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Background: A victim of child abuse can often develop mental illness. The early detection of mental illness of children could be supported by observing sleep quality. Therefore, we examined the relationship between sleep quality and the changes in child abuse by the child's own parents over the study period.Methods: Data from the 2011-2013 Korean Children and Youth Panel Survey was used, and 2012 was set as the baseline. Adolescents who had poor sleep quality in 2011 were excluded from the analysis to obtain the final study population of 1276 adolescents aged 14 and 15 years. The generalized estimating equation model (GEE) was used for statistical analysis.Results: Children who had experienced and/or were currently experiencing child abuse showed significantly poorer sleep quality (current year abuse only: odds ratio [OR] = 0.57, 95% confidence interval [CI] = 0.41, 0.79; prior year abuse only: OR = 0.72, 95% CI = 0.52, 0.99; continuous abuse: OR = 0.56, 95% CI = 0.39, 0.80) compared to children who had no experience of child abuse.Conclusion: Child abuse remains a traumatic experience that influences the quality of sleep and hinders the child's proper psychological development. We suggest approaching this issue at both the community and national levels to protect the victims. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to examine factors associated with the use of mental health consultation for depressive symptoms. Methods: We used data from the 2013 Community Health Survey, which included responses from 13,269 individuals who reported that they had experienced depressive symptoms for more than 2 weeks in Korea. We investigated associations between mental health consultation rates for depressive symptoms and sociodemographic, socioeconomic, and health-related factors. Logistic regression analysis was used to examine the significance of associations. Results: Among participants who report depressive symptoms, 16.0% (n = 2120) undergo mental health consultation. Respondents with a college education or over are more likely to undergo mental health consultation (odds ratio (OR) = 1.49; 95% CI: 1.21–1.84) than respondents with less education. Individuals aged 70 years or above are less likely to receive mental health consultation than those aged between 19 and 29 years. Females exhibit higher mental health consultation rates than males. Respondents who are divorced show greater odds of receiving mental health consultation than respondents who are married and cohabitate with their spouse. Conclusions: This study indicates that rates of use of mental health consultation services are lower among older adults and men and higher among divorced people. Educational level shows a significant positive association with mental health consultation among Koreans. The results could have implications for mental health policy in many ways in Korea. [ABSTRACT FROM AUTHOR]

Background: The prevalence of osteoporosis associated with the aging process is anticipated to increase along with the rising aging population. Periodontitis that the most common chronic infections of humankind is considered the risk factor for osteoporosis. The aim of this study was to identify the association between osteoporosis and periodontitis using a population-based cohort.Methods: The case group was defined as patients diagnosed with periodontitis and treated with subgingival curettage, root conditioning, periodontal flap operation, bone grafting for alveolar bone defects, and guided tissue regeneration. Case and control groups matched for gender, age, household income, type of social security, disability, and residential area were generated. A Cox proportional hazard model was constructed to examine the difference in the development of osteoporosis between the case and control groups. The final sample included 13,464 participants.Results: The incidence of osteoporosis was 1.1% in males and 15.8% in females during a 10-year period. The risk factors for osteoporosis in males were increasing age and Charlson Comorbidity Index score. Periodontitis was not associated with the development of osteoporosis in males. The risk factors for osteoporosis in females were increasing age, body mass index, Charlson Comorbidity Index score, diabetes, and periodontitis. Women with periodontitis were more likely to also develop osteoporosis (HR: 1.22, 95% CI: 1.01-1.48).Conclusions: Periodontitis has an effect on the development of osteoporosis in females. Managing good teeth is required for the prevention and delay of osteoporosis. This includes dental examinations, regular cleanings and gum treatment. [ABSTRACT FROM AUTHOR]

Background: Glaucoma is one of the most leading causes of permanent visual impairments in Korea, and social expenses spent for the glaucoma are increasing. This study is to identify association between socioeconomic status and the visual impairments caused by primary glaucoma in Korea.Methods: This study is based on a cohort study using stratified representative samples in the National Health Insurance claim data from 2002 to 2013 with 1,025,340 representative subjects. Target subjects were patients who are newly diagnosed with primary glaucoma from 2004 to 2013. We conducted a multiple logistic regression analysis depending on the occurrence of visual impairment and its temporal order compared to the glaucoma diagnosis.Results: Among 1728 patients with primary glaucoma, those with low and middle income shows higher odds ratio (OR) of the visual impairments than those with high income group (low income; OR = 3.42, 95% Confidential Interval (CI):2.06-5.66, middle income; OR = 2.13, 95% CI: 1.28-3.55), in case of the occurrence of the visual impairments preceded the diagnosis of glaucoma.Conclusions: Glaucoma patients without pre-existing glaucoma history before visual impairment have higher association between socioeconomic status and the occurrence of visual impairments by primary glaucoma. Since glaucoma had not been diagnosed and recognized yet, the differences may have been derived from the disparities of the awareness of the glaucoma. These findings call attention to the correlation between socioeconomic factors and the visual impairments by glaucoma, and raise public health needs over the importance of glaucoma awareness and eye screening for glaucoma, especially for low socioeconomic status. [ABSTRACT FROM AUTHOR]

Background: In South Korea, people injured in road traffic accidents receive compensation for medical costs through their automobile insurance. However, the automobile insurance system appears to manage health care inefficiently. This study aimed to investigate the factors associated with the hospital length of stay (LOS), which was used as an indicator of healthcare utilization, for inpatients covered by automobile insurance and undergoing invasive cervical discectomy.Methods: Insurance claims data from 158 hospitals were used. The study included 850 inpatients who were involved in automobile accidents in 2014 and 2015 and who underwent invasive cervical discectomy. Poisson regression analysis was performed to examine the associations between the LOS and hospital-level characteristics.Results: The mean LOS for inpatients covered by automobile insurance was 25.75 days. A higher proportion of inpatients with automobile insurance were associated with a longer LOS (rate ratio [RR]: 1.027 per 1% increase, 95% confidence interval [CI]: 1.012-1.042). A higher hospital volume of invasive cervical discectomy (RR: 0.970 per 10 case increase, 95% CI: 0.945-0.997), bed turnover rate (RR: 0.988 per 1 increase, 95% CI: 0.979-0.997), and number of neurosurgeons or orthopedic specialists (RR: 0.930 per 1/100 beds increase, 95% CI: 0.876-0.987) were associated with a shorter LOS.Conclusions: Our findings suggest that inpatients covered by automobile insurance were associated with a longer LOS when treated at small-sized, low-provider, and low-volume hospitals with high proportions of such patients. Based on these findings, policymakers and healthcare professionals ought to consider improved strategies for efficient management of automobile insurance for inpatients in small-sized hospitals. [ABSTRACT FROM AUTHOR]

Background: Previous studies have examined associations between sitting time and negative health outcomes and mental health. However, the relationship between overall sitting time and major depressive disorder (MDD) in South Korea has not been studied. This study examined the association between MDD and overall sitting time and physical activity in South Koreans. Methods: Data from the sixth Korean National Health and Nutrition Examination Survey (KNHANES), a cross-sectional, nationally representative survey, were analyzed. Total participants were 4145 in 2014. MDD was assessed using the Patient Health Questionnaire (PHQ-9). Participants' data regarding self-reported sitting time and physical activity were analyzed via multiple logistic regression. Results: Results showed that people who sat for 8-10 h (OR: 1.56, 95% CI: 1.15-2.11) or more than 10 h (OR: 1.71, 95% CI: 1.23-2.39) had increased risk of MDD compared to those who sat for less than 5 h a day. Subgroup analysis showed that the strongest effect of reported sitting time on risk of MDD was found in men with lower levels of physical activity who sat for 8 to 10 h (OR: 3.04, 95% CI: 1.15-8.01) or more than 10 h (OR: 3.43, 95% CI: 1.26-9.35). Level of physical activity was not an independent predictor for MDD. Conclusions: Sitting for long periods was associated with greater risk of MDD in South Korean adults. Reducing sitting time in people with MDD could help to prevent associated physical health problems and may improve mental health. [ABSTRACT FROM AUTHOR]

Background: Many studies have assessed the volume-outcome relationship in cancer patients, but most focused on better outcomes in higher volume groups rather than identifying a specific threshold that could assist in clinical decision-making for achieving the best outcomes. The current study suggests an optimal volume for achieving good outcome, as an extension of previous studies on the volume-outcome relationship in stomach cancer patients. Methods: We used National Health Insurance Service (NHIS) Sampling Cohort data during 2004-2013, comprising healthcare claims for 2550 patients with newly diagnosed stomach cancer. We conducted survival analyses adopting the Cox proportional hazard model to investigate the association of three threshold values for surgical volume of stomach cancer patients for cancer-specific mortality using the Youden index. Results: Overall, 17.10% of patients died due to cancer during the study period. The risk of mortality among patients who received surgical treatment gradually decreased with increasing surgical volume at the hospital, while the risk of mortality increased again in "high" surgical volume hospitals, resulting in a j-shaped curve (mid-low = hazard ratio (HR) 0.773, 95% confidence interval (CI) 0.608-0.983; mid-high = HR 0.541, 95% CI 0.372-0.788; high = HR 0.659, 95% CI 0.473-0.917; ref = low). These associations were especially significant in regions with unsubstantial surgical volumes and less severe cases. Conclusion: The optimal surgical volume threshold was about 727.3 surgical cases for stomach cancer per hospital over the 1-year study period in South Korea. However, such positive effects decreased after exceeding a certain volume of surgeries. [ABSTRACT FROM AUTHOR]

Background: We evaluated the effectiveness of a policy allowing for the sale of over-the-counter drugs outside of pharmacies by examining its effect on number of monthly outpatient visits for acute upper respiratory infections, dyspepsia, and migraine.Method: We used medical claims data extracted from the Korean National Health Insurance Cohort Database from 2009 to 2013. The Korean National Health Insurance Cohort Database comprises a nationally representative sample of claims - about 2% of the entire population - obtained from the medical record data held by the Korean National Health Insurance Corporation (which has data on the entire nation). The analysis included26,284,706 person-months of 1,042,728 individuals. An interrupted-time series analysis was performed. Outcome measures were monthly outpatient visits for acute upper respiratory infections, dyspepsia, and migraine. To investigate the effect of the policy, we compared the number of monthly visits before and after the policy's implementation in 2012.Result: For acute upper respiratory infections, monthly outpatient visits showed a decreasing trend before the policy (ß = -0.0003);after it, a prompt change and increasing trend in monthly outpatient visits were observed, but these were non-significant. For dyspepsia, the trend was increasing before implementation (ß = -0.0101), but this reversed after implementation(ß = -0.007). For migraine, an increasing trend was observed before the policy (ß = 0.0057). After it, we observed a significant prompt change (ß = -0.0314) but no significant trend.Conclusion: Deregulation of selling over-the-counter medication outside of pharmacies reduced monthly outpatient visits for dyspepsia and migraine symptoms, but not acute upper respiratory infections. [ABSTRACT FROM AUTHOR]

Background: There is an urgent need to reduce readmission of patients with pneumonia and improve quality of care. To assess the association between hospital resources and quality of care, we examined the effect of number of doctors per bed on 30-day readmission and investigated the combined effect of number of doctors per bed and number of beds.Methods: We used nationwide cohort sample data of health insurance claims by the National Health Insurance Service (NHIS) from 2002 to 2013. Pneumonia admissions to acute care hospitals among 7446 inpatients older than 65 were examined. We conducted a multivariate Cox proportional hazard model to analyze the association between the number of doctors per bed and 30-day readmission, as well as that of pneumonia-specific 30-day readmission with the combined effects of number of doctors per bed and number of beds.Results: Overall, 1421 (19.1%) patients were readmitted within 30 days and 756 (11.2%) patients were readmitted for pneumonia within 30 days. Patients with pneumonia treated by very low or low number of doctors per bed showed higher readmission (pneumonia-specific readmission: hazard ratio [HR] = 1. 406, 95% confidence interval [CI] = 1.072-1.843 for low number of doctors per bed; all-cause readmissions: HR = 1.276, 95% CI = 1.026-1.587 for very low number of doctors per bed, and HR = 1.280, 95% CI = 1.064-1.540 for low number of doctors per bed).Conclusions: This empirical study showed that patients with pneumonia cared for in hospitals with more doctors were less likely to be readmitted. Pneumonia-specific 30-day readmission was also significantly associated with the combined effect of the number of doctors and the number of hospital beds. [ABSTRACT FROM AUTHOR]

Background: The Korean healthcare system is composed of costly and inefficient structures that fail to adequately divide the functions and roles of medical care organizations. To resolve this matter, the government reformed the cost-sharing policy in November of 2011 for the management of outpatients visiting general or tertiary hospitals with comparatively mild diseases. The purpose of the present study was to examine the impact of increasing the coinsurance rate of prescription drug costs for 52 mild diseases at general or tertiary hospitals on outpatient healthcare service utilization.Methods: The present study used health insurance claim data collected from 2010 to 2013. The study population consisted of 505,691 outpatients and was defined as those aged 20-64 years who had visited medical care organizations for the treatment of 52 diseases both before and after the program began. To examine the effect of the cost-sharing policy on outpatient healthcare service utilization (percentage of general or tertiary hospital utilization, number of outpatient visits, and outpatient medical costs), a segmented regression analysis was performed.Results: After the policy to increase the coinsurance rate on prescription drug costs was implemented, the number of outpatient visits at general or tertiary hospitals decreased (β = -0.0114, p < 0.0001); however, the number increased at hospitals and clinics (β = 0.0580, p < 0.0001). Eventually, the number of outpatient visits to hospitals and clinics began to decrease after policy initiation (β = -0.0018, p < 0.0001). Outpatient medical costs decreased for both medical care organizations (general or tertiary hospitals: β = -2913.4, P < 0.0001; hospitals or clinics: β = -591.35, p < 0.0001), and this decreasing trend continued with time.Conclusions: It is not clear that decreased utilization of general or tertiary hospitals has transferred to that of clinics or hospitals due to the increased cost-sharing policy of prescription drug costs. This result indicates the cost-sharing policy, intended to change patient behaviors for healthcare service utilization, has had limited effects on rebuilding the healthcare system and the function of medical care organizations. [ABSTRACT FROM AUTHOR]

Background: The incidence of thyroid cancer among South Koreans is more than 10-fold greater than its incidence in other countries, although its associated mortality rate is similar. Amidst concerns regarding the over-diagnosis of thyroid cancer related to gradually expanded medical testing in South Korea, we hypothesized that the number of thyroid fine-needle aspiration biopsies has led to increased diagnosis of thyroid cancer.Methods: We used data from the National Health Insurance Service National Sample Cohort 2003-2013, which included all medical claims filed for the 1,122,456 people in a nationally representative sample. We performed a Poisson regression analysis using generalized estimating equation to investigate the relationship between the number of thyroid fine-needle aspiration biopsies and the newly diagnosed cases of thyroid cancer.Results: The study included 60 annual patients per 100,000 individuals out of 11,024,548 person-years. The number of biopsies per 100,000 patients positively correlated with increased incidence of thyroid cancer diagnosis (per 100 biopsy cases: RR = 1.108; 95% CI: 1.090-1.126; P < 0.0001). Such relationships were greater in males, patients with a higher socioeconomic status, and patients from regions with relatively less accessibility to biopsies.Conclusion: Our findings suggest that a higher number of thyroid fine-needle aspiration biopsies per 100,000 individuals in a specific Si-Gun-Gu is positively associated with excessively increased diagnosis of thyroid cancer. Regarding the continually increasing thyroid cancer incidence in South Korea, healthcare professionals and policy makers should consider proper guidelines for recognizing the role of thyroid fine-needle aspiration biopsies in the potential over-diagnosis of thyroid cancer. [ABSTRACT FROM AUTHOR]

Background: Numerous studies suggesting the relation between self-rated health (SRH) and depression have been reported using different measures. Therefore, we attempted to determine the difference in a depressive scale based on the different ways of measuring health between global SRH (SRH-global) and age-comparative SRH (SRH-age). Then, the combined effect of SRH-global and SRH-age on depressive symptoms was further investigated. Methods: Data from the Korean Longitudinal Study of Ageing (KLoSA) from 2008 to 2012 were analyzed. We divided the SRH-global and SRH-age into three levels--high, middle, and low--and combined each into nine new categories (SRH-combi). The Center for Epidemiologic Studies Depression Scale-10 Korean edition was used as the dependent variable. Results: A total of 8621 participant were enrolled at baseline. Individuals with lower SRHs-age compared to SRH-global tended to be more vulnerable to depressive symptoms. Low SRH-global with low (b = 0.654, p < 0.001) and middle SRH-age (b = 0.210, p = 0.003) showed association with higher CESD scores. Participants with high SRH-global × low SRH-age also had higher scores (b = 0.536, p < 0.001) compared to the "middle SRH-global × middle SRH-age" reference group. In contrast, among the middle (b = -0.696, p < 0.001) and high SRH-global (b = -0.545, p < 0.001) groups, participants with superior SRH-age had statistically lower CESD scores than the reference group. Conclusions: Although a sole general SRH has historically been widely used, it has been suggested that use of both general and age-comparative SRH would be more powerful and easy when we consider analyzing depression in old age. [ABSTRACT FROM AUTHOR]

Background: Night and shift work status has been associated with health related quality of life (HRQoL) in economically active women. This study aimed to investigate the association between night or shift work status and HRQoL of economically active women and to further analyze how marital status interplays in the objected relationship. Methods: Data were from the Korea Health Panel, 2011 to 2013. A total of 2238 working women were included for analysis. Work status was categorized into day work, night work, and rotating shift work and its association with HRQoL, measured using the EuroQol-5D (EQ-5D) index, was investigated using the generalized estimating equation (GEE) model. Results: Compared to the day work reference group, the night work group (β: -0.9757, P = 0.0202) and the rotating shift work group (β: -0.7947, P = 0.0363) showed decreases in EQ-5D scores. This trend was maintained regardless of marital status, although decreases in health related quality of life were particularly pronounced among night shift workers with a spouse. Conclusion: Night and rotating shift work status was associated with HRQoL of economically active women as individuals working night and rotating shifts showed decreases in EQ-5D scores compared to individuals working day shifts. The findings of this study signify the importance of monitoring the HRQoL status of women working night and rotating shifts as these individuals may be comparatively vulnerable to reduced HRQoL. [ABSTRACT FROM AUTHOR]

Background: South Korea has experienced problems regarding poor management of symptoms of asthma patients and remarkable increases in sleep disorders. However, few studies have investigated these issues. We examined the relationship between sleep disorders and mortality in asthma patients to suggest effective alternatives from a novel perspective. Methods: We used data from the National Health Insurance Service (NHIS) National Sample Cohort 2004-2013, which included medical claims filed for 186,491 patients who were newly diagnosed with asthma during the study period. We performed survival analyses using a Cox proportional hazards model with time-dependent covariates to examine the relationship between sleep disorders and mortality in asthma patients. Results: There were 5179 (2.78%) patients who died during the study period. Sleep disorders in patients previously diagnosed with asthma were associated with a higher risk of mortality (hazard ratio [HR]: 1.451, 95% confidence interval [CI]: 1.253-1.681). In addition, significant interaction was found between sleep disorders and Charlson comorbidity index. Conclusions: Our findings suggest that an increased prevalence of sleep disorders in asthma patients increases the risk of mortality. Considering the worsening status of asthma management and the rapid growth of sleep disorders in South Korea, clinicians and health policymakers should work to develop interventions to address these issues. [ABSTRACT FROM AUTHOR]

Background: There were some debates about the water fluoridation program in South Korea, even if the program had generally substantial effectiveness. Because the out-of-pocket expenditures for dental care were higher in South Korea than in other countries, an efficient solution was needed. Therefore, we examined the relationship between the implementation of water fluoridation and the utilization of dental care. Methods: We used the National Health Insurance Service National Sample Cohort. In this study, data finally included 472,250 patients who were newly diagnosed with dental caries during 2003-2013. We performed survival analysis using cox proportional hazard model, negative binomial-regression, and regression analyses using generalized estimating equation models. Results: There were 48.49 % outpatient dental care visit during study period. Individuals with water fluoridation had a lower risk of dental care visits (HR = 0.949, 95 % CI = 0.928-0.971). Among the individuals who experienced a dental care visit, those with water fluoridation program had a lower number of dental care visits (β = -0.029), and the period of water fluoridation had an inverse association with the dental care expenditures. Conclusion: The implementation of water fluoridation programs and these periods are associated with reducing the utilization of dental health care. Considering these positive impacts, healthcare professionals must consider preventive strategies for activating water fluoridation programs, such as changes in public perception and relations, for the effective management of dental care in South Korea. [ABSTRACT FROM AUTHOR]

Background: In 1995, the South Korean government made nutrition labeling compulsory, which has positively impacted patients with certain chronic diseases, such as dyslipidemia. We investigated the association between nutrition labeling-based awareness and the risk of dyslipidemia among individuals not yet diagnosed.Methods: Our study used data from the fifth Korea National Health and Nutrition Examination Surveys administered during 2010-2014 (n = 17,687). We performed multiple or logistic regression analysis to examine the association between nutritional analysis and various outcome variables.Results: Approximately 70 % of the respondents (n = 11,513) were familiar with nutrition labeling, of which 20 % (n = 3172) decided what food to buy based on that information. This awareness yielded mostly positive results on outcome indicators, such as triglyceride and high-density lipoprotein cholesterol levels. In general, individuals who used nutritional labels to make decisions regarding food purchases had a lower risk of dyslipidemia than individuals who did not (OR: 0.806, 95 % CI: 0.709-0.917).Conclusion: Utilizing nutrition labels for making food choices correlated with a lower risk of dyslipidemia in certain subgroups. Based on our findings, we recommend that health policymakers and medical professionals consider promoting nutrition labeling as an alternative method for managing certain chronic diseases in South Korean patients. [ABSTRACT FROM AUTHOR]

Background: Previous evidence suggests that there is a correlation between prolonged sitting time and cardio-metabolic disease, such as metabolic syndrome (MS). Cardiovascular disease is the second-leading cause of mortality in South Korea, a country with the longest working hours among all member states of the Organization for Economic Co-operation and Development. However, no previous study has investigated the relationships of overall sitting-time and occupation with MS in South Korea. Accordingly, the present study examined these relationships in a South Korean population.Methods: Data from the sixth Korean National Health and Nutrition Examination Survey (KNHANES), a nationally representative survey with a cross-sectional design, were used in the present study. MS diagnoses were evaluated using the International Diabetes Foundation (IDF) criteria. Participants self-reported their overall sitting times, and occupations were classified using the Korean version of the Standard Classification of Occupations (KSCO). A multiple logistic regression analysis was conducted to evaluate the associations of sitting time and occupation with MS.Results: The risk of MS was 1.21-fold higher among participants who sat for >7 h/day than among those who sat for ≤7 h/day (odds ratio [OR]: 1.21, 95 % confidence interval [CI]: 1.00-1.46). Regarding occupation, office workers had a two-fold higher risk of MS than did agriculture, forestry, and fishery (AFF) workers (OR: 2.01, 95 % CI: 1.26-3.22). In a combined analysis of sitting time and occupation, male participants who sat for >7 h/day and reported an occupation that involves office work (OW) or machine fitting (MF) were significantly more likely to have MS when compared to those who sat for ≤7 h/day and were employed as AFF workers (>7 h/day × OW, OR: 2.41, 95 % CI: 1.05-5.51; >7 h/day × MF, OR: 2.92, 95 % CI: 1.43-5.93).Conclusions: Excessive sitting time and a sedentary occupation correlated positively with MS in South Korean adults. Accordingly, a reduction in the overall sitting time or inclusion of energy-expending activities in the workplace might improve the rate of MS. [ABSTRACT FROM AUTHOR]

Background: To examine factors contributing to smoking cessation among male smokers, we looked at how socio-demographic and clinical characteristics influence stopping smoking with passage of time.Methods: Data from the Korea Health Panel during 2009-2012 were used. In 2009 a total of 2,941 smokers were followed up until 2012. Statistical analysis using a generalized linear mixed model was performed for all smokers, and a subgroup analysis was also performed to determine whether individual characteristics influence smoking cessation differently based on health condition.Results: Male smokers who have married or graduated college or above were more likely to succeed in smoking cessation. Those with chronic disease(s) were also more likely to quit smoking than those without. Among those without chronic disease, higher education showed significant association with smoking cessation, however, being married or ever married showed significant association with smoking cessation among those with chronic disease.Conclusions: The finding that higher education helped smokers without chronic disease succeed in smoking cessation suggests that a smoking cessation campaign should focus on those with lower education. In addition, quit smoking programs may be particularly helpful for male smokers with chronic disease(s) who have never married. [ABSTRACT FROM AUTHOR]

Background: The benefits of physical activity on physical and mental health are well known. The accessibility of sports facilities is reported to have considerable association with the amount of physical activity a person participates in. Therefore, we investigated the association between subjectively assessed accessibility of sports facilities and physical activity among Korean adults.Methods: We obtained data from the 2012 Community Health Survey. Physical activity was measured based on weekly metabolic equivalent task (MET) hours according to the International Physical Activity Questionnaire (IPAQ). Sociodemographic, economic, and health variables were used as covariates in a logistic regression model.Results: A total 201,723 participants were included in this study. Participants with easy access to sports facilities participated in physical activity more often than those without easy access (OR = 1.16, 95 % CI 1.13-1.20). More physical activity was generally observed if participants had a history of depression or if participants were among the white-collar or urban subgroups.Conclusion: Our results showed that the accessibility of sports facilities is associated with physical activity. Therefore, it is crucial to consider the accessibility of sports facilities when promoting an environment conducive to physical activity or designing programs for enhancing physical activity. [ABSTRACT FROM AUTHOR]

Background: Quality of life (QoL) in old age is of major importance because the global population is aging rapidly. Offspring support, including financial and emotional support, is important in later life and directly affects the wellbeing of elderly individuals. The aim of this study was to examine the relationship between QoL in older parents and offspring support.Methods: We used baseline data from the 2006-2012 Korean Longitudinal Study of Aging, from 3,274 individuals aged 65 years or older. We measured the individual's QoL using a visual analog scale and included both relationship satisfaction and regular economic support as variables. A generalized estimating equation (GEE) model was used to perform longitudinal regression analysis on the data.Results: Regarding the QoL of older parents, those with an unsatisfying relationship with their offspring had a QoL of -21.93 (SE = 0.55; P < 0.0001) compared to those with satisfying offspring relationships. Those receiving no regular financial aid from their offspring had a QoL of -0.92 (SE = 0.38; P = 0.0171) compared to those who received such economic support. Combination effects were observed, with cases living alone - and having poor offspring relationships and no regular financial support from their offspring - showing the most drastic decrease in QoL (-23.46; SE = 1.03; P < 0.0001).Conclusions: Offspring support influences the QoL of elderly individuals, and Korean children appear to play a crucial role in the QoL of their (older) parents. Considering that the role of offspring is rapidly diminishing due to industrialization policies, initiatives are required to revitalize offspring support for elderly parents. [ABSTRACT FROM AUTHOR]

Background: Mental health inequality along the economic strata is prominent in South Korea, particularly as intergenerational material transfer is becoming increasingly important in gaining economic status. Therefore, this study aimed to investigate the relationship between current and childhood economic status and depressive symptoms in adults aged 20 or above. Methods: This study used data from the Korean Welfare Panel Study (KOWEPS), 2010 to 2013. A total of 9,645 individuals aged 20 years or above without depressive symptoms in 2010 were analyzed. The effect of childhood and current economic status, categorized into low, middle, and high groups, on depressive symptoms was investigated using hierarchical logistic regression models. Depressive symptoms were measured using the Center for Epidemiological Studies Depression (CES-D 11) scale. Subgroup analysis was performed based on education level. Results: Compared to the middle current-middle childhood economic status group, the low-low group (OR: 1.88, CI: 1.61-2.20), low-middle group (OR: 1.68, CI: 1.43-1.98), and low-high group (OR: 1.64, CI: 1.34-2.01) were more likely to have depressive symptoms. The high-low group (OR: 0.68, CI: 0.55-0.84), high-middle group (OR: 0.67, CI: 0.56-0.81), and high-high group (OR: 0.45, CI: 0.27-0.75) were less likely to have depressive symptoms. This trend was generally maintained with regard to education level, but the effects were not statistically significant in the high current economic status groups among participants with a university degree or above. Conclusion: Low current economic status was associated with a higher likelihood of depressive symptoms. In particular, the low current-low childhood economic status group showed the highest likelihood of depressive symptoms, suggesting the adverse mental health effects of prolonged poverty. Therefore, the findings reveal that mental health inequalities are present along the economic strata and require proper addressing of the mental health of lower income individuals. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to examine the association between parental socioeconomic status (SES) and the experience as well as treatment of dental caries among children aged 9 to 18 years. Methods: Data from 1253 children aged 9-18 years from the Korean National Health and Nutrition Examination Survey (2012-2013) were analyzed. Parental socioeconomic status was measured using household income level and maternal educational level. The decayed, missing, and filled teeth (DMFT) index was used to measure experience of dental caries (DMFT = 1). Non-treatment of dental caries was measured according to whether the participants who experienced dental caries used a dental service at a dental clinic to treat caries during the previous year. Logistic regression was used to investigate the association between parental socioeconomic status and the experience of dental caries as well as the association between parental socioeconomic status and the non-treatment of dental caries among children that have experienced caries. Results: A total of 808 subjects (64.5 %) experienced dental caries among 1253 participants, and 582 of these 808 subjects (72.0 %) did not receive treatment among those having experience of dental caries. Parental socioeconomic status was not associated with experience of dental caries. However, those from low- and middle-income households were less likely to receive treatment than those from high-income households (odds ratio [OR] 2.11 [95 % confidence interval (CI) 1.16-3.86], OR 2.14 [95 % CI 1.27-3.62]). In particular, those from low- and middle-income households who had regular dental checkups were more likely to have untreated caries than those from high-income households (OR 3.58 [95 % CI 1.25-10.24]). Conclusions: This study demonstrates the parental household income--related disparities in children's dental health treatment. Efforts should be made to lower financial barriers to dental health services, particularly among those from low-income households, in order to reduce dental health disparities in the treatment of caries in children. [ABSTRACT FROM AUTHOR]

Background: Readmission rates of psychiatric inpatients are higher in South Korea than other Organization for Economic Co-operation and Development (OECD) countries. In addition, the solution for readmission control is deficient based on the characteristics of the South Korean National Health Insurance (NHI) system. Therefore, it is necessary to identify ways to reduce psychiatric inpatient readmissions. This study investigated the relationship between inpatient volume per psychiatrist and the readmission rate of psychiatric inpatients in South Korea. Method: We used NHI claim data (N = 37,796) from 53 hospitals to analyze readmission within 30 days for five diagnosis (organic mental disorders, mental and behavioral disorders due to psychoactive substance use, schizophrenia, mood disorders, neurotic disorders, and stress-related and somatoform disorders) between 2010 and 2013. We performed X2 and analysis of variance tests to investigate associations between patient and hospital-level variables and readmission within 30 days. Finally, generalized estimating equation (GEE) models were analyzed to examine possible associations with readmission. Results: Readmissions within 30 days accounted for 1,598 (4.5 %) claims. Multilevel analysis demonstrated that inpatient volume per psychiatrist were inversely related with readmission within 30 days (low odds ratio [OR]: 0.38, 95 % confidence interval [CI]: 0.28-0.51; mid-low OR: 0.48, 95 % CI: 0.36-0.63; mid-high OR: 0.55, 95 % CI: 0.44-0.69; Q4 = ref). The subgroup analysis by diagnosis revealed that both "schizophrenia, schizotypal, and delusional disorders" and "mood disorders" had inverse relationships with readmission risk for all volume groups. Conclusions: We observed an inverse association between inpatient volume per psychiatrist and the 30-day readmission rate of psychiatric inpatients, suggesting that it could be a useful quality indicator in mental health care. [ABSTRACT FROM AUTHOR]

Background: Korea has the highest suicide rate in the OECD and is one of the few OECD countries whose suicide rates have not decreased in recent years. To address these issues, we investigated the effects of weight control failure on suicidal ideation in the overweight and obese populations.Methods: We performed a cross-sectional study using data from the Korea National Health and Nutrition Examination Survey (2008-2012) consisting of 6621 individuals 40 years of age or older. Logistic regression analysis was used to identify the relationship between weight control failure and suicidal ideation in the overweight and obese populations.Results: A total of 6621 participants were analyzed in this study (overweight group: 2439; obese group: 4182). Among them, weight control failure (weight gain with weight loss efforts) was experienced in 962 obese (males 16.3%, females 29.6%) and 412 overweight individuals (males 9.1%, females 23.4%). Weight control failure was significantly associated with suicidal ideation in obese females (OR = 1.70, 95% CI 1.21-2.39), but this association was not significant in obese males or in either sex of the overweight group.Conclusions: Findings from this study suggest that weight control failure is associated with an increased risk of suicidal ideation among obese women. Furthermore, intervention programs that aim to address the prevalence of suicide, especially for obese women, are needed. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown that contextual factors and individual socioeconomic status (SES) were associated with mortality in Western developed countries. In Korea, there are few empirical studies that have evaluated the association between SES and health outcomes. Methods: We conducted cohort study to investigate the socioeconomic disparity in all-cause mortality for patients newly diagnosed with hypertension in the setting of universal health care coverage. We used stratified random sample of Korean National Health Insurance enrollees (2002-2013). We included patients newly diagnosed with hypertension (n = 28,306) from 2003-2006, who received oral medication to control their hypertension. We generated a frailty model using Cox's proportional hazard regression to assess risk factors for mortality. Results: A total of 7,825 (27.6%) of the 28,306 eligible subjects died during the study period. Compared to high income patients from advantaged neighborhoods, the adjusted hazard ratio (HR) for high income patients from disadvantaged neighborhoods was 1.10 (95% CI, 1.00-1.20; p-value = 0.05). The adjusted HR for middle income patients who lived in advantaged versus disadvantaged neighborhoods was 1.17 (95% CI, 1.08-1.26) and 1.27 (95% CI, 1.17-1.38), respectively. For low income patients, the adjusted HR for patients who lived in disadvantaged neighborhoods was higher than those who lived in advantaged neighborhoods (HR, 1.35; 95% CI, 1.22-1.49 vs HR, 1.28; 95% 0,1.16-1.41). Conclusions: Neighborhood deprivation can exacerbate the influence of individual SES on all-cause mortality among patients with newly diagnosed hypertension. [ABSTRACT FROM AUTHOR]

Background: Secondhand Smoking (SHS) has been suggested as a major health problem in the world and is known to cause various negative health effects that have in turn caused the deaths of almost 600,000 people per year. Evidence has suggested that SHS may have an effect on health problems and such findings have influenced the implementation of smoking-free areas. However, few studies have investigated the effects of SHS on stress which is considered major risk factor for mental health. Thus, the purpose of our study was to investigate the association between exposure to SHS and stress.Methods: We performed a cross-sectional study using data from the Korea National Health and Nutrition Examination Survey (2007-2012). In our study, a total of 33,728 participants were included to evaluate the association between SHS exposure and stress based on smoking status. Association between SHS exposure and stress was examined using logistic regression models.Results: A total of 12,441 participants (42.9 %) were exposed to SHS in the workplace or at home. In our study, exposure to SHS was significantly associated with higher stress compared to non-exposure, regardless of smoking status (smoker odds ratio [OR]: 1.22; ex-smoker OR: 1.25; never-smoker OR: 1.42). Our results showed that the effect of SHS on stress was greater when exposure took place both at home and in the workplace in smokers and never-smokers.Conclusions: Exposure to SHS in the workplace and at home is considered to be a risk factor for high stress in both smokers and never-smoker. Therefore, strict regulations banning smoke which can smoking ban reduce SHS exposure are recommended in order to improve the populations' health. [ABSTRACT FROM AUTHOR]

Background: Although government has implemented medical-aid policy that provides assistance to the poor with almost free medical services, there are low-income people who do not receive necessary medical services in Korea. The aim of this study is to highlight the characteristics of Medical-Aid enrollees, the poor not enrolled in Medical-Aid, and the near poor and their utilization and costs for health care. Methods: This study draws on the 2012 Korea Welfare Panel Study (KOWEPS), a nationally representative dataset. We divided people with income less than 120% of the minimum cost of living (MCL) into three groups (n = 2,784): the poor enrolled in Medical-Aid, the poor not enrolled in Medical-Aid (at or below 100% of MCL), and the near poor (100-120% of MCL). Using a cross-sectional design, this study provides an overview of health care utilization and costs of these three groups. Results: The findings of the study suggest that significantly lower health care utilization was observed for the poor not enrolled in Medical-Aid compared to those enrolled in Medical-Aid. On the other hand, two groups (the poor not enrolled in Medical-Aid, the near poor) had higher health care costs, percentage of medical expenses to income compared to Medical-Aid. Conclusion: Given the particularly low rate of the population enrolled in Medical-Aid, similarly economically vulnerable groups are more likely to face barriers to needed health services. Meeting the health needs of these groups is an important consideration. [ABSTRACT FROM AUTHOR]

Background: To examine the combined effects of education level and perceived social class on self-rated health and life satisfaction in South Korea.Methods: We used data drawn from the 8 to 15th wave of the Korean Labor and Income Panel Study (KLIPS). Using wave 8 at baseline, data included 11,175 individuals. We performed a longitudinal analysis at baseline estimating the prevalence of self-rated health and life satisfaction among individuals by education level (high, middle, and low education level) and perceived social class (high, middle, and low social class).Results: For self-rated health, odds ratio (OR) of individuals with low education and low perceived social class was 0.604 times lower (95% CI: 0.555-0.656) and the OR of individuals with low education and middle perceived social class was 0.853 time lower (95% CI: 0.790-0.922) when compared to individuals with high education and high perceived social class. For life satisfaction, OR of individuals with low education and low perceived social class was 0.068 times lower (95% CI: 0.063-0.074) and the OR of individuals with middle education and middle perceived social class was 0.235 time lower (95% CI: 0.221-0.251) compared to individuals with high education and high perceived social class.Conclusions: This study shows that the combined effects of education level and perceived social class associated with self-rated health and life satisfaction. Our study suggests increasing education level and perceived social class. Additionally, it will be important to develop multi-dimensional measurement tools including education level and subjective social class. [ABSTRACT FROM AUTHOR]

Background: Private health insurance in South Korea mainly functions as supplementary and complementary health insurance that compensates for insufficient coverage by National Health Insurance. However, full private coverage of public sector cost-sharing led to the problem of encouraging moral hazard-induced utilization, resulting in a policy change that occurred in October 2009. At that time, the Korean government introduced a minimum cost-sharing policy for indemnity health insurance. The purpose of this study was to analyze the effect of cost-sharing in private health insurance on health care utilization.Methods: We analyzed data collected from the Korean Health Panel Survey from October 2008 to December 2011. We restricted the two groups to 803 purchasers with indemnity health insurance and 7023 non-purchasers who did not obtain any private health insurance. A difference-in-difference analysis was used to evaluate the effect of the 2009 policy.Results: After the policy change, the utilization of outpatient visits by purchasers gradually decreased more than non-purchasers (0.015 in 2009 [p = 0.758], -0.117 in 2010 [p < 0.016], and -0.140 in 2011 [p = 0.004]). However, utilization of inpatient services was not statistically significant. Notably, the magnitude of the cost-sharing effect in indemnity health insurance was stronger for those receiving medical aid. Among this group, utilization of outpatient services (after the policy change in 2009) decreased more so than non-purchasers. Patients with three or more chronic diseases have not changed their health care utilization.Conclusions: Our results implied meaningful lessons for decision-makers and future health insurance policies in Korea and other countries in terms of cost-sharing in medical care. When policy makers intend to implement the cost-sharing, a different copayment scheme is needed according to the socioeconomic status or disease severity. [ABSTRACT FROM AUTHOR]

Background: Despite the sharp rise in antidepressant use, the underutilization of mental healthcare services for depression remains a concern. We investigated factors associated with the underutilization of mental health services for potential depression symptoms in the Republic of Korea, using a nationally representative sample. Methods: Data were obtained from the Community Health Survey (2011-2012) conducted in the Republic of Korea. Participants comprised adults who reported potential depression symptoms during the year prior to the study (n = 21,644); information on professional mental healthcare use for their symptoms was obtained. The association of demographic, socioeconomic, and health-related factors with consultation use was analysed via multiple logistic regression. Adjusted odds ratio and 95% confidence intervals were estimated. Results: Among those reporting potential depression symptoms, only 17.4% had consulted a medical/mental health professional. Elderly individuals of both genders had significantly lower consultation rates compared to middle-aged individuals. Unmet healthcare needs and a history of diabetes mellitus were associated with lower consultation rates. After stratification by age, elderly individuals with the lowest education and income level were significantly less likely to seek professional mental health services. Married, separated, or divorced men had lower consultation rates compared to unmarried individuals, whereas married, separated, or divorced women had higher rates. Conclusions: The results suggest that target strategies for vulnerable groups identified in this study--including elderly individuals--need to be established at the community level, including strengthening social networks and spreading awareness to reduce the social stigma of depression. [ABSTRACT FROM AUTHOR]

Background: In the year 2000, the South Korean government introduced a program for separation of drug prescribing and dispensing. The goals of the program are to reduce misuse of drugs and to contain drug expenditures. The government also designated exception regions for the program to reduce the inconvenience for people who reside in areas with a shortage of health care resources. However, according to government reports, many adverse events related to drug misuse occurred in these exception regions after the program reforms were introduced. Therefore, it is worth investigating the factors that relate to drug consumption so that misuse in exception regions can be reduced.Methods: Data from medical institutions, detailed drug supply data, and community health survey data were included in the analysis. Multilevel linear regression analysis using mixed models that included pharmacy-and regional-level variables were used to examine the associations regarding the percentages of drug types consumed (i.e., antipyretic, analgesic, anti-inflammatory drugs, psychotropic drugs, adrenal cortical hormones, and antibiotics).Results: The data used in this analysis were from a total of 16,455 pharmacies. There were 1.9 % pharmacies from program exception regions and 98.1 % pharmacies from program application regions. Compared with the pharmacies in the program application regions, the exception region pharmacies had higher values for percent consumption of the antipyretic, analgesic, anti-inflammatory drugs category, and of the adrenal cortical hormones category (antipyretic, analgesic, anti-inflammatory drugs = β: 3.19, Standard Error (SE): 0.82, t: 3.88, p-value < 0.05; adrenal cortical hormones = β: 0.72, SE: 0.07, t: 9.92, p-value < 0.05).Conclusion: Our results suggested that pharmacies in exception regions supplied more antipyretic, analgesic, anti-inflammatory drugs, and more adrenal cortical hormones compared with the pharmacies where separation of drug prescribing and dispensing had been implemented. Health care professionals and health policy makers should consider management of health care expenditure by the category of drugs consumed, especially in program exception regions. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to examine the relationship between types and amount of social activity and health-related quality of life according to gender and age group.Methods: This study used data from the Community Health Survey (CHS), which was collected in 2011 and consisted of 229,226 participants aged 19 or older. A linear mixed effects model was used to evaluate the factors influencing health-related quality of life among individuals tracked in the CHS and, in particular, to analyze the associations between the amount and types of social activities participated in and the EuroQol EQ-5D assessment.Results: We found that the average quality of life increased according to the amount of social activities individuals participated in (zero = 89.30, one = 93.28, two = 95.25, three = 96.27, four = 96.85). When people participated in one social activity, social activity was more strongly associated with EQ-5D in the elderly age group (males: 19-34 years = 0.195, 35-49 years = 0.642, 50-64 years = 1.716, ≥ 65 years = 4.408; females: 19-34 years = 0.170, 35-49 years = 0.502, 50-64 years = 1.411, ≥ 65 years = 4.180). More participation was positively associated with higher EQ-5D (one = 1.939, two = 2.377, three = 2.439, four = 2.515, p for trend < 0.0001). In females, those who participated in relationship organizations had a higher EQ-5D than those who participated in other types of social activities (Females ≥ 65 age group; Relationship = 4.373, Leisure = 2.620, Religion = 1.842, Charity = 1.544).Conclusion: There was a positive association between the increase in the number of social activities and increase in health-related quality of life, especially when evaluated in terms of type of social activities and health-related quality of life according to gender and age group. [ABSTRACT FROM AUTHOR]

Background: Almost 97 % of the Korean population is covered by National Health Insurance and are entitled to receive the same level of insurance benefits, regardless of how much each enrollee contributes to the system. However, the percentage of out-of-pocket payments is still high. This study examines whether the incurrence of high medical expenses affects household income. Methods: We use the Korea Welfare Panel and select 4,962 households to measure repeatedly over 5 years. Using propensity score matching, we set households with medical expenses of three times the annual average as "occurrence households" while "non-occurrence households" are those below the cut-off but with all other factors, such as income, held constant. We analyze whether the income of occurrence households differs significantly from the comparison group using a linear mixed effect model. Results: After the occurrence of high medical expenditure, occurrence households (n = 825) had US$ 1,737 less income than non-occurrence households. In addition, the income of households (n = 200) that incurred high medical costs repeatedly for 2 years was US$ 3,598 lower than the non-occurrence group. Conclusions: Although it is important for the government to focus on medical assistance for households that have medical expense burdens, it needs to consider providing income indemnity insurance to protect them. [ABSTRACT FROM AUTHOR]

Background: Our objective was to investigate the impact of socioeconomic status and subjective social class on health-related quality of life (HRQOL) vs. overall quality of life (QOL). Methods: We performed a longitudinal analysis using data regarding 8250 individuals drawn from the Korean Longitudinal Study of Aging (KLoSA). We analyzed differences between HRQOL and QOL in individuals of various socioeconomic strata (high, middle, or low household income and education levels) and subjective social classes (high, middle, or low) at baseline (2009). Results: Individuals with low household incomes and of low subjective social class had the highest probability of reporting discrepant HRQOL and QOL scores (B: 4.796; P < 0.0001), whereas individuals with high household incomes and high subjective social class had the lowest probability of discrepant HRQOL and QOL scores (B: -3.625; P = 0.000). Similar trends were seen when education was used as a proxy for socioeconomic status. Conclusion: In conclusion, both household income/subjective social class and education/subjective social class were found to have an impact on the degree of divergence between QOL and HRQOL. Therefore, in designing interventions, socioeconomic inequalities should be taken into account through the use of multi-dimensional measurement tools. [ABSTRACT FROM AUTHOR]

Background: To investigate the impact of the gap between subjective and objective social status on health-related quality of life. Methods: We analyzed data from 12,350 participants aged ≥18 years in the Korean Health Panel Survey. Health-related quality of life was measured by EuroQol-Visual analogue scale. Objective (income and education) and subjective social class (measured by MacArthur scale) was classified into three groups (High, Middle, Low). In terms of a gap between objective and subjective social class, social class was grouped into nine categories ranging from High-High to Low-Low. A linear mixed model was used to investigate the association between the combined social class and health-related quality of life. Results: The impact of the gap between objective and subjective status on Health-related quality of life varied according to the type of gap. Namely, at any given subjective social class, an individual's quality of life declined with a decrease in the objective social class. At any given objective social class (e.g., HH, HM, HL; in terms of both education and income), an individual's quality of life declined with a one-level decrease in subjective social class. Conclusion: Our results suggest that studies of the relationship between social class and health outcomes may consider the multidimensional nature of social status. [ABSTRACT FROM AUTHOR]

Background: In Korea, more than two-thirds of hepatocellular carcinoma patients are hepatitis B virus (HBV) surface antigen-seropositive. The effects of HBV infection on health-related quality of life (HRQoL) are important aspects in the overall management of HBV infection. However, other effects of other parameters on HBV patient HRQoL remain unknown and require clarification. Our study evaluated HRQoL in hepatitis-B patients, according to socioeconomic status. Methods: We used community health survey data to analyze the relationship between HRQoL of HBV+ patients according to socioeconomic status. We used propensity score matching (Ratio = 1:5) to balancing the patients and general population. Final analytic sample consisted of 7,098 hepatitis B patients and compared group (35,490 general populations). We examined the HRQoL in HBV+ patients (n = 7,098), stratified by socioeconomic status, compared with general populations, using the EuroQOL visual analog scale (EQ-VAS) and EQ-5D questionnaires. We used the Chi-square test and ANOVA to compare demographic variables. Multiple linear regression analysis identified associations between demographic variables and HRQoL. Results: Participants with hepatitis B numbered 7,098 (16.7 %) of the study population. HRQoL was lower in hepatitis-B patients compared to the general population (EQ-VAS: -0.985, p = 0.0004; EQ-5D: -0.673, p = 0.0003). According to occupation type, clerks (EQ-VAS: -2.628, p = 0.0030; EQ-5D: -0.802, p = 0.0099) and managers and professionals (EQ-VAS: -1.518, p = 0.0356) had the lowest HRQoLs. Higher family income and education level groups had lower HRQoLs compared to the general population. Conclusions: Patients from higher socioeconomic status groups had HRQoLs that were more affected by hepatitis B. Thus, we require more accurate information about the disease to develop appropriate patient management guidelines. This will facilitate formulating policies and management strategies that alleviate HRQoL declines in HBV+ patients. [ABSTRACT FROM AUTHOR]

Background: Body mass index (BMI) has been used as an indirect predictor for the risk of metabolic syndrome. However, there are challenges in evaluating the risk of metabolic syndrome using BMI in certain parts of the world. Therefore, it is worth exploring additional factors that could supplement BMI to predict the risk of metabolic syndrome. In this study, we assessed the combined effect of BMI and perception for predicting metabolic syndrome. Methods: We used the fifth Korea National Health and Nutrition Examination Surveys (KNHANES V, 2010-12, N = 16,537) in this study. Multivariable logistic regression analysis was performed to examine the association while controlling for potential confounding variables. We also performed an analysis for the combined effect of BMI and perception of body size, and subgroup analysis by age group or moderate physical activity. Results: Data from 16,537 participants were analyzed in this study (males: 6,978, females: 9,559). Among them, metabolic syndrome was diagnosed in 1,252 (17.9 %) males and 2,445 (25.6 %) females, respectively. The combination of BMI and body size perception had a positive relation with the presence of metabolic syndrome. People who perceived themselves to be overweight for their body size had a higher risk for metabolic syndrome even if they have the same BMI. Conclusion: Our findings suggest that the combination of body size perception and BMI is useful in predicting the risk of metabolic syndrome. The use of complementary predictors could reduce the risk for inaccurate prediction of metabolic syndrome. [ABSTRACT FROM AUTHOR]

Background: A system for managing chronic disease including diabetes mellitus based on primary care clinics has been used in Korea since April 2012. This system can reduce copayments for patients that are managed by a single primary-care provider and lead to improve continuity of care. The aim of this study is to determine whether there is an association between continuity of care for outpatients and hospital admission and identify the continuity index that best explains hospital admissions for patients with type 2 diabetes. Methods: We performed a cross-sectional study using 2009 National Health Insurance Sample (NHIS) from the Health Insurance Review & Assessment Services (HIRA) of Korea. The dependent variable was hospital admission due to type 2 diabetes mellitus. Continuity of care was measured using the Usual Provider Care index (UPC), Continuity of Care index (COC), Sequential Continuity of Care index (SECON), and Integrated Continuity of Care index (ICOC). Results: Patients with low COC scores (<0.75) were more likely to be hospitalized [odds ratio, 2.44; 95% CI, 2.17-2.75] compared with the reference group (COC >0.75), after adjusting for all covariates. we calculated the area under the receiver operating characteristic (AUROC) curve for each index to find which index had the greatest explanatory ability for hospital admission. The AUROC of the COC was the greatest (0.598), but the AUROC curves for the UPC (0.597), SECON (0.593), and ICOC (0.597) were similar. Conclusions: High continuity of care may reduce the likelihood for hospital admission. The COC had marginally more explanatory power. [ABSTRACT FROM AUTHOR]

Background The prevalence and economic burden of chronic diseases are increasing worldwide. Nevertheless, little information is available on catastrophic health expenditures (CHE) associated with chronic diseases in Korea. This study explored the burden of household outof- pocket health expenditures among the Korean population for different chronic diseases. Methods This study was conducted utilizing data collected from the 7,006 households that participated in the Korea Health Panel Survey (KHPS) in 2008. The effect of CHE in relation to type of chronic disease was assessed via multiple logistic regression analysis. Results Roughly 3.5% of the participating households experienced CHE. As opposed to households headed by females and middle-aged individuals (40-59 years), those of low economic status, elderly households, and households with a member who suffered from a chronic disease were more likely to experience CHE. According to type of chronic condition, households with a member who suffered from cerebrovascular disease, diabetes, or chronic kidney disease were at a significantly higher risk of experiencing CHE. Conclusion Although Korea has greatly expanded its health insurance coverage, financial protection against CHE remains a concern. Policy-makers need to focus on expanding benefits according to the economic burden of individual chronic conditions. [ABSTRACT FROM AUTHOR]

Background The divorce rate has been increasing rapidly in Korea; the single rate and trends in divorce are also changing rapidly. This study aimed to examine the relationship between marital status and quality of life (QOL) in an attempt to understand these changes. We also investigated the relationship between QOL and marital status by age group. Methods We used data from the Community Health Survey (2008: n = 200,800; 2009: n = 227,700; 2010: n = 229,229) administered by the Korean Centers for Disease Control and Prevention. After excluding 63,527 participants with incomplete information on QOL and/or marital status, the final analysis involved 594,202 participants. The analysis used t-tests and Chisquare tests to compare demographic variables between men and women, and ANOVA to compare QOL scores among comparison groups. We also performed a multilevel analysis on the relationship between QOL and marital status while accounting for the provincial differences. Results The multilevel analysis by marital status showed that single men had significantly worse QOL (both EQ-VAS and EQ-5D) than married men. On the other hand, the QOL measured by EQ-VAS was better in single women than in married, and separated or divorced women. When QOL was assessed using EQ-5D, single and separated or divorced women had worse scores than married women. In the analysis by age group, the QOL of married men under the age of 30 years was lower than that of single men or men with marriage problems as measured by EQ-VAS. However, among 40-69-year-old men, married men had the highest QOL values. Similarly, for women in their 30s, single women had the highest EQ-VAS values, but for 40-69-year-old women, single women had lower EQ-VAS scores than married women. Conclusion There was significant relationship between marital status and QOL, and this relationship appeared to differ by gender and age. [ABSTRACT FROM AUTHOR]