Epidemiology and Health

Original Articles

Inequality in dental flossing behavior among Korean adults based on household income levels: Zi-Lan Wang, Eun-Jae Choi, Seung-Hee Ryu, Seon-Jip Kim, Hyun-Jae Cho; Epidemiol Health. 2024;46:e2024052. Published online May 24, 2024; DOI: https://doi.org/10.4178/epih.e2024052

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Abstract Summary PDF: Abstract
OBJECTIVES
The aim of this study was to estimate the association between household income and dental flossing.
METHODS
This cross-sectional study investigated the impact of household income on flossing among 9,391 adults aged 30+ with ≥20 natural teeth, utilizing data from the seventh Korea National Health and Nutrition Examination Survey (2016-2018). Outcome measures included flossing (yes/no), with income categorized into 4 levels: lowest, medium to low, medium to high, and highest. Logistic regression, adjusted for age, gender, brushing frequency, recent dental exams, periodontitis, smoking, and alcohol use, was employed to evaluate the influence of socioeconomic status on oral hygiene practices.
RESULTS
In the highest income group, flossing was 62.6% more prevalent than in the lowest income group (adjusted odds ratio [aOR], 1.63; 95% CI, 1.27 to 2.08). The strongest association between income levels and flossing was observed in individuals aged ≥70 years (aOR, 3.64; 95% CI, 1.86 to 7.11), with a decreasing strength of association in the 60s (aOR, 1.72; 95% CI, 1.05 to 2.84) and 50s age groups (aOR, 1.69; 95% CI, 1.07 to 2.68). Higher-income women demonstrated a higher frequency of flossing than their lower-income counterparts (aOR, 1.67; 95% CI, 1.24 to 2.23). Higher-income individuals without periodontitis were more likely to floss (aOR, 1.64; 95% CI, 1.23 to 2.18), and among those with periodontitis, flossing was significantly associated only with the highest income category (aOR, 1.64; 95% CI, 1.10 to 2.44).
CONCLUSIONS
The findings of this study indicate a significant correlation between higher household income levels and an increased prevalence of flossing.; Summary

Korean summary
이 연구는 치실 사용이 개인의 건강행동 습관뿐만 아니라 사회경제적 지위에 의해 크게 영향을 받는다는 점을 강조합니다. 높은 소득층이 치실을 더 자주 사용하는 경향이 있으며, 이는 교육 수준과 건강 문해력, 경제적 여유와 관련이 있습니다. 공중보건 계획에서 경제적 요인을 고려하고, 치과 위생 교육과 제품 접근성을 개선해야 합니다.

Key Message
This study highlights that the use of dental floss is significantly influenced not only by personal health behavior habits but also by socioeconomic status. Individuals in higher income classes tend to use dental floss more frequently, which is associated with higher levels of education, health literacy, and economic resources. Public health planning should take economic factors into account and focus on improving dental hygiene education and access to dental care products.

The effect of public hospital closure on the death of long-term inpatients in Korea: Taeuk Kang, Minsung Sohn, Changwoo Shon; Epidemiol Health. 2024;46:e2024022. Published online January 17, 2024; DOI: https://doi.org/10.4178/epih.e2024022

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Abstract Summary PDF: Abstract
OBJECTIVES
This study aimed to examine the changes in health outcomes and the patterns of medical institution utilization among patients with long-term stays in public hospitals following the closure of a public medical center. It also sought to present a proposal regarding the role of public hospitals in countries with healthcare systems predominantly driven by private entities, such as Korea.
METHODS
To assess the impact of a public healthcare institution closure on health outcomes in a specific region, we utilized nationally representative health insurance claims data. A retrospective cohort study was conducted for this analysis.
RESULTS
An analysis of the medical utilization patterns of patients after the closure of Jinju Medical Center showed that 67.4% of the total medical usage was redirected to long-term care hospitals. This figure is notably high in comparison to the 20% utilization rate of nursing hospitals observed among patients from other medical facilities. These results indicate that former patients of Jinju Medical Center may have experienced limitations in accessing necessary medical services beyond nursing care. After accounting for relevant mortality factors, the analysis showed that the mortality rate in closed public hospitals was 2.47 (95% confidence interval, 0.85 to 0.96) times higher than in private hospitals.
CONCLUSIONS
The closure of public medical institutions has resulted in unmet healthcare needs, and an observed association was observed with increased mortality rates. It is essential to define the role and objectives of public medical institutions, taking into account the distribution of healthcare resources and the conditions of the population.; Summary

Korean summary
본 연구는 사회보험제도를 기반으로 하고 있는 한국의 상황에서 지방의 공공의료기관 폐쇄가 환자들의 건강에 어떠한 영향을 미쳤는지를 확인하고자 국민건강보험 청구자료를 기반으로 후향적코호트 자료를 구축하여 분석을 시행하였다. 연구결과 장기 입원 환자의 67.4%가 장기요양병원을 의료를 이용하였고, 이는 비교집단의 장기요양 이용비율인 20% 수준보다 3배 가량 높은 수치로, 의료이용에 일부 제약이 발생하였을 가능성을 시사하는 것이다. 폐업 후 1년 이내 사망률을 비교한 결과, 인근지역 내 민간병원 환자와 비교하여 공공의료기관 입원환자의 사망확률은 2.67배였고, 의료급여 수급권자들의 사망확률은 고소득 5분위에 비해 2.24배 높은 것으로 나타났다.

Key Message
Even in Korea's healthcare system with high medical accessibility, adverse health impacts have been observed due to the closure of public healthcare institutions. Systematic policy development is necessary to evaluate essential medical service provision and allocate medical resources comprehensively.

Socioeconomic inequality in health-related quality of life among Korean adults with chronic disease: an analysis of the Korean Community Health Survey: Thi Huyen Trang Nguyen, Thi Tra Bui, Jinhee Lee, Kui Son Choi, Hyunsoon Cho, Jin-Kyoung Oh; Epidemiol Health. 2024;46:e2024018. Published online January 8, 2024; DOI: https://doi.org/10.4178/epih.e2024018

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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 Korea Community Health Survey data, we examined individuals aged 30 or older with chronic diseases (diabetes, hypertension, cardiovascular disease, hyperlipidemia, arthritis) using the EuroQol 5-Dimension 3 Level tool. We analyzed the associations between socioeconomic factors (education, income, occupation, urbanization) and quality of life using descriptive statistics and regression analysis. Inequality indices (relative inequality index, absolute inequality index) 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.

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.

Citations

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Analysis of asthma incidence and mortality rates among children aged 0–14 in 204 countries from 1990 to 2019
Fei Cheng, Li He, Dachuan Deng, Jinhui Zhang, Cheng Liu
Journal of Asthma.2024; : 1. CrossRef

Decomposition of socioeconomic inequalities in glaucoma knowledge in Taiwan: Chiun-Ho Hou, Christy Pu; Epidemiol Health. 2024;46:e2024004. Published online December 5, 2023; DOI: https://doi.org/10.4178/epih.e2024004

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Abstract Summary PDF: Abstract
OBJECTIVES
Glaucoma knowledge is strongly associated with medication adherence and preventive behavior. Studies have frequently reported socioeconomic inequalities in glaucoma knowledge. This study aimed to decompose such inequalities. Decomposition analysis enables the design of policies directly targeting the underlying causes of inequality.
METHODS
We performed a cross-sectional survey from January 1, 2019 to June 30, 2019, at the departments of ophthalmology of 2 medical centers belonging to a hospital chain in northern Taiwan. Socioeconomic inequalities in glaucoma knowledge were ranked based on 3 aspects of socioeconomic status (SES): (1) education, (2) income, and (3) self-perceived financial status. The concentration index was calculated and decomposed using decomposition analysis. Elasticity and marginal effects were estimated for each decomposed factor.
RESULTS
In total, 1,203 patients completed the survey. Both measures of glaucoma knowledge and overall glaucoma knowledge score significantly contributed to the progressivity of knowledge inequalities (pro-high-SES inequalities). The concentration index for overall knowledge score with respect to education was 0.166 (p<0.001). Both objective and subjective measures of SES were associated with pro-high-SES inequalities. Our decomposition analysis revealed that demographic factors and attitudinal factors such as the level of concern regarding developing glaucoma contributed significantly to SES-based inequalities in glaucoma knowledge.
CONCLUSIONS
Our decomposition analysis provided empirical evidence regarding the underlying causes of SES-based inequalities in glaucoma knowledge. Efforts to improve glaucoma knowledge should consider specific factors that drive SES-based inequalities, such as age, sex, and concern about vision health, to ultimately achieve low SES-based inequalities.; Summary

Key Message
This study investigates the relationship between glaucoma knowledge and socioeconomic status (SES) inequalities, and the underlying causes of these disparities. The study concludes that understanding the drivers of SES-based inequalities in glaucoma knowledge, like age, gender, and concerns about vision health, is crucial. This understanding can guide efforts to improve glaucoma awareness and address SES-based disparities in knowledge, aiming to reduce these inequalities.

Trends in socioeconomic inequalities in obesity among Korean adolescents: the Korea Youth Risk Behavior Web-based Survey (KYRBS) 2006 to 2020: Eunji Kim, Ga Bin Lee, Dong Keon Yon, Hyeon Chang Kim; Epidemiol Health. 2023;45:e2023033. Published online March 7, 2023; DOI: https://doi.org/10.4178/epih.e2023033

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study investigated recent trends in the prevalence of obesity among Korean adolescents and explored socioeconomic disparities in obesity.

METHODS

This study used annual self-reported data on height, weight, and socioeconomic information from the Korea Youth Risk Behavior Web-based Survey from 2006 to 2020. With a 95.8% response rate, the sample consisted of 818,210 adolescents. Obesity prevalence was calculated according to 4 socioeconomic indicators (household income, father’s educational attainment, mother’s educational attainment, and urbanicity). Socioeconomic inequality was quantified using the relative index of inequality (RII).

RESULTS

The overall prevalence of obesity increased, doubling from 5.9% in 2006 to 11.7% in 2020. Boys and high school students showed a higher prevalence. The RIIs in household income and parental educational attainments significantly increased with time, indicating a growing inequality in obesity. Socioeconomic disadvantages had a greater influence on obesity among girls. The most recent RII values for boys were 1.25 for income, 1.79 for the father’s education, and 1.45 for the mother’s education, whereas the corresponding values for girls were 2.49, 3.17, and 2.62, respectively.

CONCLUSIONS

These findings highlight growing inequalities in adolescent obesity according to household income and parental educational attainments, especially for girls and middle schoolers.

Summary

Korean summary
2006년부터 2020년까지 청소년 비만의 유병은 증가 추세에 있을 뿐 아니라, 가정의 경제상태, 부모의 학력수준에 따른 비만의 위험 격차도 점점 심해지는 추세를 보였다. 특히, 남학생과 고등학생의 비만 유병률이 높게 나타났으나, 사회경제적 지표에 따른 비만의 불평등 격차는 여학생과 중학생에서 높게 나타났다.

Key Message
Not only the prevalence but also socioeconomic inequality in adolescent obesity increased between 2006 and 2020. The potential impact of socioeconomic disparity on obesity was greater in girls and middle school students than their counterparts.

Citations

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The Association Between Obesity Measures and Metabolic Syndrome Risk in Korean Adolescents Aged 10–18 Years
Munku Song, Seamon Kang, Hyunsik Kang
Journal of Multidisciplinary Healthcare.2024; Volume 17: 1769. CrossRef
Perceived Familial Financial Insecurity and Obesity Among Korean Adolescents During the COVID-19 Pandemic
Fumie Kaneko, Eunji Kim, Hokyou Lee, Kokoro Shirai, Ryo Kawasaki, Hyeon Chang Kim
Journal of Epidemiology.2024;[Epub] CrossRef
Obesity-related behaviors and health-related quality of life in socioeconomically vulnerable children: A cross-sectional study
Jiyoung Park, Gill ten Hoor, Jeonghyun Cho, Seohyun Won, Soorack Ryu, Siew Tiang Lau
Journal of Pediatric Nursing.2024; 78: e270. CrossRef
A Comparison of Changes in Health Behavior, Obesity, and Mental Health of Korean Adolescents Before and During the COVID-19 Pandemic: Online Cross-Sectional Study
Mi-Sun Lee, Hooyeon Lee
Psychiatry Investigation.2023; 20(11): 1086. CrossRef

Effect of socioeconomic disparities on the risk of COVID-19 in 8 metropolitan cities in the Korea: a community-based study: Myung-Jae Hwang, Shin Young Park, Tae-Ho Yoon, Jinhwa Jang, Seon-Young Lee, Myeongsu Yoo, Yoo-Yeon Kim, Hae-Kwan Cheong, Donghyok Kwon, Jong-Hun Kim; Epidemiol Health. 2022;44:e2022107. Published online November 15, 2022; DOI: https://doi.org/10.4178/epih.e2022107

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Abstract

OBJECTIVES
Socioeconomic disparities have been reported as major risk factors contributing to the spread of coronavirus disease 2019 (COVID-19) at the community level. We conducted an epidemiological study on COVID-19 incidence risk using area-based deprivation indices (DIs) reflecting the characteristics of the susceptible population.

METHODS

A database of the confirmed COVID-19 cases in 8 metropolitan cities in Korea from January 20, 2020 to December 31, 2021 was combined with area-based DI scores and standardized prevalence rates of diabetes and hypertension from the Korean Community Health Survey. Relative risk (RR) levels were estimated using a generalized linear model with a Poisson distribution by age group.

RESULTS

The risk of COVID-19 incidence generally increased with increasing age, especially in patients aged ≥75 years. The RR of COVID-19 incidence per interquartile range increment of the composite deprivation index (composite DI) was 1.54 (95% confidence interval [CI], 1.34 to 1.70). Notably, in the first wave, the risk of COVID-19 incidence was approximately 3 times higher in the region with the lowest socioeconomic status than in the region with the highest status (RR, 3.08; 95% CI, 2.42 to 3.78 based on the the composite DI and RR, 3.13; 95% CI, 2.53 to 3.83 based on the social deprivation index).

CONCLUSIONS

This study provides scientific evidence that socioeconomic deprivation is an important risk factor for the spread of COVID-19. This finding suggests that a mid-term to long-term strategy is needed to protect susceptible populations and reduce the burden of COVID-19 in the community.

Summary

Korean summary
한국의 COVID-19 발생 위험은 지역박탈수준이 높은 지역에서 증가하였고, 특히 유행 초기 75세이상 연령층에서 뚜렷하게 증가하는 것으로 나타났다. 따라서 지역사회수준에서 사회경제적 여건을 고려하여 취약집단에서의 발생위험을 감소시키기 위해 중장기 전략을 세워야 한다는 것을 시사한다.

Key Message
There is a need to develop long-term strategies to reduce the risk of COVID-19 outbreaks in vulnerable populations in areas with poor socioeconomic conditions

Citations

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Association between area deprivation index and concerns to COVID-19: A multi-level analysis of individual and area factors
Doo Woong Lee, Jieun Jang, Jaeyong Shin
SSM - Population Health.2024; 25: 101580. CrossRef
The current state of graphical abstracts and how to create good graphical abstracts
Jieun Lee, Jeong-Ju Yoo
Science Editing.2023; 10(1): 19. CrossRef
Social deprivation and SARS-CoV-2 testing: a population-based analysis in a highly contrasted southern France region
Jordi Landier, Léa Bassez, Marc-Karim Bendiane, Pascal Chaud, Florian Franke, Steve Nauleau, Fabrice Danjou, Philippe Malfait, Stanislas Rebaudet, Jean Gaudart
Frontiers in Public Health.2023;[Epub] CrossRef

Changes in eating behaviors according to household income in adolescents during the COVID-19 pandemic: findings from the Korea National Health and Nutrition Examination Survey: Hye Ah Lee, Ho Jung Lee, Bomi Park, Yoonhee Shin, Hyunjin Park, Hyesook Park; Epidemiol Health. 2022;44:e2022102. Published online November 9, 2022; DOI: https://doi.org/10.4178/epih.e2022102

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Abstract

OBJECTIVES
To assess social inequalities in changes in dietary behaviors among adolescents during the coronavirus disease 2019 (COVID-19) pandemic, we compared changes in dietary behavior indicators by household income.

METHODS

Using cross-sectional data from the 2019 and 2020 Korea National Health and Nutrition Examination Survey, the prevalence of dietary behaviors in adolescents (12-18 years old) was estimated and changes in dietary behaviors during the COVID-19 pandemic were evaluated. We assessed changes in dietary behaviors with a household income (as a measure of socioeconomic status, SES) disparity.

RESULTS

During the COVID-19 pandemic, the average consumption of vegetables decreased and food insecurity worsened. Adolescents were more likely to skip breakfast than before COVID-19 (33.1 and 37.4%). Soft drink consumption also increased in 2020 from 2019 (7.6 and 14.8%), especially among boys. Average sugar intake and sodium intake showed a tendency to decrease only in girls, but there was no significant difference according to SES level. Skipping breakfast was particularly evident in the low-SES group, and the difference according to household income level (high vs. low) was greater during COVID-19 than before. The prevalence of soft drink consumption increased significantly in the low-SES group, but the rate of increase did not differ by SES level.

CONCLUSIONS

We found that the social disparity in skipping breakfast was further aggravated during the COVID-19 pandemic. To reach a better understanding of the dietary behaviors of adolescents, continuous monitoring is necessary.

Summary

Korean summary
국민건강영양조사 자료를 활용하여, COVID-19 팬데믹 전후 청소년의 식생활 변화 및 가구소득 수준에 따른 차이를 평가하였다. 대체로, 평균 채소 섭취량은 감소하고 탄산음료 소비는 증가한 것으로 나타났으며, 아침식사 결식율도 약간 증가한 것으로 나타났다. 게다가, 가구소득 수준에 따라 평가하였을 때, 아침식사 결식율 증가는 가구소득이 높은 군에 비해 가구소득 수준이 낮은 군에서 두드러진 것으로 나타났다. COVID-19 팬데믹이 장기화됨에 따라, 청소년의 식생활 변화에 대해서는 지속적인 모니터링이 필요하다.

Key Message
Using data from the 2019 and 2020 Korea National Health and Nutrition Examination Survey, changes in dietary behaviors of adolescents (12-18 years old) during the COVID-19 pandemic were evaluated. During the COVID-19 pandemic, average consumption of vegetables decreased and consumption of soft drinks increased in 2020 from 2019 (7.6% and 14.8%). In addition, the social disparity in skipping breakfast among adolescents was further aggravated. To reach a better understanding of the dietary behaviors of adolescents, continuous monitoring is necessary.

Citations

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Dietary Changes of Youth during the COVID-19 Pandemic: A Systematic Review
Nicolas Woods, Jamie A Seabrook, Holly Schaafsma, Shauna Burke, Trish Tucker, Jason Gilliland
The Journal of Nutrition.2024; 154(4): 1376. CrossRef
Perceived Familial Financial Insecurity and Obesity Among Korean Adolescents During the COVID-19 Pandemic
Fumie Kaneko, Eunji Kim, Hokyou Lee, Kokoro Shirai, Ryo Kawasaki, Hyeon Chang Kim
Journal of Epidemiology.2024;[Epub] CrossRef
Intake of energy and macronutrients according to household income among elementary, middle, and high school students before and during the COVID-19 pandemic: a cross-sectional study
Chae-Eun Jeong, Heejin Lee, Jung Eun Lee
Korean Journal of Community Nutrition.2024; 29(3): 234. CrossRef
Analysis of health behavior, mental health, and nutritional status among Korean adolescents before and after COVID-19 outbreak: based on the 2019–2020 Korea National Health and Nutrition Examination Survey
Misun Lee, Sarang Jeong, Chong-Su Kim, Yoon Jung Yang
Journal of Nutrition and Health.2023; 56(6): 667. CrossRef

Income-based disparities in the risk of distant-stage cervical cancer and 5-year mortality after the introduction of a National Cancer Screening Program in Korea: Erdenetuya Bolormaa, Seung-Ah Choe, Mia Son, Myung Ki, Domyung Paek; Epidemiol Health. 2022;44:e2022066. Published online August 11, 2022; DOI: https://doi.org/10.4178/epih.e2022066

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Abstract

OBJECTIVES
This study assessed the socioeconomic gradient in the risk of distant-stage cervical cancer (CC) at presentation and 5-year mortality for new CC patients after the introduction of a national Cancer Screening Program (NCSP) in Korea.

METHODS

All new CC cases from 2007 to 2017 were retrieved from the Korea Central Cancer Registry database linked with the National Health Information Database of the National Health Insurance Service. The age-standardized cumulative incidence of CC, adjusted odds ratios (ORs) of distant metastasis at presentation, and adjusted all-cause mortality hazard ratios (HRs) within 5 years post-diagnosis were assessed according to the income gradient.

RESULTS

The 11-year age-standardized cumulative incidence of CC ranged from 48.9 to 381.5 per 100,000 women, with the richest quintile having the highest incidence. Of 31,391 new cases, 8.6% had distant metastasis on presentation, which was most frequent among Medical Aid beneficiaries (9.9%). Distant-stage CC was more likely when the income level was lower (OR, 1.46; 95% confidence interval [CI]), 1.28 to 1.67 for the lowest compared to the richest) and among Medical Aid beneficiaries (OR, 1.50; 95% CI, 1.24 to 1.82). The 5-year mortality was greater in the lower-income quintiles and Medical Aid beneficiaries than in the richest quintile.

CONCLUSIONS

The incidence of CC was higher in the richest quintile than in the lower income quintiles, while the risk of distant-stage CC and mortality was higher for women in lower income quintiles in the context of the NCSP. A more focused approach is needed to further alleviate disparities in the timely diagnosis and treatment of CC.

Summary

Korean summary
새로이 자궁경부암을 진단받은 여성에서 소득수준에 따른 진단시 원격 전이가 있을 위험도와 진단 이후 5년 사망위험도를 연령과 체질량 지수등의 개인 수준의 위험 요인을 보정하여 구했다. 소득 수준이 낮을수록, 의료급여 환자일수록 진단시 원격 전이가 있을 위험과 5년 내 사망 위험이 높은 것으로 나타났다. 자궁경부암에 대한 전국민 대상 선별 검사가 있지만 여전히 소득 수준에 따른 자궁경부암의 적시 진단과 진단 후 생존의 불평등이 남아 있으며 이에 대한 추가 정책이 필요하다.

Key Message
This study adds empirical evidence for an income-based disparity in the cancer stage at presentation and five-year survival among cervical cancer patients even in the presence of a universal screening program.

Citations

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Individual and joint effect of socioeconomic status and lifestyle factors on cancer in Korea
Chi Lan Tran, Kui Son Choi, Sun‐Young Kim, Jin‐Kyoung Oh
Cancer Medicine.2023; 12(16): 17389. CrossRef
Menopausal hormone therapy and risk of dementia: health insurance database in South Korea-based retrospective cohort study
Jin-Sung Yuk, Jin San Lee, Joong Hyun Park
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Brief Communication

Occupational inequalities in mortality in Korea: an analysis using nationally representative mortality follow-up data from the late 2000s and after: Eunjeong Noh, Young-Ho Khang; Epidemiol Health. 2022;44:e2022038. Published online April 6, 2022; DOI: https://doi.org/10.4178/epih.e2022038

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Abstract

Many Korean and international studies have found higher mortality rates and poorer health conditions among manual workers than among non-manual workers. However, a recent study using unlinked data argued that since the economic crisis in Korea in the late 2000s, the mortality estimates of male Korean non-manual workers have been higher than those of manual workers. Our work using individually linked data from the late 2000s and after aimed to examine mortality inequality by occupational class. We analyzed Korea National Health and Nutrition Examination Survey data that were individually linked to cause-of-death data. Cox regression analysis was used to identify the hazard ratios for mortality by occupational class. Of 11,766 males aged between 35 and 64, 397 died between 2007 and 2018: 142 died from cancer, 68 from cardiovascular disease, 88 from external causes, and 99 from other causes. After controlling for age, the mortality estimates for manual workers were 1.85 times higher than those for upper non-manual workers (p<0.05). We observed no evidence of reversed mortality inequality among occupational classes in Korea since the 2000s; this previously reported finding might have been due to numerator-denominator bias arising from the use of unlinked data.

Summary

Korean summary
개인 단위 연계자료가 아닌 분모(센서스)-분자(사망신고) 집합 자료를 사용하여 2000년대 후반 경제위기 이후 한국 남성 비육체직의 사망률이 육체직보다 높게 나타난다고 기존의 한 연구가 주장했다. 이 연구는 2000년대 이후 개인 단위로 연계된 코호트 자료를 활용하여 여전히 한국에서 육체직의 사망위험이 비육체직보다 높다는 점을 보임으로써, 기존 연구가 비연계자료의 사용으로 인한 분자-분모 바이어스(numerator-denominator bias) 때문에 그와 같은 결과를 보였다고 지적하였다.

Key Message
This paper using individually linked data from the late 2000s and after observed no evidence of reversed mortality inequality among occupational classes in Korea since the 2000s. The previously reported finding showing reversed occupational mortality inequality might have been due to numerator-denominator bias arising from the use of unlinked data.

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Insurance Types and All-Cause Mortality in Korean Cancer Patients: A Nationwide Population-Based Cohort Study
Jinyoung Shin, Yoon-Jong Bae, Hee-Taik Kang
Journal of Personalized Medicine.2024; 14(8): 861. CrossRef
Mortality of Suicide and Cerebro-Cardiovascular Diseases by Occupation in Korea, 1997–2020
Jungwon Jang, Inah Kim
International Journal of Environmental Research and Public Health.2022; 19(16): 10001. CrossRef

Original Articles

Secular trends and related factors in leisure-time sedentary behavior among Koreans: an analysis of data from the 2011-2017 Korea Community Health Survey: Hyun-Ju Seo, Min-Jung Choi, Soon-Ki Ahn; Epidemiol Health. 2022;44:e2022023. Published online February 14, 2022; DOI: https://doi.org/10.4178/epih.e2022023

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Abstract

OBJECTIVES
Sedentary behavior has gradually increased and has become a public health problem. Therefore, this study investigated trends in weekday leisure-time sedentary behaviors, as well as characteristic socio-demographic and lifestyle correlates in Korean adults.

METHODS

We analyzed data from 914,946 adults aged ≥19 years who participated in the Korea Community Health Survey (2011, 2013, 2015, and 2017). Leisure-time sedentary behavior was categorized as a binary variable (<4 and ≥4 hr/day). Multivariable regression analysis was used to model the prevalence of sedentary behavior and estimate odds ratios.

RESULTS

The prevalence of leisure-time sedentary behavior decreased from 15.2% to 14.4% in men and from 16.6% to 16.0% in women between 2011 and 2017, respectively. However, a significant increase was observed in subjects with an education lower than high school in both genders (β coefficient=0.12 for men and 0.08 for women, p for trend <0.001). Women in the lowest household income level (β coefficient=0.08, p for trend=0.001) and with poor subjective health status (β coefficient=0.05, p for trend=0.013) showed an increasing trend. Other factors associated with sedentary behavior were age, education level, body mass index, household income, walking activity, perceived stress level, and subjective health status in both genders.

CONCLUSIONS

Identifying the secular trends and correlates of sedentary behavior by gender and associated factors will provide empirical evidence for developing public health campaigns and promotion programs to reduce sedentary behavior in Koreans.

Summary

Korean summary
본 연구는 지역사회건강조사에서 2011년부터 2017년까지 격년으로 수집된 성인의 좌식행동에 대한 시간적 추세와 관련 요인에 대해 분석한 시계열 단면연구이다. 분석결과, 주중 여가시간에 4시간 이상 앉아 있는 경우는 남성의 경우 15.2%에서 14.4%로, 여성의 경우 16.6%에서 16.0%로 감소되었다. 그러나, 남녀 모두에서 노인인 경우, 중졸 이하의 학력을 가진 경우, 소득수준이 월 100만원 미만인 경우, 주관적 건강상태가 부정적인 경우 좌식행동이 증가하였다. 따라서, 본 연구에서 나타난 좌식행동 관련 요인을 가진 대상자를 목표집단으로 한 건강증진 및 공중보건 캠페인이 개발 및 실행될 필요가 있다.

Key Message
This study is a serial cross-sectional study analyzing the temporal trend and related factors of sedentary behavior of adults using KCHS collected biennially from 2011 to 2017. The prevalence of leisure-time sedentary behavior decreased from 15.2% to 14.4% in men and from 16.6% to 16.0% in women, respectively. However, elderly, subjects with an education lower than high school, with the lowest household income level, and with poor subjective health status showed an increasing sedentary behavior trend. These findings suggest that health promotion and public health campaigns are need to reduce the prevalence of sedentary behavior in population with related factors.

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Temporal trends and the association between self-rated oral health and falls in community-dwelling older adults in South Korea: a secondary analysis of survey data
Hyun-Ju Seo, Soon-Ki Ahn, Min-Jung Choi
BMJ Open.2024; 14(4): e081549. CrossRef
Association between long working hours and physical inactivity in middle-aged and older adults: a Korean longitudinal study (2006–2020)
Seong-Uk Baek, Won-Tae Lee, Min-Seok Kim, Myeong-Hun Lim, Jin-Ha Yoon, Jong-Uk Won
Journal of Epidemiology and Community Health.2023; 77(6): 355. CrossRef

Socioeconomic disparities in Korea by health insurance type during the COVID-19 pandemic: a nationwide study: Han Eol Jeong, Jongseong Lee, Hyun Joon Shin, Ju-Young Shin; Epidemiol Health. 2021;43:e2021007. Published online January 13, 2021; DOI: https://doi.org/10.4178/epih.e2021007

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study explored socioeconomic disparities in Korea using health insurance type as a proxy during the ongoing coronavirus disease 2019 (COVID-19) pandemic.

METHODS

We conducted a retrospective cohort study using Korea’s nationwide healthcare database, which contained all individuals who received a diagnostic test for COVID-19 (n=232,390) as of May 15, 2020. We classified our cohort by health insurance type into beneficiaries of the National Health Insurance (NHI) or Medicaid programs. Our study outcomes were infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and COVID-19-related outcomes, a composite of all-cause death, intensive care unit admission, and mechanical ventilation use. We estimated age-, sex-, and Charlson comorbidity index score–adjusted odds ratios (aORs) with 95% confidence intervals (CIs) using a multivariable logistic regression analysis.

RESULTS

Of the 218,070 NHI and 14,320 Medicaid beneficiaries who received COVID-19 tests, 7,777 and 738 tested positive, respectively. The Medicaid beneficiaries were older (mean age, 57.5 vs. 47.8 years), more likely to be males (47.2 vs. 40.2%), and had a higher comorbidity burden (mean CCI, 2.0 vs. 1.7) than NHI beneficiaries. Compared to NHI beneficiaries, Medicaid beneficiaries had a 22% increased risk of SARS-CoV-2 infection (aOR, 1.22; 95% CI, 1.09 to 1.38), but had no significantly elevated risk of COVID-19-related outcomes (aOR 1.10, 95% CI 0.77 to 1.57); the individual events of the composite outcome yielded similar findings.

CONCLUSIONS

As socioeconomic factors, with health insurance as a proxy, could serve as determinants during the current pandemic, pre-emptive support is needed for high-risk groups to slow its spread.

Summary

Korean summary
사회경제적 수준과 코로나19 발생률 및 예후 간 연관성 등 코로나19로 인한 건강 불평등 현상은 아직 확인된 바가 없다. 건강보험 가입자 대비 의료급여 수급권자에서 SARS-CoV-2의 감염 위험이 더 높게 나타났다. 코로나19의 확산을 늦추기 위해서는, 의료급여 수급권자를 비롯한 취약계층 대상의 선제적 지원이 제공되어야 한다.

Key Message
Socioeconomic status, with health insurance as a proxy, could explain health inequalities in clinical outcomes, diverse disease incidence and prognosis, during the COVID-19 pandemic.

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Unraveling the inhibitory potential of fatty acids from Cola lepidota seed against monoclonal antibody Fab fragment (9F8) (3VG0) leptin antagonism and restoration of ‘satiety’ in obesity condition: insight from quantum chemical analysis, pharmacokinetics,
Obinna C. Godfrey, Eze A. Adindu, Uwem O. Edet, Elizabeth N. Mbim, Gabriel C. Eze, Fredrick C. Asogwa, Innocent Benjamin, Terkumbur E. Gber, Rawlings A. Timothy, Hitler Louis
Zeitschrift für Physikalische Chemie.2024; 238(4): 763. CrossRef
Does Maintained Medical Aid Coverage Affect Healthy Lifestyle Factors, Metabolic Syndrome-Related Health Status, and Individuals’ Use of Healthcare Services?
Ilsu Park, Kyounga Lee, Eunshil Yim
Healthcare.2023; 11(13): 1811. CrossRef
The Risk Factors of COVID-19 Infection and Mortality among Older Adults in South Korea
Sungmin Lee, Jungha Park, Jae-ryun Lee, Jin Yong Lee, Byung sung Kim, Chang Won Won, Hyejin Lee, Sunyoung Kim
Annals of Geriatric Medicine and Research.2023; 27(3): 241. CrossRef
The road to recovery: impact of COVID-19 on healthcare utilization in South Korea in 2016–2022 using an interrupted time-series analysis
Katelyn Jison Yoo, Yoonkyoung Lee, Seulbi Lee, Rocco Friebel, Soon-ae Shin, Taejin Lee, David Bishai
The Lancet Regional Health - Western Pacific.2023; 41: 100904. CrossRef
Unequal burdens of COVID-19 infection: a nationwide cohort study of COVID-19-related health inequalities in Korea
Jeangeun Jeon, Jieun Park, Min-Hyeok Choi, Hongjo Choi, Myoung-Hee Kim
Epidemiology and Health.2023; 45: e2023068. CrossRef
Increased Healthcare Delays in Tuberculosis Patients During the First Wave of COVID-19 Pandemic in Korea: A Nationwide Cross-Sectional Study
Jinsoo Min, Yousang Ko, Hyung Woo Kim, Hyeon-Kyoung Koo, Jee Youn Oh, Yun-Jeong Jeong, Hyeon Hui Kang, Kwang Joo Park, Yong Il Hwang, Jin Woo Kim, Joong Hyun Ahn, Yangjin Jegal, Ji Young Kang, Sung-Soon Lee, Jae Seuk Park, Ju Sang Kim
Journal of Korean Medical Science.2022;[Epub] CrossRef
Socioeconomic Inequalities in COVID-19 Incidence During Different Epidemic Phases in South Korea
Dae-sung Yoo, Minji Hwang, Byung Chul Chun, Su Jin Kim, Mia Son, Nam-Kyu Seo, Myung Ki
Frontiers in Medicine.2022;[Epub] CrossRef
Neighbourhood socio-economic vulnerability and access to COVID-19 healthcare during the first two waves of the pandemic in Geneva, Switzerland: A gender perspective
Denis Mongin, Stéphane Cullati, Michelle Kelly-Irving, Maevane Rosselet, Simon Regard, Delphine S. Courvoisier
eClinicalMedicine.2022; 46: 101352. CrossRef
Analysis of the Relationship between Socioeconomic Status and Incidence of Hysterectomy Using Data of the Korean Genome and Epidemiology Study (KoGES)
Yung-Taek Ouh, Kyung-Jin Min, Sanghoon Lee, Jin-Hwa Hong, Jae Yun Song, Jae-Kwan Lee, Nak Woo Lee
Healthcare.2022; 10(6): 997. CrossRef
Effect of socioeconomic disparities on the risk of COVID-19 in 8 metropolitan cities in the Korea: a community-based study
Myung-Jae Hwang, Shin Young Park, Tae-Ho Yoon, Jinhwa Jang, Seon-Young Lee, Myeongsu Yoo, Yoo-Yeon Kim, Hae-Kwan Cheong, Donghyok Kwon, Jong-Hun Kim
Epidemiology and Health.2022; 44: e2022107. CrossRef
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Jennifer Ivy Kim, Sukil Kim
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Gender difference in socioeconomic factors affecting suicidal ideation and suicidal attempts among community-dwelling elderly: based on the Korea Community Health Survey: Jin-Young Jeong; Epidemiol Health. 2020;42:e2020052. Published online July 13, 2020; DOI: https://doi.org/10.4178/epih.e2020052

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study was performed to explore socioeconomic factors associated with suicidal ideation and suicidal attempts among the local community’s resident elderly.

METHODS

The subjects included 129,277 participants aged 65 years or above of the Korea Community Health Survey conducted in 2013 and 2017. Based on the questions for suicidal ideation and suicidal attempts, the subjects were divided into a no suicidal ideation group (n=111,344), a suicidal ideation group (n=17,487), and a suicidal attempt group (n=446). All analyses were stratified by gender, and a complex sample logistic regression analysis was performed to analyze associated factors. SAS version 9.4 was used for all analyses with a significance level of 0.05.

RESULTS

Common factors associated with suicidal ideation in both genders included marital status, frequency of contact with friends, social activity, and average monthly household income. Economic activity was demonstrated as relevant only to the elderly men subjects. According to the analysis, factors associated with suicidal attempts were the recipients of the National Basic Living Security Act for the elderly men compared to age, frequency of contact with family, frequency of contact with friends, and average monthly household income for the elderly women.

CONCLUSIONS

The study revealed that socioeconomic factors leading to suicidal ideation were similar in the elderly of both genders, while a difference was demonstrated for factors associated with suicidal attempts between the elderly of both genders. It is expected that the results of this study may be used as the basis for screening the local community’s elderly with a high suicidal risk, and in the development of suicide prevention services.

Summary

Korean summary
2013년과 2017년 지역사회건강조사에 참여한 129,277명의 노인을 대상으로 자살시도에 관련된 사회-경제적 요인을 탐색하였다. 분석결과, 남성 노인의 자살시도 관련요인은 국민기초생활수급자, 여성 노인의 자살시도 관련요인은 연령, 가족접촉빈도, 친구접촉빈도, 그리고 월평균가구소득으로 나타났다. 본 결과가 지역사회 거주 노인의 자살 고위험군 선별 및 자살 예방서비스 개발에 기초자료로 활용되기를 기대한다.

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A systematic review of psychosocial protective factors against suicide and suicidality among older adults
Myung Ki, Sylvie Lapierre, Boeun Gim, Minji Hwang, Minku Kang, Luc Dargis, Myoungjee Jung, Emily Jiali Koh, Brian Mishara
International Psychogeriatrics.2024; 36(5): 346. CrossRef
Body mass index, subjective body shape, and suicidal ideation among community-dwelling Korean adults
Chae Eun Yong, Young Bum Kim, Jiyoung Lyu
Archives of Public Health.2021;[Epub] CrossRef

Socio-demographic inequalities in the uptake of Papanicolaou tests in Peru: analysis of the 2015-2017 Demographic and Family Health Survey: Antonio Barrenechea-Pulache, Emmanuel Avila-Jove, Akram Hernández-Vásquez, Fernando M. Runzer-Colmenares; Epidemiol Health. 2020;42:e2020043. Published online June 18, 2020; DOI: https://doi.org/10.4178/epih.e2020043

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Abstract PDF

Abstract

OBJECTIVES
This study was conducted to analyze the inequalities in Papanicolaou test (also referred to as the Pap smear) uptake according to the socio-demographic characteristics of Peruvian women 30 years to 59 years of age using information from the 2015-2017 Demographic and Family Health Survey (ENDES, acronym in Spanish).

METHODS

This is an analytical, cross-sectional study based on information acquired from the 2015-2017 ENDES surveys. Socio-demographic characteristics were reported using absolute frequencies and weighted proportions with 95% confidence intervals, considering results with a p-value <0.05 as statistically significant. Concentration curves (CCs) and concentration indices (IndCs) were created based on the interaction of the wealth index and uptake of Pap smears, taking into account the different characteristics of the population studied for the measure of inequalities.

RESULTS

All the CCs were distributed below the line of equality. Similarly, all the IndCs were higher than zero, indicating inequality in the uptake of Pap smears, favoring those with a higher wealth index. The highest IndC values were obtained from women aged 50-59 (IndC, 0.293), those who lived in the jungle (IndC, 0.230), and those without health insurance (IndC, 0.173).

CONCLUSIONS

We found socio-demographic inequalities in the uptake of Pap smears in Peru, favoring women with a higher wealth index. More funding is needed to promote cervical cancer screening programs and to create systems that ensure equal access to healthcare in Peru.

Summary

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Ethnic inequalities in coverage and use of women’s cancer screening in Peru
Claudio Intimayta-Escalante
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Socioeconomic disparities in Papanicolaou test utilization in Western Iran
Bahare Safari-Faramani, Roya Safari-Faramani, Farid Najafi, Davoud Khorasani Zavareh, Ali Kazemi Karyani, Mitra Darbandi
BMC Public Health.2024;[Epub] CrossRef
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The double burden of malnutrition among adults in India: evidence from the National Family Health Survey-4 (2015-16): Mili Dutta, Y Selvamani, Pushpendra Singh, Lokender Prashad; Epidemiol Health. 2019;41:e2019050. Published online December 18, 2019; DOI: https://doi.org/10.4178/epih.e2019050

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Abstract PDF

Abstract

OBJECTIVES
India still faces the burden of undernutrition and communicable diseases, and the prevalence of overweight/obesity is steadily increasing. The discourse regarding the dual burden of underweight and overweight/obesity has not yet been widely explored in both men and women. The present study assessed the determinants of underweight and overweight/obesity in India among adult men and women aged 15-49.

METHODS

Population-based cross-sectional and nationally representative data from the National Family Health Survey-4 (2015-16), consisting of a sample of men and women, were analyzed. Stratified 2-stage sampling was used in the NFHS-4 study protocol. In the present study, bivariate and adjusted multinomial logistic regression analyses were performed to determine the correlates of underweight and overweight/obesity.

RESULTS

The results suggested a persistently high prevalence of underweight coexisting with an increased prevalence of overweight/obesity in India. The risk of underweight was highest in the central and western regions and was also relatively high among those who used either smoking or smokeless tobacco. Overweight/obesity was more prevalent in urban areas, in the southern region, and among adults aged 35-49. Furthermore, level of education and wealth index were positively associated with overweight/obesity. More educated and wealthier adults were less likely to be underweight.

CONCLUSIONS

In India, underweight has been prevalent, and the prevalence of overweight/obesity is increasing rapidly, particularly among men. The dual burden of underweight and overweight/obesity is alarming and needs to be considered; public health measures to address this situation must also be adopted through policy initiatives.

Summary

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Alcohol-related emergency department visits and income inequality in New York City, USA: an ecological study: Kathleen H. Reilly, Katherine Bartley, Denise Paone, Ellenie Tuazon; Epidemiol Health. 2019;41:e2019041. Published online October 8, 2019; DOI: https://doi.org/10.4178/epih.e2019041

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Abstract

OBJECTIVES
Previous research has found that greater income inequality is related to problematic alcohol use across a variety of geographical areas in the USA and New York City (NYC). Those studies used self-reported data to assess alcohol use. This study examined the relationship between within-neighborhood income inequality and alcohol-related emergency department (ED) visits.

METHODS

The study outcome was the alcohol-related ED visit rate per 10,000 persons between 2010 and 2014, using data obtained from the New York Statewide Planning and Research Cooperative System. The main predictor of interest was income inequality, measured using the Gini coefficient from the American Community Survey (2010-2014) at the public use microdata area (PUMA) level (n=55) in NYC. Variables associated with alcohol-related ED visits in bivariate analyses were considered for inclusion in a multivariable model.

RESULTS

There were 420,568 alcohol-related ED visits associated with a valid NYC address between 2010 and 2014. The overall annualized NYC alcohol-related ED visit rate was 100.7 visits per 10,000 persons. The median alcohol ED visit rate for NYC PUMAs was 88.0 visits per 10,000 persons (interquartile range [IQR], 64.5 to 133.5), and the median Gini coefficient was 0.48 (IQR, 0.45 to 0.51). In the multivariable model, a higher neighborhood Gini coefficient, a lower median age, and a lower percentage of male residents were independently associated with the alcohol-related ED visit rate.

CONCLUSIONS

This study found that higher neighborhood income inequality was associated with higher neighborhood alcohol-related ED visit rates. The precise mechanism of this relationship is not understood, and further investigation is warranted to determine temporality and to assess whether the results are generalizable to other locales.

Summary

Citations

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