active and lower-calorie counterparts, respectively. For women, overweight increased only among the non-exercising (PP from 0.27 to 0.28) and low-income (PP from 0.31 to 0.36) groups during this period.
Conclusions
These findings suggest that programs aimed at reducing overweight should target Korean men and women in specific socioeconomic and behavioral risk groups differentially.
Summary

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Association of Demographic and Socioeconomic Factors With Risk Factors for Chronic Kidney Disease
Tae Hyun Kim, Min-Jee Lee, Ki-Bong Yoo, Euna Han, Jae-Woo Choi
J Prev Med Public Health. 2015;48(3):170-177.   Published online May 15, 2015
DOI: https://doi.org/10.3961/jpmph.15.002
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AbstractAbstract PDF
Objectives
The goal of this study was to examine the association of various demographic and socioeconomic factors with risk factors for chronic kidney disease (CKD).
Methods
We used nationally representative pooled data from the Korea National Health and Nutrition Examination Survey (KNHANES), 2007–2013. We estimated the glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease equation. We defined CKD as a GFR <60 mL/min/1.73 m2, and 1304 of the 45 208 individuals included in the KNHANES were found to have CKD by this definition. The outcome variable was whether individual subjects adhered to the CKD prevention and management guidelines recommended by the Korea Centers for Disease Control and Prevention. The guidelines suggest that individuals maintain a normal weight, abstain from alcohol consumption and smoking, manage diabetes and hypertension, and engage in regular exercise in order to prevent and manage CKD.
Results
This study found that individuals with CKD were more likely to be obese and have hypertension or diabetes than individuals without CKD. In particular, male and less-educated CKD patients were less likely to adhere to the guidelines.
Conclusions
Although the prevalence of CKD, as indicated by the KNHANES data, decreased from 2007 to 2013, the prevalence of most risk factors associated with CKD fluctuated over the same time period. Since a variety of demographic and socioeconomic factors are related to the successful implementation of guidelines for preventing and managing CKD, individually tailored prevention activities should be developed.
Summary

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    Prabhakar Akurathi, Krishna Kishore Aligina, Udaragudi Prasada Rao, Panchumarthi Thanuja, Madhavi Pothukuchi, Nutakki Sridevi
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Socio-demographic Characteristics and Leading Causes of Death Among the Casualties of Meteorological Events Compared With All-cause Deaths in Korea, 2000-2011
Kyung Eun Lee, Hyung-Nam Myung, Wonwoong Na, Jae-Yeon Jang
J Prev Med Public Health. 2013;46(5):261-270.   Published online September 30, 2013
DOI: https://doi.org/10.3961/jpmph.2013.46.5.261
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AbstractAbstract PDF
Objectives

This study investigated the socio-demographic characteristics and medical causes of death among meteorological disaster casualties and compared them with deaths from all causes.

Methods

Based on the death data provided by the National Statistical Office from 2000 to 2011, the authors analyzed the gender, age, and region of 709 casualties whose external causes were recorded as natural events (X330-X389). Exact matching was applied to compare between deaths from meteorological disasters and all deaths.

Results

The total number of deaths for last 12 years was 2 728 505. After exact matching, 642 casualties of meteorological disasters were matched to 6815 all-cause deaths, which were defined as general deaths. The mean age of the meteorological disaster casualties was 51.56, which was lower than that of the general deaths by 17.02 (p<0.001). As for the gender ratio, 62.34% of the meteorological event casualties were male. While 54.09% of the matched all-cause deaths occurred at a medical institution, only 7.6% of casualties from meteorological events did. As for occupation, the rate of those working in agriculture, forestry, and fishery jobs was twice as high in the casualties from meteorological disasters as that in the general deaths (p<0.001). Meteorological disaster-related injuries like drowning were more prevalent in the casualties of meteorological events (57.48%). The rate of amputation and crushing injury in deaths from meteorological disasters was three times as high as in the general deaths.

Conclusions

The new information gained on the particular characteristics contributing to casualties from meteorological events will be useful for developing prevention policies.

Summary

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English Abstracts
Socioeconomic Inequity in Self-Rated Health Status and Contribution of Health Behavioral Factors in Korea.
Minkyung Kim, Woojin Chung, Seungji Lim, Soojin Yoon, Jakyoung Lee, Eunkyung Kim, Lanju Ko
J Prev Med Public Health. 2010;43(1):50-61.
DOI: https://doi.org/10.3961/jpmph.2010.43.1.50
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AbstractAbstract PDF
OBJECTIVES
The study is investigated socioeconomic variations in self-rated health status and contribution of health behavioral factors in Korea. METHODS: A nationally representative sample (2,800 men and 3,230 women aged 20-64 years) from the 2005 Korea National Health and Nutrition Surveys was analyzed using logistic regression. RESULTS: Self-rated health was lower among lower socioeconomic groups compared with higher socioeconomic groups, with gender being irrelevant. This association was attenuated when health behavioral and socio-demographic factors were adjusted. When each health behavioral factor was considered separately, mediators such as smoking in men, and stress or exercise in women explained a large part of the decreased socioeconomic health inequalities. CONCLUSIONS: In Korea, subjective health inequalities arise from different socioeconomic status, but this difference is decreased by health behavioral factors. Therefore, socioeconomic inequity in self-rated health status can be corrected more effectively by promotional health behaviors.
Summary

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Development of Composite Deprivation Index for Korea: The Correlation with Standardized Mortality Ratio.
Hosung Shin, Suehyung Lee, Jang Min Chu
J Prev Med Public Health. 2009;42(6):392-402.
DOI: https://doi.org/10.3961/jpmph.2009.42.6.392
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AbstractAbstract PDF
OBJECTIVES
The aims of this paper were to develop the composite deprivation index (CDI) for the sub-district (Eup-Myen-Dong) levels based on the theory of social exclusion and to explore the relationship between the CDI and the standardized mortality ratio (SMR). METHODS: The paper calculated the age adjusted SMR and we included five dimensions of social exclusion for CDI; unemployment, poverty, housing, labor and social network. The proxy variables of the five dimensions were the proportion of unemployed males, the percent of recipients receiving National Basic Livelihood Security Act benefits, the proportion of households under the minimum housing standard, the proportion of people with a low social class and the proportion of single-parent household. All the variables were standardized using geometric transformation and then we summed up them for a single index. The paper utilized the 2004-2006 National Death Registry data, the 2003-2006 national residents' registration data, the 2005 Population Census data and the 2005-2006 means-tested benefit recipients' data. RESULTS: The figures were 115.6, 105.8 and 105.1 for the CDI of metropolitan areas (big cities), middle size cities and rural areas, respectively. The distributional variation of the CDI was the highest in metropolitan areas (8.9 - 353.7) and the lowest was in the rural areas (26.8 - 209.7). The extent and relative differences of deprivation increased with urbanization. Compared to the Townsend and Carstairs index, the CDI better represented the characteristics of rural deprivation. The correlation with the SMR was statistically significant and the direction of the CDI effects on the SMR was in accordance with that of the previous studies. CONCLUSIONS: The study findings indicated mortality inequalities due to the difference in the CDI. Despite the attempt to improve deprivation measures, further research is warranted for the consensus development of a deprivation index.
Summary

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Association between the Physical Activity of Korean Adolescents and Socioeconomic Status.
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DOI: https://doi.org/10.3961/jpmph.2009.42.5.305
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AbstractAbstract PDF
OBJECTIVES
The physical activity of Korean adolescents and its distribution based on social characteristics have not yet been fully assessed. This study intends to reveal the distribution of physical activity by its subgroups and offer possible explanatory variables. METHODS: The 3rd Korea Youth Risk Behavior Web-based Survey was analyzed for this study. The appropriateness of physical activity was defined by Korea's Health Plan 2010 and physical inactivity was assessed independently. Family affluence scale, parents' education levels, subjective economic status, grade, and school location were considered explanatory variables. All statistical analysis was conducted using SAS ver. 9.1. RESULTS: The proportion of participants engaging in vigorous physical activity was high in males (41.6%), at a low grade (38.5%), within the high family affluence scale group (35.5%). The distribution of participants engaging in moderate physical activity showed similar patterns, but the overall proportion was lower (9.8%). Low family affluence and students with lower subjective economic status reported a higher prevalence of physical inactivity. In multiple logistic regression analysis for physical activity, significant factors included family affluence scale (p<0.05). For physical inactivity, family affluence scale, parents education levels, and subjective economic status were included as significant factors (p<0.05). CONCLUSIONS: The results suggest that the physical activity and inactivity of adolescents may be affected by socioeconomic variables, such as family affluence scale. This implies the need to take proper measures to address these socio-economic inequalities.
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The Impact of Socioeconomic Factors on the Gender Differences of Disability and Subjective Health Among Elderly Koreans.
Gyeong Suk Jeon, Soong Nang Jang, Seon Ja Rhee
J Prev Med Public Health. 2009;42(3):199-207.
DOI: https://doi.org/10.3961/jpmph.2009.42.3.199
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AbstractAbstract PDF
OBJECTIVES
Research on the gender differences of health among older Korean people has been limited compared with the research for other stages of life. This study first examined the patterns and magnitude of the gender differences of health in later life. Second, we examined the gender differences in the health of older men and women that were attributable to differing socioeconomic conditions. METHODS: Using the nationally representative 2005 Korean National Health and Nutrition Examination Survey, the gender differences in disability and subjective poor health were assessed by calculating the age adjusted and gender-specific prevalence. Logistic regression analyses were used to assess if the differences between the men and women for health could be explained by differential exposure to socioeconomic factors and/or the differential vulnerability of men and women to these socioeconomic factors. RESULTS: Our results indicated that older women were more likely than the men to report disability and poor subjective health. The health disadvantage of older women was diminished by differential experiences with socioeconomic factors, and especially education. The differences shrink as much as 43.7% in the case of disability and 35.4% in the case of poor subjective health by the differential exposure to educational attainment. Any differential vulnerability to socioeconomic factors was not found between the men and women, which means that socioeconomic factors may have similar effect on health in both genders. CONCLUSIONS: Differential socioeconomic experience and exposure between the men and women might cause gender difference in health in old age Koreans.
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    Hwajun Kim, Young Ko
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The Determinants of the Use of Opportunistic Screening Programs in Korea.
Sungwook Kang, Chang Hoon You, Young Dae Kwon
J Prev Med Public Health. 2009;42(3):177-182.
DOI: https://doi.org/10.3961/jpmph.2009.42.3.177
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AbstractAbstract PDF
OBJECTIVES
Both organized and opportunistic screening programs have been widely used in Korea. This paper examined the determinants of the use of opportunistic screening programs in Korea. METHODS: The subjects were a national stratified random sample of 10,254 people aged 45 or older from the first wave of the Korean Longitudinal Study of Ageing in 2006. A logit model was used to examine the determinants of the use of opportunistic screening programs in terms of the demographic and socioeconomic characteristics, the type of health insurance and the health status. RESULTS: Thirteen point seven percent of the individuals received opportunistic screening programs within 2 years from the time the survey was conducted in 2006. The individuals who graduated from college or who had even more education were 3.0 times more likely to use opportunistic screening programs compared with the individuals who were illiterate. The individuals who resided in urban areas and who had religious beliefs were more likely to receive opportunistic screening programs compared with their counterparts. Those who were in the first quartile for the total household assets were 2.6 times more likely to use opportunistic screening programs than those who were in the fourth quartile for the total household assets. Privately insured people were 1.6 times more likely to use opportunistic screening programs than those who were not insured. Finally, the individuals who self-assessed their health status as worst were 2.1 times more likely to use opportunistic screening programs compared individuals who self-assessed their health status as best. CONCLUSIONS: This study suggests that opportunistic screening programs can be an indicator for whether or not an individual is among the advantaged group in terms of their socioeconomic characteristics and type of health insurance.
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    So Yoon Park, Young-jeon Shin
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Trends in Sex Ratio at Birth according to Parental Social Positions: Results from Vital Statistics Birth, 1981-2004 in Korea.
Heeran Chun, Il Ho Kim, Young Ho Khang
J Prev Med Public Health. 2009;42(2):143-150.
DOI: https://doi.org/10.3961/jpmph.2009.42.2.143
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AbstractAbstract PDF
OBJECTIVES
South Korea has experienced unprecedented ups and downs in the sex ratio at birth (SRB), which has been a unique phenomenon in the last two decades. However, little is known about socioeconomic factors that influence the SRB. Employing the diffusion theory by Rogers, this study was undertaken to examine the trends in social variations in the SRB from 1981 to 2004 in Korea. METHODS: The data was taken from Vital Birth Statistics for the period from 1981-2004. We computed the annual male proportion of live births according to the parental education (university, middle/high school, primary) and occupation (non-manual, manual, others). Logistic regression analysis was employed to estimate the odds ratios of male birth according to social position for the equidistant three time periods (1981-1984, 1991-1994, and 2001-2004). RESULTS: An increased SRB was detected among parents with higher social position before the mid 1980s. Since then, however, a greater SRB was found for the less educated and manual jobholders. The inverse social gradient for the SRB was most prominent in early 1990s, but the gap has narrowed since the late 1990s. The mother's socioeconomic position could be a sensitive indicator of the social variations in the sex ratio at birth. CONCLUSIONS: Changes in the relationship of parental social position with the SRB were detected during the 1980-2004 in Korea. This Korean experience may well be explained by diffusion theory, suggesting there have been socioeconomic differences in the adoption and spread of sex-detection technology.
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Review
A Review on Socioeconomic Position Indicators in Health Inequality Research.
Yong Jun Choi, Baek Geun Jeong, Sung Il Cho, Kyunghee Jung-Choi, Soong Nang Jang, Minah Kang, Young Ho Khang
J Prev Med Public Health. 2007;40(6):475-486.
DOI: https://doi.org/10.3961/jpmph.2007.40.6.475
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AbstractAbstract PDF
OBJECTIVES
Socioeconomic position (SEP) refers to the socioeconomic factors that influence which position an individual or group of people will hold within the structure of a society. In this study, we provide a comprehensive review of various indicators of SEP, including education level, occupation-based SEP, income and wealth, area SEP, lifecourse SEP, and SEP indicators for women, elderly and youth. METHODS AND RESULTS: This report provides a brief theoretical background and discusses the measurement, interpretation issues, advantages and limitations associated with the use of each SEP indicator. We also describe some problems that arise when selecting SEP indicators and highlight the indicators that appear to be appropriate for health inequality research. Some practical information for use in health inequality research in South Korea is also presented. CONCLUSIONS: Investigation into the associations between various SEP indicators and health outcomes can provide a more complete understanding of mechanisms between SEP and health. The relationship between specific SEP indicators and specific health outcomes can vary by country due to the differences in the historical, socioeconomic, and cultural contexts of the SEP indicators.
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English Abstract
The Proposal of Policies Aimed at Tackling Health Inequalities in Korea.
Tae Ho Yoon
J Prev Med Public Health. 2007;40(6):447-453.
DOI: https://doi.org/10.3961/jpmph.2007.40.6.447
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AbstractAbstract PDF
Although the New National Health Promotion Plan 2010 target to reduce health inequalities, whether the program will be effective for reducing the health inequalities in Korea remains quite unclear. More and more developed countries have been started to concentrate on comprehensive policies for reducing health inequalities. The health policies of the UK, Netherlands, and Sweden are the most wellknown. I propose that a comprehensive blueprint for tackling health inequalities in Korea should be made and that it must contain five domains: a target, structure and process, life-course approach, area-based approach, and reorganization of health care resources. The target should be based on determinants of health and more attention should be paid to socioeconmic factors. The structure and process require changes from the national health care policy based on medical services to the national health policy that involves the establishment of a Social Deputy Prime Minister and the strengthening multidisciplinary action. A life-course approach especially focused on the early childhood years. Area-based approach such as the establishment of healthy communities, healthy schools, or healthy work-places which are focused on deprived areas or places is also required. Finally, health care resources should be a greater investment on public resources and strengthening primary care to reduce health inequalities. The policy or intervention studies for tackling health inequalities should be implemented much more in Korea. In addition, it is essential to have political will to encoruage policy action.
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Historical Article
Historical Advances in Health Inequality Research.
Young Ho Khang
J Prev Med Public Health. 2007;40(6):422-430.
DOI: https://doi.org/10.3961/jpmph.2007.40.6.422
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AbstractAbstract PDF
The socioeconomic inequalities in health have recently become an important public health concern in South Korea, and the issue has gained increasing attention from many South Korean researchers due to the increasing income inequality and widening social polarization following its economic crisis in the late 1990s. However, despite the mounting literature on health inequalities published in recent years, the history of research on health inequality in South Korea is premature in comparison to the long histories in several Western countries. Understanding the historical background underlying the issue of health inequality research may aid in establishing and accumulating scientifically solid evidence in South Korea. It may also direct the South Korean research community to develop research agendas that are more politically and academically appropriate for South Korean society. This paper describes the historical development of health inequality research in the West and introduces several important issues contributing to the advancement of health inequality research. Specifically, the major studies conducted before and after the UK Black Report are presented. In addition, the history and current status of health inequality research in South Korea are documented and evaluated. Finally, several research agendas for the quantitative and qualitative improvement of health inequality research in South Korea are proposed.
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English Abstracts
Socioeconomic Inequalities in Preventive Services among the Elderly: Results from Medical Checkup, Cancer Check, and BP Check.
Heeran Chun, Il Ho Kim
J Prev Med Public Health. 2007;40(5):404-410.
DOI: https://doi.org/10.3961/jpmph.2007.40.5.404
  • 6,063 View
  • 53 Download
  • 11 Crossref
AbstractAbstract PDF
OBJECTIVES
Due to the assumptions of homogeneity as well as challenges in the socioeconomic position of the elderly, they have been relatively neglected in studies of health inequalities. Therefore, this study was conducted to investigate the social inequalities in preventive services among elderly men and women. METHODS: Data were obtained from a nationally representative sample of 342 men and 525 women aged 65 and over collected during the 2001 National Health and Nutrition Examination Survey. Age adjusted proportions and logistic regression were used to identify the social patterning of preventive services among elderly Koreans using various social position indicators. RESULTS: The findings of this study generally supported the presence of social gradients in preventive services among the Korean elderly. The likelihood of using the service becomes progressively higher with social position. Educational level, income, and self-rated living status were significantly associated with increased medical checkups and cancer checks. In addition, logistic regression detected educational inequalities only among older women receiving BP checks. After being stratified based on health status and chronic disease status, social disparities still existed when educational level and self-rated living status were considered. Among unhealthy individuals, place of residence was observed as a barrier to medical checkups. CONCLUSIONS: This study demonstrated strong and consistent associations between socioeconomic position and preventive services among the elderly in Korea. The results indicate that public health strategies should be developed to reduce the barriers to preventive services encountered by the elderly.
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    Esther Priscilla Biamah Danquah, Samuel Agyei Agyemang, Samuel Amon, Moses Aikins
    International Journal of Health Promotion and Education.2020; 58(6): 320.     CrossRef
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    Hee-Jung Kim, Mi-jin Yu
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    J.H. Park, K.S. Lee
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    Kyung-Hyun Choi, Jeongyun Heo, Soyeun Kim, Young-Jee Jeon, Myungju Oh
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    Liang En Wee, Gerald Choon-Huat Koh
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    Ryoung Choi, Byung-Deog Hwang
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    Lisiane Manganelli Girardi Paskulin, Daiany Borghetti Valer, Lucila Amaral Carneiro Vianna
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Differential Effects of Family Income on Self-rated Health by Age: Analysis of Seoul Citizens Health Indicators Survey 2001, 2005.
Youn Jung, Youngtae Cho, Juhwan Oh
J Prev Med Public Health. 2007;40(5):381-387.
DOI: https://doi.org/10.3961/jpmph.2007.40.5.381
  • 5,973 View
  • 38 Download
  • 8 Crossref
AbstractAbstract PDF
OBJECTIVES
This study was conducted in order to determine how the association between socioeconomic position(SEP) and health status changes with age among Seoul residents aged 25 and over. METHODS: We utilized the 2001 and 2005 Seoul Citizens Health Indicators Surveys. We used self-rated 'poor' health status as an outcome variable, and family income as an indicator of SEP. In order to characterize the differential effects of socioeconomic position on health by age, we conducted separate multivariate analyses by 10-year age groups, controlling for sociodemographic covariates. In order to assess the relative health inequality across socioeconomic groups, we estimated the Relative Index of Inequality (RII). RESULTS: The risk of 'poor health' is significantly high in low family income groups, and this increased risk is seen at all ages. However, the magnitude of relative socioeconomic inequality in health, as measured by the odds ratio and RII, is not identical across age groups. The difference in health across income groups is small in early adulthood (ages 25-34), but increases with age until relatively late in life (ages 35-64). It then decreases among the elderly population (ages more than 65). When the RII reported in 2005 is compared to that reported in 2001, RII can be seen to have increased across all ages, with the exception of individuals aged 25-34. CONCLUSIONS: The magnitude of health inequality is the greatest during mid- to late adulthood (ages 45-64). In addition, health inequalities have worsened between 2001 and 2005 across all age groups after economic crisis.
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Disparities in Participation in Health Examination by Socio-economic Position among Adult Seoul Residents.
Eun Jeong Chun, Soong Nang Jang, Sung Il Cho, Youngtae Cho, Ok Ryun Moon
J Prev Med Public Health. 2007;40(5):345-350.
DOI: https://doi.org/10.3961/jpmph.2007.40.5.345
  • 6,662 View
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AbstractAbstract PDF
OBJECTIVES
To determine the disparity in the rate people undergo health examinations according to socioeconomic position (SEP) and the changes in this disparity with time. METHODS: Seoul citizens}health profile data from 1997 to 2005 were analyzed. The study subjects were 40 years old and over, and the total number of subjects was 6,601 in 1997, 8,994 in 2001, and 8,819 in 2005. Those aged 60 years and over were eliminated from the analysis of subjects}occupation. We used education, family income and occupation as indicators of SEP. The age-standardized health examination attendance rate for each year was calculated according to the education, family income and occupation. The odds ratios (ORs) from multiple logistic regressions were adjusted for age. RESULTS: The disparity in the rate of attendance according to the SEP decreased from 1997 to 2005 but still existed. Even though the disparities among the subgroups according to education, family income and occupation were not that high, the disparity between the group with the highest SEP and the other groups was considerable. CONCLUSIONS: Our findings suggest that unequal access to health examination services according to socioeconomic position still exists. This disparity has decreased recently but the disparity according to level of education was the greatest.
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    Epidemiology and Health.2025; 47: e2025005.     CrossRef
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    Nayeon Kim, Hye-won Yun, Juwon Park, Fatima Nari, Hee Jin Wang, Jae Kwan Jun, Kui Son Choi, Mina Suh
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    Kwan-Sik Moon, Yang-Kyun Kim, Hye-Jung Chang
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    Minjee Lee, Eun-Cheol Park, Hoo-Sun Chang, Jeoung A Kwon, Ki Bong Yoo, Tae Hyun Kim
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  • The Relationship between Trust in Healthcare System and Health Examination Participation
    Baek-Geun Jeong, In-Kyoung Hwang, Hae-Sook Sohn, Kwang-Wook Koh, Tae-Ho Yoon, Jeong-Hun Lim
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  • The Determinants of the Use of Opportunistic Screening Programs in Korea
    Sungwook Kang, Chang Hoon You, Young Dae Kwon
    Journal of Preventive Medicine and Public Health.2009; 42(3): 177.     CrossRef
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    Chung Gun Lee, Youngtae Cho
    Journal of Preventive Medicine and Public Health.2009; 42(4): 215.     CrossRef
Study on the Relationship between Childhood Obesity and Various Determinants, including Socioeconomic Factors, in an Urban Area.
Hee Tae Kang, Young Su Ju, Kyung Hee Park, Young Jun Kwon, Hyoung June Im, Do Myung Paek, Hyun Joo Lee
J Prev Med Public Health. 2006;39(5):371-378.
  • 3,244 View
  • 125 Download
AbstractAbstract PDF
OBJECTIVES
This study was conducted to investigate the prevalence of childhood obesity, the association between the undesirable lifestyles and socioeconomic factors, the association between childhood obesity and various risk factors, including socioeconomic factors, and the agreement between the body mass index (BMI) classification and the body fat percentage. METHODS: The study subjects were all the 5th grade students from all the elementary schools in Gunpo City, Kyunggi Province, South Korea (4043 children at 22 schools). The subjects were measured for their height, weight and percent body fat etc. and they were also surveyed by questionnaire from March 18th to April 25th, 2005. To determine whether the children were within normal limits or not, standardized BMIs for each age group were used. The data was analyzed by logistic regression analysis using SAS 9.0 version. RESULTS: The prevalence of childhood obesity prevalence was 25.1%. Boys had a higher prevalence of obesity (27.5%) than did the girls (22.5%). Children had tendencies of having undesirable lifestyles and getting obese if they had a lower socioeconomic status. The risk factors for childhood obesity were low paternal education (OR: 1.17, 95% CI: 0.97-1.42) and non-parental caregivers (OR : 1.34, 95% CI: 0.98-1.82). Other risk factors for childhood obesity were a high birth-weight, longer TV/computer-using time, a lower fruit-eating frequency, short sleeping hours and parental obesity. The agreement rate between the BMI classification and the body fat percentage was 93.1%. CONCLUSIONS: This study showed the children had a higher prevalence of obesity: further, not only individual lifestyles, but also socioeconomic factors could influence childhood obesity. Childhood obesity was especially more problematic for children with a low socioeconomic status.
Summary
Health Behavior Factors Affecting Waist Circumference as an Indicator of Abdominal Obesity.
Kyung Won Paek, Yoon Mi Hong
J Prev Med Public Health. 2006;39(1):59-66.
  • 2,734 View
  • 84 Download
AbstractAbstract PDF
OBJECTIVES
This study was performed to identify the socioeconomic factors, the psychosocial factors and the heath behavior factors that have an influence on abdominal obesity, as measured by using the waist circumference. METHODS: Data was obtained from individuals aged above 20 years who had their waist circumference measured on the Korean National Health and Nutrition Examination Survey 2001, which was a cross-sectional health survey. RESULTS: Regression analysis of the factors that affect abdominal obesity showed that the education level, income, smoking, duration of smoking, drinking consumption, frequency of exercises and sleeping were the associated factors for abdominal obesity. For men, the duration of smoking, education level, income and drinking consumption were the associated factors for abdominal obesity. For woman, the education level, income, duration of smoking, drinking consumption and frequency of exercise were the associated factors for abdominal obesity. CONCLUSIONS: Abdominal obesity is a risk factor for morbidity and mortality, and it is associated with chronic diseases, including cardiovascular disease and diabetes. Based on the findings, it is essential to modify heath behaviors for preventing abdominal obesity, which is a condition associated with the incidence of chronic disease.
Summary
Lifecourse Approaches to Socioeconomic Health Inequalities.
Young Ho Khang
J Prev Med Public Health. 2005;38(3):267-275.
  • 3,080 View
  • 66 Download
AbstractAbstract PDF
Evidence on the relation of socioeconomic position (SEP) with health and illness is mounting in South Korea. Several unlinked studies and individually linked studies (longitudinal study) showed a graded inverse relationship between SEP and mortality among South Korean males and females. Based on the mortality relative ratios by occupational class reported in the published papers of South Korea and western countries, the magnitude of the socioeconomic inequality in mortality in South Korea seems to be similar to or even greater than that in western industrialized countries. A potential contribution of health related selection, health behaviors and psychosocial factors to explain this socioeconomic inequality in mortality was discussed. It was suggested that early life exposure measures would demonstrate a greater ability to explain socioeconomic inequalities in all-cause mortality than the above pathway variables in South Korea. This is based on the cause-specific structure of mortality among the South Korean population who have a relatively greater proportion of stomach cancer, hemorrhagic stroke, liver cancer and liver disease, and tuberculosis, which share early life exposures as important elements of their etiology, than western countries. However, the relative contribution of early and later life socioeconomic conditions in producing socioeconomic inequality in health may differ according to the outcome, thus remains to be investigated.
Summary
JPMPH : Journal of Preventive Medicine and Public Health
© Korean Society for Preventive Medicine.
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