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Determinants of unhealthy living by gender, age group, and chronic health conditions across districts in Korea using the 2010-2017 Community Health Surveys
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Thi Tra Bui, Thi Huyen Trang Nguyen, Jinhee Lee, Sun Young Kim, Jin-Kyoung Oh
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Epidemiol Health. 2024;46:e2024014. Published online January 4, 2024
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DOI: https://doi.org/10.4178/epih.e2024014
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 Abstract
Summary
 PDF Supplementary Material
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Abstract
OBJECTIVES
We investigated the prevalence and determinants of unhealthy living by gender, age, and comorbidities across Korean districts.
METHODS For 806,246 men and 923,260 women from 245 districts who participated in the 2010-2017 Korean Community Health Surveys, risk scores were calculated based on obesity, physical inactivity, smoking, and high-risk alcohol consumption, each scored from 0 (lowest risk) to 2 (highest risk). A risk score ≥4 was defined as indicating unhealthy living, and weighted proportions were calculated for each district. Using multivariate regression, an ecological model including community socioeconomic, interpersonal, and neighborhood factors was examined by gender, age, and comorbidities.
RESULTS The mean age-standardized rate of unhealthy living was 24.05% for men and 4.91% for women (coefficients of variation, 13.94% and 29.51%, respectively). Individuals with chronic diseases more frequently exhibited unhealthy lifestyles. Unhealthy lifestyles were associated with educational attainment (β-coefficients: men, -0.21; women, -0.15), high household income (β=0.08 and 0.03, respectively), pub density (β=0.52 and 0.22, respectively), and fast-food outlet density (β=2.81 and 1.63, respectively). Negative associations were observed with manual labor, social activity participation, and hospital bed density. Unhealthy living was positively associated with living alone among women and with being unemployed among middle-aged men. Access to parks was negatively associated with unhealthy living among young men and women. The ecological model explained 32% of regional variation in men and 41% in women.
CONCLUSIONS Improving the neighborhood built and socioeconomic environment may reduce regional disparities in lifestyle behaviors; however, the impacts may vary according to socio-demographic traits and comorbidities.
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Summary
Korean summary
- 시군구 지역단위의 불건강생활(흡연, 음주, 비만, 신체활동 부족 각 0-2점, 합 4점 이상 불건강) 유병률은 여자보다 남자에서 높고, 연령이 높아지면서 감소한다.
- 지역사회 환경개선(술집 개수, 패스트푸드점 밀도, 공원 면적, 병상밀도)과 사회경제적 수준 강화(교육수준, 가구소득, 고용)를 통해 생활습관적 건강행태의 지역 격차를 줄일 수 있다.
- 이러한 향상 노력의 효과는 지역의 건강상태 수준이나 사회인구학적 특성에 따라 다를 수 있다.
Key Message
• District prevalence rates of unhealthy living were higher among men than women and decreased with advancing age.
• Efforts to reduce regional disparities in lifestyle behaviors could benefit from enhancements to the neighborhood environment and the socioeconomic status of the area.
• The effectiveness of such improvements may vary based on socio-demographic characteristics and health conditions.
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Socioeconomic inequality in health-related quality of life among Korean adults with chronic disease: an analysis of the Korean Community Health Survey
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Thi Huyen Trang Nguyen, Thi Tra Bui, Jinhee Lee, Kui Son Choi, Hyunsoon Cho, Jin-Kyoung Oh
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Epidemiol Health. 2024;e2024018. Published online January 8, 2024
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DOI: https://doi.org/10.4178/epih.e2024018
[Accepted]
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Abstract
Summary
PDF
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Abstract
OBJECTIVES
Health-related quality of life is crucial for people dealing with chronic illness. This study investigated the quality of life in individuals with 5 common chronic conditions in Korea. We also analyzed socioeconomic factors such as education, income, occupation, and urbanization to identify determinants of inequality.
METHODS Using 2016 Community Health Survey data, we examined individuals aged 30 or older with chronic diseases (diabetes, hypertension, cardiovascular disease, hyperlipidemia, arthritis) using the EQ-5D-3L tool. We analyzed the associations between socioeconomic factors (education, income, occupation, urbanization) and quality of life using descriptive statistics and regression analysis. Inequality indices (RII, SII) were used to measure inequality in quality of life.
RESULTS Individuals with higher income levels showed a 1.95-fold higher likelihood of a better quality of life than those with the lowest income. The lowest income group had higher odds of mobility (adjusted odds ratio [aOR]=2.2), self-care (aOR=2.1), activity limitations (aOR=2.4), pain/discomfort (aOR=1.8), and anxiety/depression (aOR=2.3). Educational disparities included a 3-fold increase in mobility and daily activity problems for those with elementary or lower education. Well-educated participants had a 1.94 times higher quality of life, with smaller differences in anxiety/depression and self-management. The income gap accounted for 14.1% of variance in quality-of-life disparities.
CONCLUSIONS Addressing socioeconomic disparities in the quality of life for individuals with chronic diseases necessitates tailored interventions and targeted health policies. This research informs policymakers in developing focused initiatives to alleviate health inequities. It emphasizes the importance of mental health support and ensuring affordable, accessible healthcare services.
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Summary
Korean summary
- 지역사회건강조사 자료를 통해 확인한 한국인에게 호발하는 만성질환자(당뇨, 고혈압, 심혈관질환, 고지혈증, 관절염)에서 삶의 질 점수(EQ-5D)는 평균 0.7점으로, 남성에서 높고, 연령이 높을수록 낮다.
- 소득이 낮거나 교육수준이 낮은 군에서 삶의 질이 상대적으로 낮으며, 특히 운동능력, 자기관리, 통증/불편, 불안/우울 각각에서 두배 가량 어려움을 겪는 것으로 나타났다.
- 만성질환자에서 삶의 질은 사회경제적 여건에 따라 격차가 존재하므로, 취약한 계층 발굴과 지원이 필요하다.
Key Message
- Quality of life score (EQ-5D) in patients with chronic diseases (i.e., diabetes, hypertension, cardiovascular disease, hyperlipidemia, and arthritis) that are prevalent in Koreans identified through data from community health surveys averaged 0.7, lower in women than in men, and decreased by age.
- Low-income or low-educated patients have relatively low quality of life, and they have more than twice as much problem in mobility, self-care, pain/discomfort, and anxiety/depression.
- Disparities in quality of life in patients with chronic diseases according to socioeconomic conditions have been found, and support for the vulnerable is needed.
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