Journal of Preventive Medicine and Public Health

Original Article

Measurement and Decomposition of Socioeconomic Inequality in Metabolic Syndrome: A Cross-sectional Analysis of the RaNCD Cohort Study in the West of Iran: Moslem Soofi, Farid Najafi, Shahin Soltani, Behzad Karamimatin; J Prev Med Public Health. 2023;56(1):50-58. Published online January 6, 2023; DOI: https://doi.org/10.3961/jpmph.22.373

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Objectives
Socioeconomic inequality in metabolic syndrome (MetS) remains poorly understood in Iran. The present study examined the extent of the socioeconomic inequalities in MetS and quantified the contribution of its determinants to explain the observed inequality, with a focus on middle-aged adults in Iran.
Methods
This cross-sectional study used data from the Ravansar Non-Communicable Disease cohort study. A sample of 9975 middle-aged adults aged 35-65 years was analyzed. MetS was assessed based on the International Diabetes Federation definition. Principal component analysis was used to construct socioeconomic status (SES). The Wagstaff normalized concentration index (CI_n) was employed to measure the magnitude of socioeconomic inequalities in MetS. Decomposition analysis was performed to identify and calculate the contribution of the MetS inequality determinants.
Results
The proportion of MetS in the sample was 41.1%. The CI_n of having MetS was 0.043 (95% confidence interval, 0.020 to 0.066), indicating that MetS was more concentrated among individuals with high SES. The main contributors to the observed inequality in MetS were SES (72.0%), residence (rural or urban, 46.9%), and physical activity (31.5%).
Conclusions
Our findings indicated a pro-poor inequality in MetS among Iranian middle-aged adults. These results highlight the importance of persuading middle-aged adults to be physically active, particularly those in an urban setting. In addition to targeting physically inactive individuals and those with low levels of education, policy interventions aimed at mitigating socioeconomic inequality in MetS should increase the focus on high-SES individuals and the urban population.

Summary

Citations

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Sleep Quality, Nutrient Intake, and Social Development Index Predict Metabolic Syndrome in the Tlalpan 2020 Cohort: A Machine Learning and Synthetic Data Study
Guadalupe Gutiérrez-Esparza, Mireya Martinez-Garcia, Tania Ramírez-delReal, Lucero Elizabeth Groves-Miralrio, Manlio F. Marquez, Tomás Pulido, Luis M. Amezcua-Guerra, Enrique Hernández-Lemus
Nutrients.2024; 16(5): 612. CrossRef
Socioeconomic inequalities in metabolic syndrome and its components in a sample of Iranian Kurdish adults
Pardis Mohammadzadeh, Farhad Moradpour, Bijan Nouri, Farideh Mostafavi, Farid Najafi, Ghobad Moradi
Epidemiology and Health.2023; 45: e2023083. CrossRef

COVID-19: Original Article

Social Determinants of COVID-19 in Massachusetts, United States: An Ecological Study: Devan Hawkins; J Prev Med Public Health. 2020;53(4):220-227. Published online June 24, 2020; DOI: https://doi.org/10.3961/jpmph.20.256

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Abstract PDF Supplementary Material

Objectives
The aim of this study was to assess how different social determinants of health (SDoH) may be related to variability in coronavirus disease 2019 (COVID-19) rates in cities and towns in Massachusetts (MA).
Methods
Data about the total number of cases, tests, and rates of COVID-19 as of June 10, 2020 were obtained for cities and towns in MA. The data on COVID-19 were matched with data on various SDoH variables at the city and town level from the American Community Survey. These variables included information about income, poverty, employment, renting, and insurance coverage. We compared COVID-19 rates according to these SDoH variables.
Results
There were clear gradients in the rates of COVID-19 according to SDoH variables. Communities with more poverty, lower income, lower insurance coverage, more unemployment, and a higher percentage of the workforce employed in essential services, including healthcare, had higher rates of COVID-19. Most of these differences were not accounted for by different rates of testing in these cities and towns.
Conclusions
SDoH variables may explain some of the variability in the risk of COVID-19 across cities and towns in MA. Data about SDoH should be part of the standard surveillance for COVID-19. Efforts should be made to address social factors that may be putting communities at an elevated risk.

Summary

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Original Articles

An Exploratory Study of Health Inequality Discourse Using Korean Newspaper Articles: A Topic Modeling Approach: Jin-Hwan Kim; J Prev Med Public Health. 2019;52(6):384-392. Published online October 25, 2019; DOI: https://doi.org/10.3961/jpmph.19.221

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Abstract Summary PDF Supplementary Material

Objectives
This study aimed to explore the health inequality discourse in the Korean press by analyzing newspaper articles using a relatively new content analysis technique.
Methods
This study used the search term “health inequality” to collect articles containing that term that were published between 2000 and 2018. The collected articles went through pre-processing and topic modeling, and the contents and temporal trends of the extracted topics were analyzed.
Results
A total of 1038 articles were identified, and 5 topics were extracted. As the number of studies on health inequality has increased over the past 2 decades, so too has the number of news articles regarding health inequality. The extracted topics were public health policies, social inequalities in health, inequality as a social problem, healthcare policies, and regional health gaps. The total number of occurrences of each topic increased every year, and the trend observed for each theme was influenced by events related to its contents, such as elections. Finally, the frequency of appearance of each topic differed depending on the type of news source.
Conclusions
The results of this study can be used as preliminary data for future attempts to address health inequality in Korea. To make addressing health inequality part of the public agenda, the media’s perspective and discourse regarding health inequality should be monitored to facilitate further strategic action.

Summary

Korean summary
건강불평등 해소는 한국사회의 중요한 목표이다. 이 연구에서는 건강불평등을 다룬 신문기사를 추출, 토픽모델링 기법을 적용해 공공의료, 사회경제적 요인에 따른 건강불평등, 사회문제로 불평등, 보건의료정책, 지역건강격차의 다섯 가지 주제를 도출하였다. 언론이 건강불평등을 다루는 방식은 학술적 연구에서 건강불평등을 다루는 방식과는 유사하였으나, 건강취약지역의 저소득층의 인식과는 차이가 있었다.

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Regional Health Disparities in Hypertension-Related Hospitalization of Hypertensive Patients: A Nationwide Population-Based Nested Case-Control Study
Woo-Ri Lee, Jun Hyuk Koo, Ji Yun Jeong, Min Su Kim, Ki-Bong Yoo
International Journal of Public Health.2023;[Epub] CrossRef

Effects of Iranian Economic Reforms on Equity in Social and Healthcare Financing: A Segmented Regression Analysis: Hamed Zandian, Amirhossein Takian, Arash Rashidian, Mohsen Bayati, Telma Zahirian Moghadam, Satar Rezaei, Alireza Olyaeemanesh; J Prev Med Public Health. 2018;51(2):83-91. Published online February 6, 2018; DOI: https://doi.org/10.3961/jpmph.17.050

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Abstract PDF

Objectives
One of the main objectives of the Targeted Subsidies Law (TSL) in Iran was to improve equity in healthcare financing. This study aimed at measuring the effects of the TSL, which was implemented in Iran in 2010, on equity in healthcare financing. Methods: Segmented regression analysis was applied to assess the effects of TSL implementation on the Gini and Kakwani indices of outcome variables in Iranian households. Data for the years 1977-2014 were retrieved from formal databases. Changes in the levels and trends of the outcome variables before and after TSL implementation were assessed using Stata version 13. Results: In the 33 years before the implementation of the TSL, the Gini index decreased from 0.401 to 0.381. The Gini index and its intercept significantly decreased to 0.362 (p<0.001) 5 years after the implementation of the TSL. There was no statistically significant change in the gross domestic product or inflation rate after TSL implementation. The Kakwani index significantly increased from -0.020 to 0.007 (p<0.001) before the implementation of the TSL, while we observed no statistically significant change (p=0.81) in the Kakwani index after TSL implementation. Conclusions: The TSL reform, which was introduced as part of an economic development plan in Iran in 2010, led to a significant reduction in households’ income inequality. However, the TSL did not significantly affect equity in healthcare financing. Hence, while measuring the long-term impact of TSL is paramount, healthcare decision-makers need to consider the efficacy of the TSL in order to develop plans for achieving the desired equity in healthcare financing.

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Changes in Contribution of Causes of Death to Socioeconomic Mortality Inequalities in Korean Adults: Kyunghee Jung-Choi, Young-Ho Khang, Hong-Jun Cho; J Prev Med Public Health. 2011;44(6):249-259. Published online November 14, 2011; DOI: https://doi.org/10.3961/jpmph.2011.44.6.249

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Abstract PDF

Objectives

This study aimed to analyze long-term trends in the contribution of each cause of death to socioeconomic inequalities in all-cause mortality among Korean adults.

Methods

Data were collected from death certificates between 1990 and 2004 and from censuses in 1990, 1995, and 2000. Age-standardized death rates by gender were produced according to education as the socioeconomic position indicator, and the slope index of inequality was calculated to evaluate the contribution of each cause of death to socioeconomic inequalities in all-cause mortality.

Results

Among adults aged 25-44, accidental injuries with transport accidents, suicide, liver disease and cerebrovascular disease made relatively large contributions to socioeconomic inequalities in all-cause mortality, while, among adults aged 45-64, liver disease, cerebrovascular disease, transport accidents, liver cancer, and lung cancer did so. Ischemic heart disease, a very important contributor to socioeconomic mortality inequality in North America and Western Europe, showed a very low contribution (less than 3%) in both genders of Koreans.

Conclusions

Considering the contributions of different causes of death to absolute mortality inequalities, establishing effective strategies to reduce socioeconomic inequalities in mortality is warranted.

Summary

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Research Support, Non-U.S. Gov'ts

Gender, Professional and Non-Professional Work, and the Changing Pattern of Employment-Related Inequality in Poor Self-Rated Health, 1995-2006 in South Korea.: Il Ho Kim, Young Ho Khang, Sung Il Cho, Heeran Chun, Carles Muntaner; J Prev Med Public Health. 2011;44(1):22-31.; DOI: https://doi.org/10.3961/jpmph.2011.44.1.22

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Abstract PDF

OBJECTIVES
We examined gender differential changes in employment-related health inequalities according to occupational position (professional/nonprofessional) in South Korea during the last decade. METHODS: Data were taken from four rounds of Social Statistical Surveys of South Korea (1995, 1999, 2003, and 2006) from the Korean National Statistics Office. The total study population was 55435 male and 33 913 female employees aged 25-64. Employment arrangements were divided into permanent, fixed-term, and daily employment. RESULTS: After stratification according to occupational position (professional/nonprofessional) and gender, different patterns in employment - related health inequalities were observed. In the professional group, the gaps in absolute and relative employment inequalities for poor self-rated health were more likely to widen following Korea's 1997 economic downturn. In the nonprofessional group, during the study period, graded patterns of employment-related health inequalities were continuously observed in both genders. Absolute health inequalities by employment status, however, decreased among men but increased among women. In addition, a remarkable increase in relative health inequalities was found among female temporary and daily employees (p = 0.009, < 0.001, respectively), but only among male daily employees (p = 0.001). Relative employment-related health inequalities had clearly widened for female daily workers between 2003 and 2006 (p = 0.047). The 1997 Korean economic downturn, in particular, seemingly stimulated a widening gap in employment health inequalities. CONCLUSIONS: Our study revealed that whereas absolute health inequalities in relation to employment status increased in the professional group, relative employment-related health inequalities increased in the nonprofessional group, especially among women. In view of the high concentration of female nonstandard employees, further monitoring of inequality should consider gender specific patterns according to employee's occupational and employment status.

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Associations of Income and Wealth with Health Status in the Korean Elderly.: Bo Hyun Park, Minsoo Jung, Tae Jin Lee; J Prev Med Public Health. 2009;42(5):275-282.; DOI: https://doi.org/10.3961/jpmph.2009.42.5.275

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Abstract PDF

OBJECTIVES
This study aimed to verify the association between wealth or income level and health status after adjusting for other socio-economic position (SEP) indicators among Korean adults aged 45 and over. METHODS: Data were obtained from the 1st wave of Korean Longitudinal Study of Ageing (households: 6,171, persons: 10,254). We used self-rated health status and activities of daily living (ADLs) as dependent variables. Explanatory variables included both net wealth measured by savings, immovables, the other valuated assets and total income including pay, transfer, property and so on. Binary logistic regression was conducted to examine the relationships. Also, in order to determine the relative health inequality across economic groups, we estimated the relative index of inequality (RII). RESULTS: The inequality of health status was evident among various wealth and income groups. The wealthiest group (5th quintile) was much healthier than the poorest group, and this differential increased with age. Likewise, higher income was associated with better health status among the elderly. However, these effects, as measured by the odds ratio and RII, showed that wealth was more important in determining health status of elderly people. CONCLUSIONS: This study suggests that economic capability plays a significant role in determining the health status and other health-related problems among the elderly. Particularly, our results show that health status of the aged is related more closely to the individual's wealth than income.

Summary

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English Abstracts

Health Inequality Measurement in Korea Using EuroQol-5 Dimension Valuation Weights.: Hosung Shin, Dongjin Kim; J Prev Med Public Health. 2008;41(3):165-172.; DOI: https://doi.org/10.3961/jpmph.2008.41.3.165

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Abstract PDF

OBJECTIVES
Despite various government initiatives, including the expansion of national health insurance coverage, health inequality has been a key health policy issue in South Korea during the past decade. This study describes and compares the extent of the total health inequality and the income-related health inequality over time among Korean adults. METHODS: This study employs the 1998, 2001 and 2005 Korean National Health and Nutrition Examination Surveys (KNHANESs). The self-assessed health (SAH) ordinal responses, measured on a five-point scale, rescaled to cardinal values to measure the health inequalities with using interval regression. The boundaries of each threshold for the interval regression analysis were obtained from the empirical distribution of the EuroQol-5 Dimension (EQ-5D) valuation weights estimated from the 2005 KNHANES. The final model predicting the individuals' health status included age, gender, educational attainment, occupation, income, and the regional prosperity index. The concentration index was used to measure and analyze the health inequality. RESULTS: The KNHANES data showed an unequal distribution of the total health inequality in favor of the higher income groups, and this is getting worse over time (0.0327 in 1998, 0.0393 in 2001 and 0.0924 in 2005). The income-related health inequality in 2005 was 0.0278, indicating that 30.1% of the total health inequality can be attributed to income. CONCLUSIONS: The findings indicate there are health inequalities across the sociodemographic and income groups despite the recent government's efforts. Further research is warranted to investigate what potential policy actions are necessary to decrease the health inequality in Korea.

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Introduction of Health Impact Assessment and Healthy Cities as a Tool for Tackling Health Inequality.: Weon Seob Yoo, Keon Yeop Kim, Kwang Wook Koh; J Prev Med Public Health. 2007;40(6):439-446.; DOI: https://doi.org/10.3961/jpmph.2007.40.6.439

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In order to reduce the health inequalities within a society changes need to be made in broad health determinants and their distribution in the population. It has been expected that the Health impact assessment(HIA) and Healthy Cities can provide opportunities and useful means for changing social policy and environment related with the broad health determinants in developed countries. HIA is any combination of procedures or methods by which a proposed 4P(policy, plan, program, project) may be judged as to the effects it may have on the health of a population. Healthy city is one that is continually creating and improving those physical and social environments and expanding those community resources which enable people to mutually support each other in performing all the functions of life and in developing to their maximum potential. In Korea, social and academic interest regarding the HIA and Healthy Cities has been growing recently but the need of HIA and Healthy Cities in the perspective of reducing health inequality was not introduced adequately. So we reviewed the basic concepts and methods of the HIA and Healthy Cities, and its possible contribution to reducing health inequalities. We concluded that though the concepts and methods of the HIA and Healthy Cities are relatively new and still in need of improvement, they will be useful in approaching the issue of health inequality in Korea.

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Gil-Ho Jung, Keon-Yeop Kim, Bak-Ju Na
Journal of agricultural medicine and community health.2009; 34(2): 155. CrossRef

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Why Do Health Inequalities Matter?.: Young Jeon Shin, Myoung Hee Kim; J Prev Med Public Health. 2007;40(6):419-421.; DOI: https://doi.org/10.3961/jpmph.2007.40.6.419

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OBJECTIVES
The aim of this study was to introduce the concept of health inequalities, and to discuss the underlying assumptions and ethical backgrounds associated with the issue, as well as the theoretical and practical implications of health inequalities. METHODS: Based on a review of the literature, we summarize the concepts of health inequalities and inequities and discuss the underlying assumptions and ethical backgrounds associated with these issues from the view of social justice theory. We then discuss the theoretical and practical implications of health inequalities. RESULTS: Health inequality involves ethical considerations, such as judgments on fairness, and it could provide a sensitive barometer to reflect the fairness of social arrangements. Discussion on health inequalities could deepen our understanding of the social etiology of health and provide a basis for the development of comprehensive and integrative social policies. CONCLUSIONS: Health equity is not a social goal in and of itself, but should be considered as a part of a broader effort to seek social justice.

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A Study on Factors Affecting Cancer Mortality in Busan
Su-Kyung Song, Hye-Sook Kim, Kyoung-Min Lim
The Korean Journal of Health Service Management.2014; 8(4): 81. CrossRef

English Abstracts

The Effects of the Parents' Social Class on Infant and Child Death among 1995-2004 Birth Cohort in Korea.: Mia Son, Juhwan Oh, Yong Jun Choi, Jeong Ok Kong, Jisook Choi, Eunjeong Jin, Sung Tae Jung, Se Jin Park; J Prev Med Public Health. 2006;39(6):469-476.

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Abstract PDF: OBJECTIVES
To investigate the effect of parents' social class on infant and child mortality rates among the birth cohort, for the period of transition to and from the Koran economic crisis 1995-2004. METHODS: All births reported to between 1995 and 2004 (n=5,711,337) were analyzed using a Cox regression model, to study the role of the social determinants of parents in infant and child mortality. The results were adjusted for the parents' age, education and occupation, together with mother's obstetrical history. RESULTS: The crude death rate among those under 10 was 3.71 per 1000 births (21,217 deaths among 5,711,337 births) between 1995 and 2004. The birth cohorts from lower educated parents less than elementary school showed higher mortality rates compared with those from higher educated parents over university level (HR:3.0 (95%CI:2.8-3.7) for father and HR:3.4 (95%CI:3.3-4.5) for mother). The mother's education level showed a stronger relationship with mortality among the birth cohort than that of the fathers'. The gaps in infant mortality rates by parents' social class, and educational level became wider from 1995 to 2004. In particular, the breadth of the existing gap between higher and lower parents' social class groups has dramatically widened since the economic crisis of 1998. DISCUSSIONS: This study shows that social differences exist in infant and child mortality rates. Also, the gap for the infant mortality due to social class has become wider since the economic crisis of 1998.; Summary

The Relationship between Regional Material Deprivation and the Standardized Mortality Ratio of the Community Residents Aged 15-64 in Korea.: Baek Geun Jeong, Kap Yeol Jung, Joon Youn Kim, Ok Ryun Moon, Yong Hwan Lee, Young Seoub Hong, Tae Ho Yoon; J Prev Med Public Health. 2006;39(1):46-52.

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Abstract PDF: OBJECTIVES
This study was performed to investigate the relationship between regional material deprivation and the standardized mortality ratios(SMRs) of community residents aged 15-64 in Korea. METHODS: SMRs were investigated using the registered death data from 1995 to 2000 that was obtained from the Korean National Statistics Office with the denominators being drawn from the 1995 to 2000 census. Material deprivation was measured using the Townsend score that was calculated from the 1995 to 2000 census. The relationship between the regional material deprivation and the SMRs of the community residents aged 15-64 was investigated by using ANOVA, Spearman's rank correlation analysis and Pearson's correlation analysis. The trends in mortality inequality were investigated using the concentration index. RESULTS: On the ANOVA, the SMRs of the men and women residents in the least deprived areas were the smallest and those in the most deprived areas were the largest. Spearman's rank correlation analysis, Pearson's correlation analysis and the concentration index revealed that significant positive relationships exist between the regional material deprivation and the SMRs of the community residents aged 15-64. CONCLUSIONS: This study suggests that there are mortality inequalities among the communities in Korea and part of this difference is due to the material deprivation of the community. Strategies aimed at reducing mortality inequalities among the communities will be needed to address economic inequalities. Further studies are needed to explore the mechanisms of how the regional deprivation influences on health and how the other factors of the community influence on the health of the community residents.; Summary

Changes in Mortality Inequality in Relation to the South Korean Economic Crisis: Use of Area-based Socioeconomic Position.: Young Ho Khang, Sung Cheol Yun, In A Hwang, Moo Song Lee, Sang Il Lee, Min Woo Jo, Min Jung Lee; J Prev Med Public Health. 2005;38(3):359-365.

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Abstract PDF: OBJECTIVE
An abrupt economic decline may widen the socioeconomic differences in health between the advantaged and disadvantaged in a society. The aim of this study was to examine whether the South Korean economic crisis of 1997-98 affected the socioeconomic inequality from all-causes and from cause-specific mortality between 1995 and 2001. METHODS: Population denominators were obtained from the registration population data, with the number of death (numerators) calculated from raw death certificate data. The indicator used to assess the geographic socioeconomic position was the per capita regional tax revenue. Administrative districts (Si-Gun-Gu) were ranked according to this socioeconomic measure, and divided into equal population size quintiles on the basis of this ranking. The sex- and 5-year age-specific numbers of the population and deaths were used to compute the sex- and age-adjusted mortality rates (via direct standardization method), standardized mortality ratios (via indirect standardization methods) and relative indices of inequality (RII) (via Poisson regression). RESULTS: Geographic inequalities from all-causes of mortality, as measured by RII, did not increase as a result of the economic crisis (from 1998-2001). This was true for both sexes and all age groups. However, the cause-specific analyses showed that socioeconomic inequalities in mortalities from external causes were affected by South Korean economic crisis. For males, the RIIs for mortalities from transport accidents and intentional self-harm increased between 1995 and 2001. For females, the RII for mortality from intentional self-harm increased during the same period. CONCLUSIONS: The South Korean economic crisis widened the geographic inequality in mortalities from major external causes. This increased inequality requires social discourse and counter policies with respect to the rising health inequalities in the South Korean society.; Summary

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