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Background Recent life expectancy gains in high-income Asia-pacific countries have been largely the result of postponement of death from non-communicable diseases in old age, causing rapid demographic ageing. This study compared and quantified age- and cause-specific contributions to changes in old-age life expectancy in two high-income Asia-pacific countries with ageing populations, South Korea and Japan. Methods This study used Pollard’s actuarial method of decomposing life expectancy to compare age- and cause-specific contributions to changes in old-age life expectancy between South Korea and Japan during 1997 and 2017. Results South Korea experienced rapid population ageing, and the gaps in life expectancy at 60 years old between South Korea and Japan were reduced by 2.47 years during 1997 and 2017. Decomposition analysis showed that mortality reductions from non-communicable diseases in South Korea were the leading causes of death contributing to the decreased gaps in old-age life expectancy between the two countries. More specifically, mortality reductions from cardiovascular diseases (stroke, ischaemic and hypertensive heart disease) and cancers (stomach, liver, lung, pancreatic cancers) in South Korea contributed to the decreased gap by 1.34 and 0.41 years, respectively. However, increased mortality from Alzheimer and dementia, lower respiratory tract disease, self-harm and falls in South Korea widened the gaps by 0.41 years. Conclusions Age- and cause- specific contributions to changes in old-age life expectancy can differ between high-income Asia-pacific countries. Although the gaps in old-age life expectancy between high-income Asia-pacific countries are primarily attributed to mortality changes in non-communicable diseases, these countries should also identify potential emerging threats of communicable diseases and injuries along with demographic ageing in pursuit of healthy life years in old age.

BackgroundEthiopia has experienced great improvements in life expectancy (LE) at birth over the last three decades. Despite consistent increases in LE for both males and females in Ethiopia, the country has simultaneously witnessed an increasing discrepancy in LE between males and females.MethodsThis study used Pollard’s actuarial method of decomposing LE to compare age- and cause- specific contributions to changes in sex differences in LE between 1995 and 2015 in Ethiopia.ResultsLife expectancy at birth in Ethiopia increased for both males and females from 48.28 years and 50.12 years in 1995 to 65.59 years and 69.11 years in 2015, respectively. However, the sex differences in LE at birth also increased from 1.85 years in 1995 to 3.51 years in 2015. Decomposition analysis shows that the higher male mortality was consistently due to injuries and respiratory infections, which contributed to 1.57 out of 1.85 years in 1995 and 1.62 out of 3.51 years in 2015 of the sex differences in LE. Increased male mortality from non-communicable diseases (NCDs) also contributed to the increased difference in LE between males and females over the period, accounting for 0.21 out of 1.85 years and 1.05 out of 3.51 years in 1995 and 2015, respectively.ConclusionsWhile injuries and respiratory infections causing male mortality were the most consistent causes of the sex differences in LE in Ethiopia, morality from NCDs is the main cause of the recent increasing differences in LE between males and females. However, unlike the higher exposure of males to death from injuries due to road traffic injuries or interpersonal violence, to what extent sex differences are caused by the higher male mortality compared to female mortality from respiratory infection diseases is unclear. Similarly, despite Ethiopia’s weak social security system, an explanation for the increased sex differences after the age of 40 years due to either longer female LE or reduced male LE should be further investigated.

Under-5 child mortality decreased throughout the world by 49% from 1990 to 2013. However, it is unknown if this reduction was more effectively achieved in countries with a higher child mortality burden. We investigated the reduction of cause-specific global child mortality burden in 2000-2010. A total of 195 countries were selected for this analysis. A random-effect or fixed-effect model was chosen based on the Hausman test. Countries with a higher child mortality rate performed better with regard to the prevention of child deaths from major infectious diseases, but cause-specific progress was highly variable by disease within each country. Pneumonia-specific progress was much slower than that for diarrhea, and neonatal-specific child mortality increased in some countries. With a few exceptions, the overall performance in the countries with the largest share of child deaths was not good. This study identified priority interventions for child survival in the post-2015 period.

Although several studies have reported that social isolation is one of the important health risk factors in the elderly population living in urban areas, its effects on vulnerability to heatwaves have been studied relatively less than climatic and other socio-economic factors. Thus, we investigated the association between social isolation levels and heatwave-related mortality risk in the elderly population in 119 urban administrative districts in Korea, using a time-series multi-city dataset (2008–2017). We used a two-stage analysis. In the first stage, we estimated the heatwave-related mortality risk in the elderly population (age ≥ 65) for each district using a time-series regression with a distributed lag model. Subsequently, in the second stage, we applied meta-regressions to pool the estimates across all the districts and estimate the association between social isolation variables and heatwave-related mortality risk. Our findings showed that higher social gathering and mutual aid levels were associated with lower heatwave-related mortality risk. Further, the lower percentage of single elderly households living in detached houses was also related to higher heatwave-related mortality risk. The associations were generally more evident in males compared to females. Our findings suggest that vulnerability to heatwave-related mortality among the urban, city-dwelling, elderly population may be amplified by higher isolation indicators.

Ethiopia's average life expectancy has improved by more than 18 years from 1990 to 2015. This initiated interest to study the gain in life expectancy with respect to age structure and cause of death. Applying a life expectancy decomposition technique on secondary data obtained from the Institute of Health Metrics and Evaluation, the study found that the burden of disease in Ethiopia has declined from 626.18 in 1990 to 225.69 in 2015 per 1000 population measured in age-standardized rate of life years lost. The major causes of burden in 1990; namely lower respiratory tract infections, neonatal disorders, diarrheal diseases and neglected tropical diseases at rates of 89.2, 63.2, 61.2, and 42.2 age-standardized years of life lost per 1000 population respectively; have shown a fast decline in 2015. Deaths from neglected tropical disease showed 94.95% reduction, contributing to 5.71(27.30%) years gain in life expectancy followed by lower respiratory tract infection and diarrheal disease contributing about 4.65 years (22.23%) and 1.48 years (7.10%) respectively. On the other hand, about 3.3 (15.73%) years and 6.4 (30.71%) years of increase in life expectancy are achieved through improved longevity in infants and children aged 1-4 years respectively. In conclusion, the study found that reductions in under-five child mortality and decline in burden of major communicable diseases could explain the major gain in life expectancy. However, findings also revealed that the prevalence of non-communicable diseases and injuries are on the rise calling for the need to be addressed by the public health system.

Background Ethiopia, the second most populous country in Africa, has a total fertility rate of 4.6, a decrease from 5.5 in 2000. However, only 35.3% of women in the reproductive age group use modern family planning (FP) methods, and the 22.3% of them who have an unmet need for family planning is among the highest rates in sub-Saharan African countries. The Small, Happy, and Prosperous family in Ethiopia (SHaPE) is one of the country’s first comprehensive multimedia family planning campaigns. Its purpose is to increase FP-related knowledge, attitude, and practice of Ethiopians, particularly women of reproductive age. Methods/Design The SHaPE campaign has multiple components: (1) a nationwide representative survey, which serves as formative research to identify region-specific and culture-appropriate media, messages, and barriers and determinants of family planning; (2) a multimedia communication campaign intervention, including radio dramas and other interpersonal, community-level, and mass media channels; and (3) campaign evaluation, including pre-, process-, and post-evaluation research using both quantitative and qualitative methodologies. The main target population for SHaPE is reproductive age women and men in three regions: Amhara, Oromia, and Somali. These regions take up about 66.6% of the entire country and have distinct ethnicities, cultures, and languages. Discussion SHaPE contributes to existing family planning research and intervention because it is theory- and evidence-based, and it employs integrated marketing communications and entertainment-education approaches with key messages that are tailored to audiences within unique cultures. But even within a country, a nationwide campaign with uniform messages is neither possible nor desirable due to different cultures, norms, and languages across regions. Last, media campaigns in developing and underdeveloped countries require constant monitoring of political situations.

Background In order to provide essential scientific evidence on the population's health status and social health determinants as well as the current capacity of the health care system in Vietnam to health policy makers and managers, Vietnam Ministry of Health, Hanoi University of Public Health, Hanoi Medical University, and Ho Chi Minh University of Medicine and Pharmacy collaborated with Seoul National University (Korea) and conducted a health system survey in the Quoc Oai district (of Hanoi capital) that represented northern rural Vietnam. Methods The study design was a cross-sectional study. The survey covered different topics (more than 200 questions) and was administered in three separate questionnaires: 1) Basic information of all household members; 2) Household characteristics; and 3) Individual characteristics. Socio-demographic characteristics among the households and individuals were collected from 2,400 households sampled by multi-stage cluster sampling method: more than 200 questions. Results The household size of Quoc Oai was larger than the national average and there was no significant difference in gender composition. In addition, the proportions of pre-elderly, age 55–64, and elderly group (65 years old and over) were higher than the national population statistics. In this context, demographic transition has begun in Quoc Oai. Conclusion This study design description provides the basic information about a baseline survey of a future prospective cohort (as a part of a collaborative project on strengthening the health system in Vietnam) to the prospective data user of this survey., Graphical Abstract

The Sewol ferry disaster severely shocked Korean society. The objective of this study was to explore how the public mood in Korea changed following the Sewol disaster using Twitter data. Data were collected from daily Twitter posts from 1 January 2011 to 31 December 2013 and from 1 March 2014 to 30 June 2014 using natural language-processing and text-mining technologies. We investigated the emotional utterances in reaction to the disaster by analyzing the appearance of keywords, the human-made disaster-related keywords and suicide-related keywords. This disaster elicited immediate emotional reactions from the public, including anger directed at various social and political events occurring in the aftermath of the disaster. We also found that although the frequency of Twitter keywords fluctuated greatly during the month after the Sewol disaster, keywords associated with suicide were common in the general population. Policy makers should recognize that both those directly affected and the general public still suffers from the effects of this traumatic event and its aftermath. The mood changes experienced by the general population should be monitored after a disaster, and social media data can be useful for this purpose.

BACKGROUND: Migrant workers now represent an increasing percentage of workers in Korea, but few studies have evaluated work-related health risks in this population. In this study, we explored the relative risk of occupational injuries and diseases in migrant workers compared with native Korean workers. METHOD: An analysis of work-related injuries and diseases among migrant workers in Korea during 2005-2007 was conducted in each industrial subsector using nationwide data. RESULTS: Risks of fatal and non-fatal occupational injuries for migrant workers were considerably higher than their Korean counterparts. The industry-adjusted standard mortality ratios of fatal occupational injuries were 1.89 (1.45-2.47), 2.29 (1.81-2.88), and 1.73 (1.36-2.22) for 2005, 2006, and 2007, respectively. CONCLUSIONS: A greater proportion of migrant workers is exposed to higher risks of occupational safety and health issues than their Korean counterparts, demonstrating that the occupational safety and health of migrant workers requires more attention than that of Korean workers. Am. J. Ind. Med. © 2014 Wiley Periodicals, Inc. Language: en

Background Emerging and re-emerging infectious diseases are a significant public health concern, and early detection and immediate response is crucial for disease control. These challenges have led to the need for new approaches and technologies to reinforce the capacity of traditional surveillance systems for detecting emerging infectious diseases. In the last few years, the availability of novel web-based data sources has contributed substantially to infectious disease surveillance. This study explores the burgeoning field of web-based infectious disease surveillance systems by examining their current status, importance, and potential challenges. Methods A systematic review framework was applied to the search, screening, and analysis of web-based infectious disease surveillance systems. We searched PubMed, Web of Science, and Embase databases to extensively review the English literature published between 2000 and 2015. Eleven surveillance systems were chosen for evaluation according to their high frequency of application. Relevant terms, including newly coined terms, development and classification of the surveillance systems, and various characteristics associated with the systems were studied. Results Based on a detailed and informative review of the 11 web-based infectious disease surveillance systems, it was evident that these systems exhibited clear strengths, as compared to traditional surveillance systems, but with some limitations yet to be overcome. The major strengths of the newly emerging surveillance systems are that they are intuitive, adaptable, low-cost, and operated in real-time, all of which are necessary features of an effective public health tool. The most apparent potential challenges of the web-based systems are those of inaccurate interpretation and prediction of health status, and privacy issues, based on an individual’s internet activity. Conclusion Despite being in a nascent stage with further modification needed, web-based surveillance systems have evolved to complement traditional national surveillance systems. This review highlights ways in which the strengths of existing systems can be maintained and weaknesses alleviated to implement optimal web surveillance systems. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3893-0) contains supplementary material, which is available to authorized users.

Background: The effects of socio-economic factors on suicide were gender-dependent. Japanese suicide mortality gender ratio (male: female) had gradually increased during the twentieth century. Methods: With the data covering 1947-2010 collected from Japanese official websites, we conducted non-parametric rank test, curve estimations, spearman ranking correlation and quantile regression in succession with Stata version 12.0. Results: The suicide mortality rate in male with a "U" shape had been always higher than that in female with a "J" shape. The male suicide mortality peaked around in 1955 (38.5 per 100,000 populations), dropped quickly afterwards until the 19705; it increased in the 19805 with another peak in 2003 (33.2 per 100,000 populations). For female, an overall decreasing trend was seen with a peak during the 1950s (23.5 per 100,000 populations in 1958). It dropped gradually afterwards with small variations in 1970s and 80s, and was stabilized after 1995 (9.3 per 100,000 populations). The unemployment rate could be used as a single positive predictor of suicide mortality for men (p < 0.01), while the total fertility rate (TFR) (p < 0.01) and divorce rate (p < 0.01) were significantly associated positively and negatively with women's suicide, respectively. Limitations: The impact of mental disorders was not analyzed and age specific analysis was not conducted. Conclusion: The findings of these gender differences in, and the associated factors with, suicide in Japan, warranted further studies including delineation of the implications of differential economic pressure between genders, as well as child rearing pressure and marriage satisfaction. (C) 2013 Elsevier B.V. All rights reserved.

Purpose:Suicide is the leading cause of death among Korean adolescents. This study investigates the cross-sectional relations of physical activity with suicidal ideation and attempts in adolescents, simultaneously considering previously reported risk factors of suicide such as depression, stress, and body image.Methods:This study used the 2007 Korea Youth Risk Behavior Web-based Survey (KYRBWS). Four hundred middle schools and 400 high schools in Korea were monitored, and 74,698 students completed the questionnaire. Logistic regression analysis was conducted to investigate the relationship between physical activity and suicidal ideation and attempts, progressively adjusting for body image, depression and stress.Results:After controlling for body image, stress, and depression, the significant relationship between physical activity and suicidal ideation disappeared, and the only remaining relationship was a positive relationship between frequent vigorous physical activity and suicide attempts. No sex differences were found after adjusting for all the variables.Conclusion:Unlike the general expectation that physical activity protects adolescents from suicidal behaviors, the results from this study suggest that physical activity does not have protective effect. Korean adolescents who perform frequent vigorous physical activities are more likely to attempt suicide.

Background: Ethiopia, a sub-Saharan country with over 94 million populations growing at a rate of 2.6 percent is showing a fast socio-economic improvement. According to World Health Organization 2014, life expectancy in the country has increased by about 19 years with in the last two decades. It has also reduced child mortality by 2/3rd; two years ahead of millennium development goal deadline. This research will focus in decomposing the improvement in life expectancy in the country from 1990 to 2010. Methods: We used a secondary data on cause and age specific mortality estimate of Ethiopia from institute of health metrics and evaluation. Burden of disease is measured using potential life years lost and potential life years gained using survival 6 program and compared across time. Further improvement in life expectancy is decomposed across age and specific causes using Pollard’s life expectancy decomposition method. Results: Burden of disease measured in weighted years of life lost (YLL) shows that lower respiratory infection at a value of 5.35, neonatal disorders [4.058], diarrheal diseases [3.6], neglected tropical diseases [2.4], meningitis [1.49] and tuberculosis [1.19] are the top causes of burden in 1990 which showed a slight shift in 2010. Lower respiratory tract infections showed the highest reduction in YLL by about 41.27%, followed by diarrheal disease (32.8%) and meningitis (26.46%). Decomposition of life expectancy shows among the total 15.25 years increase in life expectancy from 1990 to 2010, about 5.8 (35.78%) years of increase in life expectancy is achieved through improved longevity in children’s aged 1- 4 year. On the other hand diarrheal diseases reduction contributes about 3.12 [15.96%] followed by lower respiratory infection about 2.54 [12.98%], neglected tropical diseases by 1.45 [7.43%] and tuberculosis by 1.2 [6.25%] years. Conclusions and recommendation: Burden of disease in Ethiopia has declined dramatically which has contributed to the improvement in life expectancy, with the highest reduction already recorded in major communicable diseases. Though it is encouraging that mortality from children has reduced in the country, the slow change in mortality and burden of disease in the general adult population needs future public attention.

This study examined the association between individuals' proportion of life spent in the United States and the health status and health behaviors among Korean immigrants aged 25 and above. The analysis is stratified by level of education to test whether a higher proportion of time spent in the United States is associated with poorer health among both less educated and highly educated Korean immigrants. California health interview survey data from 2005 to 2007 were used to estimate logistic regression models of health and health behaviour among Korean immigrants, stratified by educational attainment. The health and health behaviour of less educated Korean immigrants tended to be worse among those with a higher proportion of residence in the United States. However, more highly educated Korean immigrants tended to exhibit lower odds of being unhealthy and lower odds of poor health behavior with a higher proportion of life spent in the United States. Acculturation is not always associated with poorer immigrant health outcomes. A higher proportion of life spent in the United States tends to be associated with more favorable health and health behavior among highly educated Korean immigrants.

Background: Despite the importance of obesity and its association with socioeconomic status, little is known about this condition in Korean adolescents. We examined the relationship between obesity in Korean adolescents and several socioeconomic variables and compared the association of obesity with conventional and subjective indicators of socioeconomic status.Methods: The study comprised 60 643 Korean adolescents aged 12 to 18 years who participated in the 2007 Korea Youth Risk Behavior Web-Based Survey. The dependent variable, obesity, and the independent variables of parental education levels, family affluence scale, subjective family economic status, and subjective school achievement were collected by using a self-administered anonymous questionnaire. Data on behavioral and psychological characteristics were also collected and used as confounding factors. Multivariate logistic regression was conducted to identify associations between socioeconomic status and obesity.Results: In the descriptive analysis, adolescents with low parental education, low family affluence level, low subjective family economic status, and low subjective school achievement were more likely to be obese. However, after controlling for other risk factors in multivariate analysis, only the associations with subjective family economic status and subjective school achievement remained statistically significant.Conclusions: Our results provide further evidence that the prevalent pattern of obesity in Korean adolescents—i.e., the inverse relationship between obesity and socioeconomic status—is similar to that in developed countries. In addition, these findings support the hypothesis that, as compared with objective socioeconomic status, subjective social status is more closely related to obesity.

Background: Suicide is one of the leading causes of mortality in both South Korea and Japan. Aims: The study aims to compare the descriptive epidemiology of suicide over the last two decades (1985–2006) and to explore the conditions associated with the different distribution of suicides in both countries. Methods: Age-standardized suicide rates were obtained from the OECD Health Data 2009. Age-specific suicide rates for the age groups were calculated from the WHO Mortality Database. Suicide methods were identified based on ICD-10. Results: Through 1980–2000, Japan showed consistently higher suicide rates compared to Korea. However, from the mid-1990s, Korea showed an acute increase of suicides and finally surpassed Japan; the age-standardized suicide rate of Korea increased from 10.2 (per 100,000) in 1985 to 21.5 in 2006, while it slightly increased from 18.4 to 19.1 in Japan. The highest age-specific suicide rate was observed among Japanese men aged 45–64 years and Korean men aged over 64 years. The increase of elderly suicides among Korean women was notable. The gender ratio increased in Japan and decreased in Korea, respectively. The preferred suicide methods were hanging and pesticide poisoning in Korea and hanging in Japan. Because of the limited number of observations, hypothesis testing of specific risk factors was not possible. Conclusions: Age and gender distribution of suicide rates differed considerably between the two countries. Welfare protection throughout the life course in both countries, and pesticide regulation in Korea would be helpful in reducing the burden of suicide mortality in both countries, even if the social values could not be changed in a short time.

Although the number of North Koreans seeking asylum in South Korea has increased notably in recent years, studies on the health of North Koreans residing in South Korea are rare. This study examined the roles of social inclusion and the length of stay on refugees' self-rated health.Employing a data set (n = 1,111) created by the South Korean government, we conduct multivariate logistic regression analyses.We found that degree of familiarity with South Koreans, employed as an indicator of social inclusion, was significantly associated with North Korean refugees' self-rated health status. Further, self-rated health seemed to be poorest when the duration of stay in South Korea reached about 2-4 years. Self-rated health outcomes improved after this time period.Social inclusion through close contacts with South Koreans and overcoming an arduous adaptation period, as well as addressing economic deprivation, are important in promoting the health of North Korean refugees in South Korea. These findings should be considered in crafting better resettlement and training programs for this population.

Some epidemiological literature has observed that air pollution effects on health differed across regional or individual socioeconomic position. This study evaluated whether regional and individual socioeconomic position, as indicated by health insurance premiums, modified the effect of air pollution on hospital visits for asthma. Effects of ambient air pollutants (particulate matter, carbon monoxide, sulfur dioxide, nitrogen dioxide, and ozone) on 92,535 emergency out-patient hospital visits for asthma in Seoul, Korea during 2002 were estimated using case-crossover analysis, adjusting for time trend, weather conditions, and seasonality. Next, interactions between air pollutants and Korean National Health Insurance premium (1) for the individual patient and (2) averaged across the patient’s residence district, were entered, first singly then jointly, in the models. Relative risks of emergency outpatient hospital visits were all positively and significantly associated with interquartile increases for selected lags for all air pollutants. In the regression model with interaction terms for both individual premium and regional-average premium, associations with all five-air pollutants ranged from 1.03 to 1.09 times higher among the lowest premium districts compared to the highest premium districts. Of all the pollutants, nitrogen dioxide showed the strongest associations in lower premium districts compared to the higher premium districts. Individual socioeconomic position did not modify the associations in either the single or joint interaction models. In Seoul, community but not individual socioeconomic conditions modified risk of asthma hospital visits on high air pollution days.

In the past two decades, the size of the Korean American population has notably increased. Despite this, there has been little research on the perinatal health of this population. This paper examines which and to what extent maternal risk factors are associated with birth outcomes (prematurity and intrauterine growth retardation [IUGR]) among Korean Americans, particularly focusing on maternal nativity and residential proximity to other Koreans. The authors employ the National Center for Health Statistics Linked Birth/Infant Death Files for 1995–1997, pooled and linked with contextual information obtained from the 2000 Census Summary File 1 for seven selected states. Major findings, based on multinomial logistic regression models, suggest that maternal educational attainments and the status of prenatal care are strong predictors of adverse birth outcomes among this population. Although descriptive analysis indicates an elevated risk of adverse birth among U.S.-born Korean women, compared to their foreign-born counterparts, the control of prenatal care eliminates the effect of maternal nativity. Social proximity to co-ethnics, measured by the population size of Koreans in counties, has little influence on birth outcomes among Korean Americans.

This study examines the role of the perception of neighborhood quality with respect to its influence on adult health in Korea. Employing the Quality of Korean Life Survey 2001, we found that the extent to which respondents perceive their neighborhood quality selectively affects the health of adult Koreans. That is, how individuals are satisfied with overall neighborhood characteristics, with neighborhood safety and with relationships to neighbors is considerably and significantly associated with self-rated and emotional health status among Koreans, net of individual demographic and socioeconomic characteristics. Although not statistically significant, the same direction of effect is found for daily activity limitation status, which may have been significant if a larger sample size were considered. This study also demonstrates that most individual demographic and socioeconomic risk factors are associated with health in a pattern consistent with that generally found in most Western societies, with the exception of the effect of education on psychological aspects of health.

This article examines subgroup differences in the health status of Hispanic adults in comparison to non-Hispanic whites and non-Hispanic lacks. We pay particular attention to the influences of nativity and duration of residence in the United States. Data are pooled from the National Health Interview Survey (NHIS) for 1989–94. Puerto Ricans exhibited the worst health outcomes of any group (including whites and blacks) for each of the three health measures. Persons of Central/South American origin exhibited the most favorable outcomes for activity limitations and bed sick days, advantages that were eliminated when controlled for nativity/duration. For two of the three health status variables, Mexican Americans were very similar to non-Hispanic whites in baseline models and were more favorable than non-Hispanic whites once socioeconomic factors were controlled; this was not the case, however, for self-reported overall health. Immigration also helped to explain the relatively positive outcomes among Central/South American origin individuals, Cubans, and Mexican Americans. For most Hispanic groups (as well as non-Hispanic whites and non-Hispanic blacks), immigrants reported better health than the U.S. born, which is consistent with a selectivity hypothesis of immigrant health. In addition, this advantage tended to be significantly smaller among immigrants with ten or more years’ duration in the United States. Although the latter finding is consistent with the negative acculturation hypothesis, alternative interpretations, including the generally more limited access of immigrants to the formal health care system, are suggested.

Backgrounds This study examines social inequalities in life expectancy and mortality during the transition period of the Korean economic crisis (1993–2010) among Korean adults aged 40 and over. Methods Data from the census and the national death file from the Statistics Korea are employed to calculate life expectancy and age-specific-death-rates (ASDR) by age, gender, and educational attainment for five years: 1993, 1995, 2000, 2005, and 2010. Absolute and relative differences in life expectancy and Age-Specific Death Rates by educational attainment were utilized as proxy measures of social inequality. Results Clear educational gradient of life expectancy was observed at age 40 by both sexes and across five time periods (1993, 1995, 2000, 2005, and 2010). The gradient became notably worse in females between 1993 and 2010 compared to the trend in males. The educational gradient was also found for ASDR in all five years, but it was more pronounced in working age groups (40s and 50s) than in elderly groups. The relative disadvantage of ASDR among working age Korean adults, both males and females, became substantially worse over time. Conclusions Social inequalities in life expectancy and ASDR of the working age group across socioeconomic status over time were closely related to the widening of the social difference created by the macroeconomic crisis and the expansion of neo-liberalism in Korea.

This study aimed to examine whether the relative importance of maternal age as a correlate of adverse birth outcomes has changed and to investigate if social inequalities in birth outcomes have widened during the past decade when the marriage and fertility related social environment has undergone tremendous change in Korea. Probabilities of adverse birth outcomes (prematurity and intrauterine growth retardation [IUGR]) were estimated with multinomial logistic regression models, utilizing the Korean birth registration data of 1995 and 2005. The main effects of maternal age and parental socioeconomic characteristics were compared between two study years, net of infant sex, birth order, and plurality. The association between maternal age and adverse birth outcomes, relative to the maternal and parental social characteristics, has clearly diminished between 1995 and 2005. During this period, differences in prematurity and IUGR by maternal age have also diminished, while those by parental social characteristics, particularly maternal education, have substantially widened. The intensified overall socioeconomic polarization since the economic crisis of the late 1990s is most likely responsible for the increased social inequality in adverse birth outcomes in Korea. A massive structural change in macro-economic conditions and culture during the study period may have modified the relationship between maternal age and birth outcomes.

BACKGROUND: This study examined the mediating function of body weight perception (BWP) in the relation between body mass index (BMI) and unhealthy weight control behaviors (UWCBs; eg, fasting, using diet pills, or laxatives), and between BMI and suicidal ideation. It also explored the correlation between exposure to multiple UWCBs and suicidal ideation among Korean adolescents. METHODS: Data on BMI, BWP, UWCBs, and suicidal ideation were obtained from the 2006 Korean Youth Risk Behavior Web-based Survey, a school-based survey conducted on a nationally representative sample of students in grades 7-12 (36,463 boys and 33,433 girls). Data were analyzed using bivariate and multivariate logistic regression. RESULTS: BMI was significantly associated with both UWCB and suicidal ideation among boys and girls, even after controlling for covariates. However, the significance and magnitude of the association between BMI and UWCB were considerably attenuated when BWP was added to the model. When BWP was included, the association between overweight BMI status and suicidal ideation became nonsignificant in both sexes, whereas the association between underweight BMI status and suicidal ideation remained significant among boys. Adolescent boys and girls engaging in multiple UWCBs were at greater risk for experiencing suicidal thoughts. CONCLUSIONS: This study suggests that BWP represents a potential mediator between BMI and UWCB, and between BMI and suicidal ideation among both boys and girls. Thus, school programs addressing issues related to BWP should be developed and targeted at adolescents to reduce the potential risks for both UWCB and suicidal behavior. Language: en

Objectives : This study was conducted to examine the mediating function of body weight perception (BWP) on the relationship between body mass index (BMI) and unhealthy weight control behaviors (UWCB: e.g., fasting, or taking diet pills or laxatives) and between BMI and depressed mood, and to explore the effect of distorted BWP on UWCB and depressed mood among adult women. Methods : A regionally representative sample of 8,581 women aged 20-64 years residing in Seoul, the capital of Korea, completed the 2001 Seoul Citizens Health Indicator Survey which provides self-reported information about height, weight, BWP, UWCB, depressed mood, demo graphic/socioeconomic characteristics, and health-related behaviors. Data were analyzed using bivariate and multivariate logistic regression. Results : BMI was significantly associated both with UWCB and depressed mood, even controlling for all covariates. However, the magnitude and significance of each association was considerably attenuated when BWP was taken into account, indicating that BWP functioned, in part, as a mediator between BMI and UWCB and between BMI and depressed mood, respectively. Among the combinations of BMI and BWP, women who perceived themselves to be heavier than their actual BMls appeared more likely to use UWCB, whereas women who had a distorted BWP, either underestimation or overestimation as compared with their BMIs, tended to be at greater risk for depressed mood than those who had an undistorted BWP. Conclusions : These findings suggest that how women perceive their body weight may be an important predictor and/or mediator of UWCB and depressed mood among adult Korean women.

Objectives: This study was conducted in order to determine how the association between socioeconomic position(SEP) and health status changes with age among Seoul residents aged 25 and over. Methods: We utilized the 2001 and 2005 Seoul Citizens Health Indicators Surveys. We used self-rated 'poor' health status as an outcome variable, and family income as an indicator of SEP. In order to characterize the differential effects of socioeconomic position on health by age, we conducted separate multivariate analyses by 10-year age groups, controlling for sociodemographic covariates. In order to assess the relative health inequality across socioeconomic groups, we estimated the Relative Index of Inequality (RII). Results: The risk of 'poor health' is significantly high in low family income groups, and this increased risk is seen at all ages. However, the magnitude of relative socioeconomic inequality in health, as measured by the odds ratio and RII, is not identical across age groups. The difference in health across income groups is small in early adulthood (ages 25-34), but increases with age until relatively late in life (ages 35-64). It then decreases among the elderly population (ages more than 65). When the RII reported in 2005 is compared to that reported in 2001, RII can be seen to have increased across all ages, with the exception of individuals aged 25-34. Conclusions: The magnitude of health inequality is the greatest during mid- to late adulthood (ages 45-64). In addition, health inequalities have worsened between 2001 and 2005 across all age groups after economic crisis.

Objectives: To determine the disparity in the rate people undergo health examinations according to socioeconomic position (SEP) and the changes in this disparity with time. Methods: Seoul citizens' health profile data from 1997 to 2005 were analyzed. The study subjects were 40 years old and over, and the total number of subjects was 6,601 in 1997, 8,994 in 2001, and 8,819 in 2005. Those aged 60 years and over were eliminated from the analysis of subjects' occupation. We used education, family income and occupation as indicators of SEP. The age-standardized health examination attendance rate for each year was calculated according to the education, family income and occupation. The odds ratios (ORs) from multiple logistic regressions were adjusted for age. Results: The disparity in the rate of attendance according to the SEP decreased from 1997 to 2005 but still existed. Even though the disparities among the subgroups according to education, family income and occupation were not that high, the disparity between the group with the highest SEP and the other groups was considerable. Conclusions: Our findings suggest that unequal access to health examination services according to socioeconomic position still exists. This disparity has decreased recently but the disparity according to level of education was the greatest.

The authors used the 1992-1995 National Health Interview Survey to examine the effect of immigrant status (both nativity and duration of residence in the United States) on the health of Asian and Pacific Islander adults by constructing models in which national origin was also specified. In logistic regression models adjusted for age, marital status, living arrangement, family size, and several socioeconomic indicators, immigrants were found to be in better health than their US-born counterparts, but their health advantages consistently decreased with duration of residence. For example, for Asian and Pacific Islander immigrants whose duration of residence was less than 5 years, 5-9 years, and 10 years or more, the odds ratios for activity limitations were 0.45 (95% confidence interval (CI): 0.33, 0.62), 0.65 (95% CI: 0.46, 0.93), and 0.73 (95% CI: 0.60, 0.90), respectively. Similar findings emerged for respondent-reported health and bed days due to illness. These results support the validity and complementarity of the migration selectivity and acculturation hypotheses. However, the picture was not uniformly positive. The health of certain Asian and Pacific Islander groups, notably Pacific Islanders and Vietnamese, was found to be less favorable than average. Finally, after adjustment for health status, immigrants seemed to have less adequate access to formal medical care.

Background Suicide among adults in the Korean population merits study to improve the understanding of the salient risk and protective factors because suicide rates in Korea have increased dramatically over the past 20 years. However, the association between social participation and suicidal ideation is poorly understood. Thus, this study aimed to identify the components of social participation in Korean society and to examine the processes through which the components of social participation influence the degree of suicidal ideation people experience across age groups. Methods This study used survey data from the 2010 Seoul Welfare Panel Study. The sample population was restricted to adults aged 20 or older and was categorised into three groups by respondents’ ages. The groups were defined as 'young adults’ (aged 20–39), 'middle-aged adults’ (aged 40–64) and 'the elderly’ (age 65 or more). Three dimensions of social participation were identified by factor analysis – friendship network and hobby group, religious involvement, and instrumental social participation. Results In the young adult group, only instrumental participation was statistically significant (-0.10, p = 0.06). In the middle-aged adult group, only friendship network and hobby group had a strong association with suicidal ideation (-0.11, p = 0.01). Interestingly, for the elderly, religious involvement was related to suicidal ideation, but in a positive way (0.26, p = 0.02). Conclusion The study results supported the theory that different components of social participation are associated with a lower risk of suicidal ideation in different stages of adulthood.