Journal of Preventive Medicine and Public Health

Original Articles

Epidemiology of Suicide by Hanging in Fars Province, Iran (2011-2019): A Population-based Cross-sectional Study: Leila Moftakhar, Alireza Mirahmadizadeh, Sanaz Amiri, Fariba Rezaei, Habibollah Azarbakhsh; J Prev Med Public Health. 2023;56(3):264-271. Published online April 20, 2023; DOI: https://doi.org/10.3961/jpmph.22.519

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Objectives
Hanging is a common method of attempted suicide. This study investigated the epidemiological profile of attempted and completed suicides by hanging in southern Iran.
Methods
This cross-sectional study was performed on 1167 suicide attempts by hanging between 2011 and 2019. All data related to suicide attempts by hanging were collected from the Fars Suicide Surveillance System. The trends in suicide cases and the mean age of attempted and completed suicides were plotted. The chi-square test was used to identify suicide-related factors. Crude rates of incidence, mortality, and standardized fatality during the study period were calculated. Finally, logistic regression was used to identify the predictors of death in individuals who attempted suicide.
Results
The mean age of those who attempted suicide was 33.21±16.82 years; the majority were male (80.5%). The rate of attempted and completed suicide by hanging were 3.50 and 2.79 per 100 000 people, respectively. The case-fatality rate was calculated as 79.34%. The results of our study indicated an increasing trend in suicide attempts by hanging. The likelihood of death was 2.28 times higher in individuals with a previous history of suicide attempts and 1.85 times higher in those with a psychological disorder.
Conclusions
The findings of this study suggest an increasing trend in attempted and completed suicide by hanging, especially among individuals with a history of suicide attempts and psychological disorders. It is necessary to take action to reduce the rate of suicide attempts and identify the underlying causes of suicide attempts by hanging.

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Assessing the knot in a noose position by thyrohyoid and cervical spine fracture patterns in suicidal hangings using machine learning algorithms: A new insight into old dilemmas
Aleksa Leković, Arso Vukićević, Slobodan Nikolić
Forensic Science International.2024; 357: 111973. CrossRef

Spatio-temporal Distribution of Suicide Risk in Iran: A Bayesian Hierarchical Analysis of Repeated Cross-sectional Data: Seyed Saeed Hashemi Nazari, Kamyar Mansori, Hajar Nazari Kangavari, Ahmad Shojaei, Shahram Arsang-Jang; J Prev Med Public Health. 2022;55(2):164-172. Published online February 10, 2022; DOI: https://doi.org/10.3961/jpmph.21.385

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Abstract PDF Supplementary Material

Objectives
We aimed to estimate the space-time distribution of the risk of suicide mortality in Iran from 2006 to 2016.
Methods
In this repeated cross-sectional study, the age-standardized risk of suicide mortality from 2006 to 2016 was determined. To estimate the cumulative and temporal risk, the Besag, York, and Mollié and Bernardinelli models were used.
Results
The relative risk of suicide mortality was greater than 1 in 43.0% of Iran’s provinces (posterior probability >0.8; range, 0.46 to 3.93). The spatio-temporal model indicated a high risk of suicide in 36.7% of Iran’s provinces. In addition, significant upward temporal trends in suicide risk were observed in the provinces of Tehran, Fars, Kermanshah, and Gilan. A significantly decreasing pattern of risk was observed for men (β, -0.013; 95% credible interval [CrI], -0.010 to -0.007), and a stable pattern of risk was observed for women (β, -0.001; 95% CrI, -0.010 to 0.007). A decreasing pattern of suicide risk was observed for those aged 15-29 years (β, -0.006; 95% CrI, -0.010 to -0.0001) and 30-49 years (β, -0.001; 95% CrI, -0.018 to -0.002). The risk was stable for those aged >50 years.
Conclusions
The highest risk of suicide mortality was observed in Iran’s northwestern provinces and among Kurdish women. Although a low risk of suicide mortality was observed in the provinces of Tehran, Fars, and Gilan, the risk in these provinces is increasing rapidly compared to other regions.

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Spatial, geographic, and demographic factors associated with adolescent and youth suicide: a systematic review study
Masoud Ghadipasha, Ramin Talaie, Zohreh Mahmoodi, Salah Eddin Karimi, Mehdi Forouzesh, Masoud Morsalpour, Seyed Amirhosein Mahdavi, Seyed Shahram Mousavi, Shayesteh Ashrafiesfahani, Roya Kordrostami, Nahid Dadashzadehasl
Frontiers in Psychiatry.2024;[Epub] CrossRef

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

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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.

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Recent Trends in Blood Pressure According to Economic Status: Korean National Health and Nutrition Examination Survey From 2005 to 2015
Hyun-Young Shin, Hee-Taik Kang
Asia Pacific Journal of Public Health.2018; 30(3): 266. CrossRef
Recent trends in the prevalence of underweight, overweight, and obesity in Korean adults: The Korean National Health and Nutrition Examination Survey from 1998 to 2014
Hyun-Young Shin, Hee-Taik Kang
Journal of Epidemiology.2017; 27(9): 413. CrossRef

The Prevalence of Cardiovascular Disease Risk Factors and the Framingham Risk Score in Patients Undergoing Percutaneous Intervention Over the Last 17 Years by Gender: Time-trend Analysis From the Mayo Clinic PCI Registry: Moo-Sik Lee, Andreas J. Flammer, Hyun-Soo Kim, Jee-Young Hong, Jing Li, Ryan J. Lennon, Amir Lerman; J Prev Med Public Health. 2014;47(4):216-229. Published online July 31, 2014; DOI: https://doi.org/10.3961/jpmph.2014.47.4.216

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Abstract PDF

Objectives
This study aims to investigate trends of cardiovascular disease (CVD) risk factor profiles over 17 years in percutaneous coronary intervention (PCI) patients at the Mayo Clinic. Methods: We performed a time-trend analysis within the Mayo Clinic PCI Registry from 1994 to 2010. Results were the incidence and prevalence of CVD risk factors as estimate by the Framingham risk score. Results: Between 1994 and 2010, 25 519 patients underwent a PCI. During the time assessed, the mean age at PCI became older, but the gender distribution did not change. A significant trend towards higher body mass index and more prevalent hypercholesterolemia, hypertension, and diabetes was found over time. The prevalence of current smokers remained unchanged. The prevalence of ever-smokers decreased among males, but increased among females. However, overall CVD risk according to the Framingham risk score (FRS) and 10-year CVD risk significantly decreased. The use of most of medications elevated from 1994 to 2010, except for β-blockers and angiotensin converting enzyme inhibitors decreased after 2007 and 2006 in both baseline and discharge, respectively. Conclusions: Most of the major risk factors improved and the FRS and 10-year CVD risk declined in this population of PCI patients. However, obesity, history of hypercholesterolemia, hypertension, diabetes, and medication use increased substantially. Improvements to blood pressure and lipid profile management because of medication use may have influenced the positive trends.

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Special Article

Noncommunicable Diseases: Current Status of Major Modifiable Risk Factors in Korea: Hyeon Chang Kim, Sun Min Oh; J Prev Med Public Health. 2013;46(4):165-172. Published online July 31, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.4.165

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Abstract PDF

A noncommunicable disease (NCD) is a medical condition or disease that is by definition non-infectious and non-transmissible among people. Currently, NCDs are the leading causes of death and disease burden worldwide. The four main types of NCDs, including cardiovascular disease, cancer, chronic lung disease, and diabetes, result in more than 30 million deaths annually. To reduce the burden of NCDs on global health, current public health actions stress the importance of preventing, detecting, and correcting modifiable risk factors; controlling major modifiable risk factors has been shown to effectively reduce NCD mortality. The World Health Organization's World Health Report 2002 identified tobacco use, alcohol consumption, overweight, physical inactivity, high blood pressure, and high cholesterol as the most important risk factors for NCDs. Accordingly, the present report set out to review the prevalence and trends of these modifiable risk factors in the Korean population. Over the past few decades, we observed significant risk factor modifications of improved blood pressure control and decreased smoking rate. However, hypertension and cigarette smoking remained the most contributable factors of NCDs in the Korean population. Moreover, other major modifiable risk factors show no improvement or even worsened. The current status and trends in major modifiable risk factors reinforce the importance of prevention, detection, and treatment of risk factors in reducing the burden of NCDs on individuals and society.

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Original Article

Factors Related to Increasing Trends in Cigarette Smoking of Adolescent Males in Rural Areas of Korea: Nam Soo Hong, Sin Kam, Keon Yeop Kim; J Prev Med Public Health. 2013;46(3):139-146. Published online May 31, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.3.139

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Abstract PDF

Objectives

Cigarette smoking prevalence among adolescent males in rural areas of Korea has increased in recent years. The aim of this study was to explore the factors related to increasing trends in cigarette smoking among adolescent males living in rural areas.

Methods

The raw data from the Korea Youth Risk Behavior Web-based Survey from 2006 to 2009 were used. Data were analyzed by using the method of complex survey data analysis considering complex sampling design. Multiple logistic regression models were used to explore the factors affecting cigarette smoking. We evaluated the linear time trends in the prevalence of factors that were related to current smoking status and the linear time trends in cigarette smoking in groups stratified by the exposure to each factor using logistic regression models. Finally, we examined the contributions of the factors to the time trends in cigarette smoking by adjusting for each of those factors in the baseline regression models and changes in the adjusted odds ratio by survey year.

Results

A statistically significant increasing trend in smoking was observed after adjusting for the factors affecting cigarette smoking. Significant factors related to cigarette use were perceived stress, experience with depression, current alcohol drinking, exposure to secondhand smoke, and academic performance. The factor related to increasing trends in cigarette smoking was academic performance.

Conclusions

Stress about academic performance is an important factor affecting the increase in cigarette smoking among adolescent males in a rural area of Korea.

Summary

Citations

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Special Article

Global Trends in Mercury Management: Dae-Seon Kim, Kyunghee Choi; J Prev Med Public Health. 2012;45(6):364-373. Published online November 29, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.6.364

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Abstract PDF

The United Nations Environmental Program Governing Council has regulated mercury as a global pollutant since 2001 and has been preparing the mercury convention, which will have a strongly binding force through Global Mercury Assessment, Global Mercury Partnership Activities, and establishment of the Open-Ended Working Group on Mercury. The European Union maintains an inclusive strategy on risks and contamination of mercury, and has executed the Mercury Export Ban Act since December in 2010. The US Environmental Protection Agency established the Mercury Action Plan (1998) and the Mercury Roadmap (2006) and has proposed systematic mercury management methods to reduce the health risks posed by mercury exposure. Japan, which experienced Minamata disease, aims vigorously at perfection in mercury management in several ways. In Korea, the Ministry of Environment established the Comprehensive Plan and Countermeasures for Mercury Management to prepare for the mercury convention and to reduce risks of mercury to protect public health.

Summary

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Original Articles

Trends in Gender-based Health Inequality in a Transitional Society: A Historical Analysis of South Korea: Heeran Chun, Sung-Il Cho, Young-Ho Khang, Minah Kang, Il-Ho Kim; J Prev Med Public Health. 2012;45(2):113-121. Published online March 31, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.2.113

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Abstract PDF

Objectives

This study examined the trends in gender disparity in the self-rated health of people aged 25 to 64 in South Korea, a rapidly changing society, with specific attention to socio-structural inequality.

Methods

Representative sample data were obtained from six successive, nationwide Social Statistics Surveys of the Korean National Statistical Office performed during 1992 to 2010.

Results

The results showed a convergent trend in poor self-rated health between genders since 1992, with a sharper decline in gender disparity observed in younger adults (aged 25 to 44) than in older adults (aged 45 to 64). The diminishing gender gap seemed to be attributable to an increase in women's educational attainment levels and to their higher status in the labor market.

Conclusions

The study indicated the importance of equitable social opportunities for both genders for understanding the historical trends in the gender gap in the self-reported health data from South Korea.

Summary

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Gyu Ri Kim, Chung Mo Nam, C. Mary Schooling
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Changes in Dietary Behavior Among Adolescents and Their Association With Government Nutrition Policies in Korea, 2005-2009: Sang Geun Bae, Jong Yeon Kim, Keon Yeop Kim, Soon Woo Park, Jisuk Bae, Won Kee Lee; J Prev Med Public Health. 2012;45(1):47-59. Published online January 31, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.1.47

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Abstract PDF

Objectives

This study was conducted to observe recent changes in adolescents' dietary behavior and indirectly evaluate the effects of the government's nutritional policies in Korea.

Methods

We analyzed the secular trends in seven dietary behaviors using the Korea Youth Risk Behavior Web-based Survey data from 2005 to 2009. Through literature review, we included the policies implemented for the improvement of adolescents'dietary behaviors during the same periods.

Results

The significant linear trends were observed in all dietary behaviors (p<0.05). Overall, all behaviors except the fruit intake rate were desirably changed during five years but undesirable changes were observed between 2008 and 2009 in all behaviors. Within those periods, several policies were implemented including 'Ban on carbonated-beverages in school', 'Green Food Zone', etc. Despite confirmed evidence of their effects, the policies on individual behavior such as nutrition education didn't influence the prevalence of dietary behaviors because they were conducted to too limited persons. Polices on the school environmental improvement, such as ban on carbonated beverage in school, were more effective because they decreased the exposure of undesirable food environment. However, for effect of Green Food Zone improving community environment we couldn't come to a conclusion because of too short period after full implementation.

Conclusions

Among government nutrition policies conducted from 2005 to 2009, those on environmental improvement, especially in school, were more effective than those on individual behavior. Therefore, the development and implement of policies on school environmental improvement are needed in Korea.

Summary

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Trends in Cigarette Use Behaviors Among Adolescents by Region in Korea: Nam Soo Hong, Keon Yeop Kim, Soon-Woo Park, Jong-Yeon Kim, Jisuk Bae, Won Kee Lee, Ki Su Kim; J Prev Med Public Health. 2011;44(4):176-184. Published online July 29, 2010; DOI: https://doi.org/10.3961/jpmph.2011.44.4.176

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Abstract PDF

Objectives

Understanding recent trends in cigarette smoking among adolescents is important in order to develop strategies to prevent cigarette smoking. The aim of this study was to compare recent trends in cigarette smoking for adolescents living in rural areas, small towns and metropolitan cities in Korea.

Methods

The raw data from the Korea Youth Risk Behavior Web-based Survey (KYRBWS) from 2005 to 2009 were used. Data were analyzed by using the method of complex survey data analysis considering complex sampling design. Logistic regression models were used to evaluate significant linear time trends in cigarette smoking. The indicators of cigarette use behaviors were 'current smoking rate', 'frequent smoking rate', 'heavy smoking rate' and 'smoking experience rate before 13 years of age'. All analyses were conducted according to gender.

Results

Statistically significant increasing trends in current smoking rate and frequent smoking rate were observed and borderline significant increasing trends in heavy smoking rate were shown among rural boys. Among metropolitan city boys, statistically significant increasing trends were also seen for frequent smoking. Statistically significant decreasing trends in current smoking rate were observed among small town and metropolitan city girls. Smoking experience rate before 13 years of age for rural girls decreased significantly.

Conclusions

Cigarette smoking prevalence among adolescents in the rural areas has increased in the last five years especially among boys. Our findings suggest that anti-tobacco program for adolescents should be conducted primarily for those in rural areas.

Summary

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Trends in Body Mass Index and Associations With Physical Activity Among Career Soldiers in South Korea: Kyoung-Ki Bae, Ho Kim, Sung-Il Cho; J Prev Med Public Health. 2011;44(4):167-175. Published online July 29, 2010; DOI: https://doi.org/10.3961/jpmph.2011.44.4.167

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Abstract PDF

Objective

This study was designed to describe the trends in body mass index (BMI) during 6 years (2002 - 2008) and to identify associations between these trends and the amount of physical activity of South Korean career soldiers.

Method

This study targeted the 40 993 (38 857 men and 2136 women) of the 58 657 career soldiers who had undergone four (2002, 2004, 2006, and 2008) biennial medical examinations conducted by the National Health Insurance Corporation; 17 664 soldiers with missing data on height, weight, and physical activity were excluded. A linear mixed-regression model was used to categorize changes in BMI due to age versus those due to amount of physical activity.

Results

Career soldiers experienced significant increases in BMI compared with baseline data gathered in 2002. The increases in each age group were as follows: men aged 20- 29: 1.16, men aged 30 - 39: 0.61, men aged 40 - 49: 0.05, women aged 20- 29: 0.35, women aged 30- 39: 0.30, women aged 40-49: 0.26, and women aged 50- 59: 0.21. However, men aged 50 or older showed significant decreases (as high as 0.5) in BMI compared with baseline data obtained in 2002. They also experienced significant decreases in BMI compared with those who reported no physical activity. The differences between baseline and final BMIs were: 0.02 for men exercising 1- 2 times per week, -0.07 for men exercising 3-4 times per week, -0.19 for men exercising 5-6 times per week, -0.21 for men exercising seven times per week, -0.05 for women exercising 1- 2 times per week, -0.19 for women exercising 3- 4 times per week, -0.30 for women exercising 5-6 times per week, and -0.30 for women exercising seven times per week.

Conclusions

Obesity in South Korean career soldiers increased markedly between 2002 and 2008, and our data showed that the amount of physical activity was inversely related to increases in BMI. Policies to prevent obesity are needed to reduce this trend.

Summary

Citations

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Socioeconomic Disparities in Breast Cancer Screening among US Women: Trends from 2000 to 2005.: Jaeyoung Kim, Soong Nang Jang; J Prev Med Public Health. 2008;41(3):186-194.; DOI: https://doi.org/10.3961/jpmph.2008.41.3.186

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Abstract PDF

OBJECTIVES
This study describes trends in the socioeconomic disparities in breast cancer screening among US women aged 40 or over, from 2000 to 2005. We assessed 1) the disparities in each socioeconomic dimension; 2) the changes in screening mammography rates over time according to income, education, and race; and 3) the sizes and trends of the disparities over time. METHODS: Using data from the Behavioral Risk Factor Surveillance System (BRFSS) from 2000 to 2005, we calculated the age-adjusted screening rate according to relative household income, education level, health insurance, and race. Odds ratios and the relative inequality index (RII) were also calculated, controlling for age. RESULTS: Women in their 40s and those with lower relative incomes were less likely to undergo screening mammography. The disparity based on relative income was greater than that based on education or race (the RII among low-income women across the survey years was 3.00 to 3.48). The overall participation rate and absolute differences among socioeconomic groups changed little or decreased slightly across the survey years. However, the degree of each socioeconomic disparity and the relative inequality among socioeconomic positions remained quite consistent. CONCLUSIONS: These findings suggest that the trend of the disparity in breast cancer screening varied by socioeconomic dimension. ontinued differences in breast cancer screening rates related to income level should be considered in future efforts to decrease the disparities in breast cancer among socioeconomic groups. More focused interventions, as well as the monitoring of trends in cancer screening participation by income and education, are needed in different social settings.

Summary

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English Abstracts

Ten Year Trend of Cancer Incidence in Seoul, Korea: 1993-2002.: Myung Hee Shin, Hyun Kyung Oh, Yoon Ok Ahn; J Prev Med Public Health. 2008;41(2):92-99.; DOI: https://doi.org/10.3961/jpmph.2008.41.2.92

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Abstract PDF

OBJECTIVES
Effective cancer prevention and control measures can only be done when dependable data on the cancer incidence is available. The Seoul Cancer Registry (SCR) was founded to provide valid, comparable and representative cancer incidence data for Koreans. We aimed to compare the cancer incidence in the first (1993-1997) and second term (1998-2002) of the SCR, and we analyzed the annual incidence trend during that 10 years. METHODS: The SCR detects potential cancer cases through the Korean Central Cancer Registry (KCCR) data, the health insurance claims, the individual hospital's discharge records and the death certificates. About 87% of the SCR data is registered through the KCCR. The rest of the data is registered by SCR registrars who visit about 70~80 mid-sized hospitals in Seoul to review and abstract the medical records of the potential cancer patients. RESULTS: The total number of new cancer cases was higher in 1998~2002 than in 1993~1997 by 20.6% for men and 18.4% for women, respectively. The age-standardized rate (ASR) of total cancer per 100,000 increased 1% (from 295.4 to 298.3) for men and 5.1% (from 181.5 to 190.7) for women, between the two periods. The commonest cancer sites during 1998-2002 for men were stomach, liver, bronchus/lung, colorectum, bladder and prostate, and the commonest cancer sites for women were breast, stomach, colorectum, cervix uteri, thyroid and bronchus/lung. Compared with the ASRs in 1993, the ASRs in 2002 increased for colorectum (58.4% for men, 27.1% for women), prostate (81.5%), breast (58.3% for women), thyroid (141% for women), and bronchus/lung (15.4% for women). The ASRs for stomach (-18.7% for men, -20.7% for women) and uterine cervix cancer (-39.7%) had decreased. CONCLUSIONS: The cancer incidence is increasing in Seoul, Korea, especially for the colorectum and prostate for men, and for the breast, colorectum, bronchus/lung and thyroid for women.

Summary

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The Trend of Risk-adjusted Hospital Mortality Rates of Coronary Artery Bypass Graft Patients from 2001 to 2003.: Kwang Soo Lee; J Prev Med Public Health. 2007;40(1):29-35.; DOI: https://doi.org/10.3961/jpmph.2007.40.1.29

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Abstract PDF: OBJECTIVES
To assess whether the risk-adjusted inhospital mortality rates for non-emergent and isolated coronary artery bypass graft surgery (CABG) patients exhibited a consistent trend from 2001 to 2003. METHODS: The data used in this study came from CABG claims that were submitted to a Korean Health Insurance Review Agency (HIRA) in 2001, 2002, and 2003. Study datasets included data from 17 tertiary hospitals, which had at least 25 claims each year over 3 years. The interhospital differences in patients' risk-factors were identified and controlled in the risk-adjustment model. Actual and predicted mortality rates for each hospital were calculated in 2001, 2002, 2003, and 2001+2002, and were then examined to identify consistent rate patterns over time. Kappa analysis was applied to assess the agreements between rates. RESULTS: Hospitals with lower-than-expected inpatient mortality rates showed more consistent rates than those with higher-than-expected mortality rates. The mortality rates that were calculated based on data obtained over multiple years had less variation among hospitals than rates based on single year data. Based on the Kappa score, the highest agreement was found when the rates were compared between the 2-year combined data (2001+2002) and 2003. CONCLUSIONS: Consistent patterns over 3 years were most evident for hospitals which had lower-than expected mortality rates. Policy makers can use this information to identify the degree of outcomes in hospitals and help motivate or channel the behaviors of providers.; Summary

Original Article

Medical Service Utilization and Trends among Korean Elderly in the Last One Year of Life.: Jee Jeon Yi, Ki Soon Park, Seung Hum Yu, Jeong In Kim, Jae Yong Park, Wang Kun Yoo, Sang Wook Yi; Korean J Prev Med. 2003;36(4):325-331.

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Abstract PDF: OBJECTIVES
To analyze medical service utilization and trends among the elderly in the last year of life. METHOD: The subjects of this study were people that had died at the age sixty-five and above between January 1st and June 30th 2000 The names of the deceased and their dates of death were collected from the data of the funeral-expenses-receivers of the National Health Insurance Corporation (NHIC). This data was merged with that of the individual medical expenses of the NHIC. RESULTS: In the first half of 2000, 84.2% of the funeral-expenses-receivers (53, 063) utilized medical services during the year prior to their death; 51.0% (27, 042) were female and 49.0% (26, 021) male. In the last twelve months of life, the medical fees, the number of days receiving medical services and the number of days receiving medicine were 3, 107, 935 Won, 47.88 and 153.21, respectively, for each person. As the age of the groups increased, the level of medical service utilization decreased; the change was more obvious in female group. The level of medical service utilization during the twelve months prior to death drastically increased around the time of death. CONCLUSIONS: This study, from an analysis of the level of medical service utilization prior to death, shows a concentrated volume of medical services during a certain time period prior to death.; Summary

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