Journal of Preventive Medicine and Public Health

Young Ho Khang

20 Articles

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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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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Association between temporary employment and current smoking and change in smoking behaviors: A prospective cohort study from South Korea (2009–2018)
Seong-Uk Baek, Min-Seok Kim, Myeong-Hun Lim, Taeyeon Kim, Jin-Ha Yoon, Yu-Min Lee, Jong-Uk Won
Journal of Epidemiology.2024;[Epub] CrossRef
Temporary Employment Is Associated with Poor Dietary Quality in Middle-Aged Workers in Korea: A Nationwide Study Based on the Korean Healthy Eating Index, 2013–2021
Seong-Uk Baek, Myeong-Hun Lim, Yu-Min Lee, Jong-Uk Won, Jin-Ha Yoon
Nutrients.2024; 16(10): 1482. CrossRef
An evolution of socioeconomic inequalities in self-rated health in Korea: Evidence from Korea National Health and Nutrition Examination Survey (KNHANES) 1998–2018
Daseul Moon, Roman Pabayo, Jongnam Hwang
SSM - Population Health.2024; 26: 101689. CrossRef
Initiatives Addressing Precarious Employment and Its Effects on Workers’ Health and Well-Being: A Systematic Review
Virginia Gunn, Bertina Kreshpaj, Nuria Matilla-Santander, Emilia F. Vignola, David H. Wegman, Christer Hogstedt, Emily Q. Ahonen, Theo Bodin, Cecilia Orellana, Sherry Baron, Carles Muntaner, Patricia O’Campo, Maria Albin, Carin Håkansta
International Journal of Environmental Research and Public Health.2022; 19(4): 2232. CrossRef
Changes in cause-specific mortality trends across occupations in working-age Japanese women from 1980 to 2015: a cross-sectional analysis
Bibha Dhungel, Kuniyasu Takagi, Shijan Acharya, Koji Wada, Stuart Gilmour
BMC Women's Health.2022;[Epub] CrossRef
A Longitudinal Evaluation of Risk Factors and Interactions for the Development of Nonspecific Neck Pain in Office Workers in Two Cultures
Deokhoon Jun, Venerina Johnston, Steven M. McPhail, Shaun O’Leary
Human Factors: The Journal of the Human Factors and Ergonomics Society.2021; 63(4): 663. CrossRef
Initiatives addressing precarious employment and its effects on workers’ health and well-being: a protocol for a systematic review
Virginia Gunn, Carin Håkansta, Emilia Vignola, Nuria Matilla-Santander, Bertina Kreshpaj, David H. Wegman, Christer Hogstedt, Emily Q. Ahonen, Carles Muntaner, Sherry Baron, Theo Bodin
Systematic Reviews.2021;[Epub] CrossRef
Comparison of occupational health problems of employees and self-employed individuals who work in different fields
Jungsun Park, Boyoung Han, Yangho Kim
Archives of Environmental & Occupational Health.2020; 75(2): 98. CrossRef
Nonstandard workers and differential occupational safety and health vulnerabilities
Jungsun Park, Boyoung Han, Jong‐shik Park, Eun Ji Park, Yangho Kim
American Journal of Industrial Medicine.2019; 62(8): 701. CrossRef
Relationship of Occupational Category With Risk of Physical and Mental Health Problems
Jaeouk Ahn, Nam-Soo Kim, Byung-Kook Lee, Jungsun Park, Yangho Kim
Safety and Health at Work.2019; 10(4): 504. CrossRef
Cross-cultural adaptation and validation of the Depression, Anxiety and Stress Scale-21 (DASS-21) in the Korean working population
Deokhoon Jun, Venerina Johnston, Jun-Mo Kim, Shaun O’Leary
Work.2018; 59(1): 93. CrossRef
Self‐employed individuals performing different types of work have different occupational safety and health problems
Jungsun Park, Boyoung Han, Yangho Kim
American Journal of Industrial Medicine.2018; 61(8): 681. CrossRef
Nonstandard Employment and Health in South Korea: The Role of Gender and Family Status
Sojung Lim, Sun Young Jeon, Joongbaeck Kim, Hyeyoung Woo
Sociological Perspectives.2018; 61(6): 973. CrossRef
“Blue flags”, development of a short clinical questionnaire on work-related psychosocial risk factors - a validation study in primary care
Charlotte Post Sennehed, Gunvor Gard, Sara Holmberg, Kjerstin Stigmar, Malin Forsbrand, Birgitta Grahn
BMC Musculoskeletal Disorders.2017;[Epub] CrossRef
Association of Occupational Class with Healthcare Utilization among Economically Active Korean Adults from 2006 to 2014: A Repeated Cross-Sectional Study of Koreans Aged 19 Years and Older
Jae-Hyun Kim, Kwang Soo Lee, Yunhwan Lee, Eun-Cheol Park
Korean Journal of Family Medicine.2017; 38(6): 365. CrossRef
Gender Differences in the Effects of Job Control and Demands on the Health of Korean Manual Workers
HeeJoo Kim, Ji Hye Kim, Yeon Jin Jang, Ji Young Bae
Health Care for Women International.2016; 37(3): 290. CrossRef
Economic shocks and health resilience: lessons from the Russian Federation
Vladimir S. Gordeev, Yevgeniy Goryakin, Martin McKee, David Stuckler, Bayard Roberts
Journal of Public Health.2016; 38(4): e409. CrossRef
Impact of health insurance status changes on healthcare utilisation patterns: a longitudinal cohort study in South Korea
Jae-Hyun Kim, Sang Gyu Lee, Kwang-Soo Lee, Sung-In Jang, Kyung-Hee Cho, Eun-Cheol Park
BMJ Open.2016; 6(4): e009538. CrossRef
Working conditions, psychosocial environmental factors, and depressive symptoms among wage workers in South Korea
Minsung Sohn, Mankyu Choi, Minsoo Jung
International Journal of Occupational and Environmental Health.2016; 22(3): 209. CrossRef
Scoping review: national monitoring frameworks for social determinants of health and health equity
Leo Pedrana, Marina Pamponet, Ruth Walker, Federico Costa, Davide Rasella
Global Health Action.2016; 9(1): 28831. CrossRef
Trade liberalization, social policies and health: an empirical case study
Courtney McNamara
Globalization and Health.2015;[Epub] CrossRef
A Systematic Review on Health Resilience to Economic Crises
Ketevan Glonti, Vladimir S. Gordeev, Yevgeniy Goryakin, Aaron Reeves, David Stuckler, Martin McKee, Bayard Roberts, Daisuke Nishi
PLOS ONE.2015; 10(4): e0123117. CrossRef
The impact of economic crises on social inequalities in health: what do we know so far?
Amaia Bacigalupe, Antonio Escolar-Pujolar
International Journal for Equity in Health.2014;[Epub] CrossRef
Socioeconomic inequalities in health status in Korea
Kyunghee Jung-Choi, Yu-Mi Kim
Journal of the Korean Medical Association.2013; 56(3): 167. CrossRef
Self-rated health and its determinants in Japan and South Korea
J.H. Park, K.S. Lee
Public Health.2013; 127(9): 834. CrossRef
Health Status and Affecting Factors related to Job among Korean Women Employees
Eun-Young Hong, Sang-Dol Kim
Journal of the Korea Academia-Industrial cooperation Society.2012; 13(9): 4107. CrossRef

Trends in Sex Ratio at Birth according to Parental Social Positions: Results from Vital Statistics Birth, 1981-2004 in Korea.: Heeran Chun, Il Ho Kim, Young Ho Khang; J Prev Med Public Health. 2009;42(2):143-150.; DOI: https://doi.org/10.3961/jpmph.2009.42.2.143

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OBJECTIVES
South Korea has experienced unprecedented ups and downs in the sex ratio at birth (SRB), which has been a unique phenomenon in the last two decades. However, little is known about socioeconomic factors that influence the SRB. Employing the diffusion theory by Rogers, this study was undertaken to examine the trends in social variations in the SRB from 1981 to 2004 in Korea. METHODS: The data was taken from Vital Birth Statistics for the period from 1981-2004. We computed the annual male proportion of live births according to the parental education (university, middle/high school, primary) and occupation (non-manual, manual, others). Logistic regression analysis was employed to estimate the odds ratios of male birth according to social position for the equidistant three time periods (1981-1984, 1991-1994, and 2001-2004). RESULTS: An increased SRB was detected among parents with higher social position before the mid 1980s. Since then, however, a greater SRB was found for the less educated and manual jobholders. The inverse social gradient for the SRB was most prominent in early 1990s, but the gap has narrowed since the late 1990s. The mother's socioeconomic position could be a sensitive indicator of the social variations in the sex ratio at birth. CONCLUSIONS: Changes in the relationship of parental social position with the SRB were detected during the 1980-2004 in Korea. This Korean experience may well be explained by diffusion theory, suggesting there have been socioeconomic differences in the adoption and spread of sex-detection technology.

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Effects of Socio-demographic Factors on the Decreasing Trend in the Sex Ratio at Birth in Korea, 1997-2017
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Does the Mother or Father Determine the Offspring Sex Ratio? Investigating the Relationship between Maternal Digit Ratio and Offspring Sex Ratio
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La masculinisation des naissances. État des lieux et des connaissances
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Development and Change.2011; 42(5): 1269. CrossRef
The Sex Ratio Transition in Asia
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A Review on Socioeconomic Position Indicators in Health Inequality Research.: Yong Jun Choi, Baek Geun Jeong, Sung Il Cho, Kyunghee Jung-Choi, Soong Nang Jang, Minah Kang, Young Ho Khang; J Prev Med Public Health. 2007;40(6):475-486.; DOI: https://doi.org/10.3961/jpmph.2007.40.6.475

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OBJECTIVES
Socioeconomic position (SEP) refers to the socioeconomic factors that influence which position an individual or group of people will hold within the structure of a society. In this study, we provide a comprehensive review of various indicators of SEP, including education level, occupation-based SEP, income and wealth, area SEP, lifecourse SEP, and SEP indicators for women, elderly and youth. METHODS AND RESULTS: This report provides a brief theoretical background and discusses the measurement, interpretation issues, advantages and limitations associated with the use of each SEP indicator. We also describe some problems that arise when selecting SEP indicators and highlight the indicators that appear to be appropriate for health inequality research. Some practical information for use in health inequality research in South Korea is also presented. CONCLUSIONS: Investigation into the associations between various SEP indicators and health outcomes can provide a more complete understanding of mechanisms between SEP and health. The relationship between specific SEP indicators and specific health outcomes can vary by country due to the differences in the historical, socioeconomic, and cultural contexts of the SEP indicators.

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European Journal of Cancer Prevention.2022; 31(2): 137. CrossRef
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Social Science & Medicine.2020; 253: 112945. CrossRef
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Archives of Gerontology and Geriatrics.2018; 78: 196. CrossRef
The mediation effect of individual eating behaviours on the relationship between socioeconomic status and dietary quality in children: the Korean National Health and Nutrition Examination Survey
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European Journal of Nutrition.2017; 56(3): 1339. CrossRef
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Historical Advances in Health Inequality Research.: Young Ho Khang; J Prev Med Public Health. 2007;40(6):422-430.; DOI: https://doi.org/10.3961/jpmph.2007.40.6.422

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Abstract PDF

The socioeconomic inequalities in health have recently become an important public health concern in South Korea, and the issue has gained increasing attention from many South Korean researchers due to the increasing income inequality and widening social polarization following its economic crisis in the late 1990s. However, despite the mounting literature on health inequalities published in recent years, the history of research on health inequality in South Korea is premature in comparison to the long histories in several Western countries. Understanding the historical background underlying the issue of health inequality research may aid in establishing and accumulating scientifically solid evidence in South Korea. It may also direct the South Korean research community to develop research agendas that are more politically and academically appropriate for South Korean society. This paper describes the historical development of health inequality research in the West and introduces several important issues contributing to the advancement of health inequality research. Specifically, the major studies conducted before and after the UK Black Report are presented. In addition, the history and current status of health inequality research in South Korea are documented and evaluated. Finally, several research agendas for the quantitative and qualitative improvement of health inequality research in South Korea are proposed.

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Occupational Differentials in Cigarette Smoking in South Korea: Findings from the 2003 Social Statistics Survey.: Hong Jun Cho, Young Ho Khang, Sung Cheol Yun; J Prev Med Public Health. 2006;39(4):365-370.

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The purpose of this study was to investigate the differences in smoking rates according to the major occupational categories in South Korea. METHODS: The study subjects were a weighted sample of 24,495 men and 26,121 women aged 25-64 from the 2003 Social Statistics Survey, which was conducted by the Korea National Statistical Office. Occupation was classified according to the Korean Standard Occupation Classification. We computed the age-standardized smoking rates according to gender and occupations after adjusting for the education level, marital status, and self-rated health. RESULTS: For men, the smoking rate in elementary occupations was two times higher than that of clerks (OR= 1.98, 95% CI=1.74-2.26). In general, a more prestigious job(professionals) correlated with lower smoking rates, and less prestigious jobs correlated with higher smoking rates, except for legislators, senior officials and managers. For women, smoking among service workers was 4.1 times higher than among clerical workers (OR=4.11, 95% CI= 2.87-5.88). For women, their occupations, except elementary workers, and the unemployed, the retired and the armed forces, failed to show significant differences in smoking compared with the clerical workers. After adjusting for education, occupational differences in the smoking rate for men were attenuated in most occupations, except for legislators, professionals, and technicians. Further adjustment for marital status and self-rated health had a minimal effect on the occupational differences in the smoking rate for men. For women workers with service or elementary occupations, the ORs of smoking were attenuated with adjustment of the educational levels. However, the ORs of smoking were increased in workers with service, sales or elementary occupations, as well as for legislators, and the unemployed, the retired and the armed forces, after additionally adjusting for marital status. CONCLUSIONS: More prestigious jobs generally correlated with lower smoking rates in both sexes. The anti-tobacco policy should consider smoking rate differentials by occupations.; Summary

Socioeconomic Mortality Inequality in Korea: Mortality Follow-up of the 1998 National Health and Nutrition Examination Survey(NHANES) Data.: Young Ho Khang, Hye Ryun Kim; J Prev Med Public Health. 2006;39(2):115-122.

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This study was conducted to examine the relationships of the several socioeconomic position indicators with the mortality risk in a representative longitudinal study of South Korea. METHODS: The 1998 National Health and Nutrition Examination Survey was conducted on a cross-sectional probability sample of South Korean households, and it contained unique 13-digit personal identification numbers that were linked to the data on mortality from the National Statistical Office of Korea. Of 5,607 males and females, 264 died between 1999 and 2003. Cox's regression was used to estimate the relative risks (RR) and their 95% confidence intervals (CI) of mortality. RESULTS: Socioeconomic differences in mortality were observed after adjustments were made for gender and age. Compared with those people having college or higher education, those people without any formal education had a greater mortality risk (RR=2.21, 95% CI=1.12-4.40). The mortality risk among manual workers was significantly greater than that for the non-manual workers (RR=2.73, 95% CI=1.47-5.06). A non-standard employment status was also associated with an increase in mortality: temporary or daily workers had a greater mortality risk than did the full-time workers (RR=3.01, 95% CI=1.50-6.03). The mortality risk for the low occupational class was 3.06 times greater than that of the high and middle occupational classes (95% CI=1.75-5.36). In addition, graded mortality differences according to equivalized monthly household income were found. A reduction of monthly household income by 500 thousand Korean Won (about 400 US dollars) was related with a 20% excess risk of mortality. Self-reported poor living standards were also associated with an increased risk of mortality. Those without health insurance had a 3.63 times greater risk of mortality than the insured (95% CI=1.61-8.19). CONCLUSIONS: This study showed the socioeconomic differentials in mortality in a national longitudinal study of South Korea. The existence of socioeconomic mortality inequalities requires increased social discussion on social policies in Korean society. Furthermore, the mechanisms for the socioeconomic inequalities of mortality need to be explored in future studies.; Summary

A Multilevel Study on the Relationship between the Residential Distribution of High Class (Power Elites) and Smoking in Seoul.: Chang Seok Kim, Sung Cheol Yun, Hye Ryun Kim, Young Ho Khang; J Prev Med Public Health. 2006;39(1):30-38.

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Abstract PDF: OBJECTIVES
We examined whether the neighborhood socioeconomic position predicts the smoking rates after adjusting for individual socioeconomic position indicators. METHODS: Data were obtained from the 2001 Seoul Health Indicators Survey. The neighborhood socioeconomic position was the residential distribution of the high class (power elites), as measured by the location quotients (LQ) for each administrative dong (district). A high LQ denotes a high neighborhood socioeconomic status. The individual socioeconomic position included education, occupation and income. Age-adjusted smoking rates according to the LQ level were computed with the direct method. The total number of subjects in this study (26,022 men and 28,007 women) was the reference. A multilevel logistic regression analysis was conducted with the individuals at the first level and the neighborhoods at the second level to estimate the odds ratios of smoking with 95% confidence intervals. RESULTS: For men, the age-adjusted smoking rates increased with a decrease in the LQ. For women, the relationship between the age-adjusted smoking rate and the LQ was not clear. The odds of smoking for both genders were greater among those subjects with lower incomes and lower education. The manual occupational class had greater odds of smoking than the non-manual class for the males, while the odds ratio of smoking among females with a manual occupation tended to be lower than those females with a non-manual occupation. For the males, the LQ levels independently predicted smoking after adjustment for individual income. However, this relation between the LQ and smoking in males was explained by full adjustment for the individual socioeconomic position indicators (education, occupation and income). CONCLUSIONS: A low level of neighborhood socioeconom-ic position was associated with higher smoking rates among the men residing in Seoul. This association between the neighborhood socioeconomic position and smoking in men was explained by the individual socioeconomic position. Anti-smoking efforts to reduce geographical inequality in smoking should be directed at reducing the smoking rates between the individuals with different socioeconomic backgrounds in the metropolitan city of Seoul, South Korea.; Summary

Reliability of Education and Occupational Class: A Comparison of Health Survey and Death Certificate Data.: Hye Ryun Kim, Young Ho Khang; J Prev Med Public Health. 2005;38(4):443-448.

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Abstract PDF: OBJECTIVES
This study was done to evaluate the reliability of education and occupational class between using the health survey and the death certificate data. METHODS: The 1998 National Health and Nutrition Examination Survey (NHANES) was conducted on a crosssectional probability sample of South Korean households, and it contained unique 13-digit personal identification numbers that were linked to the data on mortality from the Korean National Statistical Office. The data from 263 deaths were used to estimate the agreement rates and the Kappa indices of the education and occupational class between using the NHANES data and the death certificate data. RESULTS: The simple and weighted Kappa indices for education were 0.60 (95% CI=0.53-0.68) and 0.73 (95% CI=0.67-0.79) respectively, if the educational level was grouped into five categories: no-formal-education, elementary-school, middle-school, high-school and college or over. The overall agreement rate was 71.9% for these educational groups. The magnitude of reliability, as measured by the overall agreement rates and Kappa indices, tended to increase with a decrease in the educational class. The number of non-educated people with using the death certificate data was smaller than that with using the NHANES data. For the occupational class (manual workers, non-manual workers and others), the Kappa index was 0.40 (95% CI=0.30-0.51), which was relatively lower than that for the educational class. Compared with the NHANES, the number of non-manual workers for the deceased who were aged 30-64 tended to be increased (8 to 12) when using the death certificate data, whereas the number of manual workers tended to be decreased (59 to 41). CONCLUSIONS: The socioeconomic inequalities in the mortality rates that were based on the previous unlinked studies in South Korea were not due to a numerator/denominator bias. The mortality rates for the manual workers and the no-education groups might have been underestimated.; Summary

Socioeconomic Differentials in Health and Health Related Behaviors: Findings from the Korea Youth Panel Survey.: Young Ho Khang, Sung Il Cho, Seungmi Yang, Moo Song Lee; J Prev Med Public Health. 2005;38(4):391-400.

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This study examined the socioeconomic differentials for the health and health related behaviors among South Korean middle school students. METHODS: A nationwide cross-sectional interview survey of 3, 449 middle school second-grade students and their parents was conducted using a stratified multi-stage cluster sampling method. The response rate was 93.3%. The socioeconomic position indicators were based on selfreported information from the students and their parents: parental education, father's occupational class, monthly family income, out-of-pocket expenditure for education, housing ownership, educational expectations, educational performance and the perceived economic hardships. The outcome variables that were measured were also based on the self-reported information from the students. The health measures included self-rated health conditions, psychological or mental problems, the feelings of loneliness at school, the overall satisfaction of life and the perceived level of stress. The health related behaviors included were smoking, alcohol drinking, sexual intercourse, violence, bullying and verbal and physical abuse by parents. RESULTS: Socioeconomic differences for the health and health related behaviors were found among the eighth grade boys and girls of South Korea. However, the pattern varied with gender, the socioeconomic position indicators and the outcome measures. The prevalence rates of the overall dissatisfaction with life for both genders differed according to most of the eight socioeconomic position indicators. All the health measures were significantly different according to the perceived economic hardship. However, the socioeconomic differences in the self-rated health conditions and the psychosocial or mental problems were not clear. The students having higher socioeconomic position tended to be a perpetrator of bullying while those students with lower socioeconomic position were more likely to be a victim. CONCLUSIONS: The perceived economic hardships predicted the health status among the eighth graders of South Korea. The overall satisfaction of life was associated with the socioeconomic position indicators. Further research efforts are needed to explore the mechanisms on how and why the socioeconomic position affects the health and health related behaviors in this age group.; 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

Lifecourse Approaches to Socioeconomic Health Inequalities.: Young Ho Khang; J Prev Med Public Health. 2005;38(3):267-275.

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Abstract PDF: Evidence on the relation of socioeconomic position (SEP) with health and illness is mounting in South Korea. Several unlinked studies and individually linked studies (longitudinal study) showed a graded inverse relationship between SEP and mortality among South Korean males and females. Based on the mortality relative ratios by occupational class reported in the published papers of South Korea and western countries, the magnitude of the socioeconomic inequality in mortality in South Korea seems to be similar to or even greater than that in western industrialized countries. A potential contribution of health related selection, health behaviors and psychosocial factors to explain this socioeconomic inequality in mortality was discussed. It was suggested that early life exposure measures would demonstrate a greater ability to explain socioeconomic inequalities in all-cause mortality than the above pathway variables in South Korea. This is based on the cause-specific structure of mortality among the South Korean population who have a relatively greater proportion of stomach cancer, hemorrhagic stroke, liver cancer and liver disease, and tuberculosis, which share early life exposures as important elements of their etiology, than western countries. However, the relative contribution of early and later life socioeconomic conditions in producing socioeconomic inequality in health may differ according to the outcome, thus remains to be investigated.; Summary

Census Population vs. Registration Population: Which Population Denominator Should be used to Calculate Geographical Mortality.: Young Ho Khang, In A Hwang, Sung Cheol Yun, Moo Song Lee, Sang Il Lee, Min Woo Jo, Min Jung Lee; J Prev Med Public Health. 2005;38(2):147-153.

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Abstract PDF: OBJECTIVES
Studies on the geographical differences in mortality tend to use a census population, rather than a registration population, as the denominator of mortality rates in South Korea. However, an administratively determined registration population would be the logical denominator, as the geographical areas for death certificates (numerator) have been determined by the administratively registered residence of the deceased, rather than the actual residence at the time of death. The purpose of this study was to examine the differences in the total number of a district population, and the associated district-specific mortality indicators, when two different measures as a population denominator (census and registration) were used. METHODS: Population denominators were obtained from census and registration population data, and the numbers of deaths (numerators) were calculated from raw death certificate data. Sex- and 5-year age-specific numbers for the populations and deaths were used to compute sex- and age-standardized mortality rates (by direct standardization methods) and standardized mortality ratios (by indirect standardization methods). Bland-Altman tests were used to compare district populations and district-specific mortality indicators according to the two different population denominators. RESULTS: In 1995, 9 of 232 (3.9%) districts were not included in the 95% confidence interval (CI) of the population differences. A total of 8 (3.4%) among 234 districts had large differences between their census and registration populations in 2000, which exceeded the 95% CI of the population differences. Most districts (13 of 17) exceeding the 95% CI were rural. The results of the sexand age-standardized mortality rates showed 15 (6.5%) and 16 (6.8%) districts in 1995 and 2000, respectively, were not included in the 95% CI of the differences in their rates. In addition, the differences in the standardized mortality ratios using the two different population denominators were significantly greater among 14 districts in 1995 and 11 districts in 2002 than the 95% CI. Geographical variations in the mortality indicators, using a registration population, were greater than when using a census population. CONCLUSION: The use of census population denominators may provide biased geographical mortality indicators. The geographical mortality rates when using registration population denominators are logical, but do not necessarily represent the exact mortality rate of a certain district. The removal of districts with large differences between their census and registration populations or associated mortality indicators should be considered to monitor geographical mortality rates in South Korea.; Summary

Proportion of Death Certificates Issued by Physicians and Associated Factors in Korea, 1990-2002.: Min Woo Jo, Young Ho Khang, Sungcheol Yun, Jin Yong Lee, Moo Song Lee, Sang Il Lee; J Prev Med Public Health. 2004;37(4):345-352. Published online November 30, 2004

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Abstract PDF: OBJECTIVES
Previous studies showed that death certification by physicians was an important predictor to improve the quality of death certificate data in South Korea. This study was conducted to examine the proportion of death certificates issued by physicians and associated factors in South Korea from 1990 to 2002. METHODS: Data from 3, 110, 883 death certificates issued between 1990 and 2002, available to the public from the National Statistical Office of Korea, were used to calculate the proportion of death certificates issued by physicians and to examine associated factors with logistic regression analysis. RESULTS: The overall proportion of death certificates issued by physicians increased from 44.6% in 1990 to 77.6% in 2002 (mean: 63.5%). However, the proportion was greatly influenced by the deceased's age. In 2002, more than 90% of the deceased aged 51 or less were certified by physicians. A higher proportion was found among deceased who had tertiary education (college or higher) living in more developed urban areas. CONCLUSION: The information regarding the cause of death for younger, well-educated deceased in urban areas of South Korea may show a higher level of accuracy. Epidemiologic research using information on causes of death may well benefit from the continually increasing proportion of death certificates issued by physicians in the future in South Korea.; Summary

Cost-Effectiveness Analysis of a Hyperlipidemia Mass Screening Program in Korea.: Yeon Soon Cha, Young Ho Khang, Moo Song Lee, Weechang Kang, Sung Hoon Jeon, Kee Lak Kim, Sang Il Lee; Korean J Prev Med. 2002;35(2):99-106.

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Abstract PDF: OBJECTIVE
Until now, there have been no evidence-based guidelines produced for the mass screening of hyperlipidemia cases in Korea. This study was done to find the most efficient strategy for a hyperlipidemia-screening program among Korean adults. METHOD: Seven alternative strategies for hyperlipidemia screening were formulated and compared in terms of cost-effectiveness. Cost and effectiveness were estimated from social perspectives and using a two-stage screening process (initial testing and additional testing for positives from the first test). A computerized database (based on persons who had visited a health promotion center in one teaching hospital for a routine health check-up) was used to determine the cost and the outcome of various strategies. Official data was used in calculating direct and indirect costs. Effectiveness was measured according to the number of persons who needed clinical intervention for hyperlipidemia. A stratified analysis, considering age group and sex, was then done. Sensitivity analyses, focusing on several uncertain parameters, were also done. RESULTS: Of the seven test alternatives available, the most cost-effective strategy was a screening program, which consisted of an initial test of total cholesterol,high-density lipoprotein cholesterol and triglyceride. There was some variation in the rank of the cost-effectiveness ratios for the seven alternatives dependent on age group or gender. CONCLUSIONS: Current hyperlipidemia screening practice, for National Health Insurance beneficiaries, tests only the total cholesterol level with a cut-off value of 260mg/dl as an initial screening test. It is not the best strategy for cost-effectiveness, and should be modified. Different screening strategies taking age group and sex into account should be developed and used for the efficient mass screening of hyperlipidemia cases among Korean adults.; Summary

Inter-hospital Comparison of Cesarean Section Rates after Risk Adjustment.: Sang Il Lee, Young Ho Khang, Beom Man Ha, Moo Song Lee, Weechang Kang, Hee Jo Koo, Chang Yup Kim; Korean J Prev Med. 2001;34(4):337-346.

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Abstract PDF: OBJECTIVE
To determine the clinical risk factors associated with the mode of delivery decision and to compare cesarean section rates after adjusting for risk factors identified among Korean hospitals. METHODS: Data were collected from 9 general hospitals in two provincial regions by medical record abstraction during February 2000. A total of 3,467 cases were enrolled and analyzed by stepwise logistic regression. Performance of the risk-adjustment model (discrimination and calibration) was evaluated by the C statistic and the Hosmer-Lemeshow test. Crude rates, predicted rates with 95% confidence intervals, and adjusted rates of cesarean section were calculated and compared among the hospitals. RESULTS: The average crude cesarean section rate was 53.2%, ranging from 39.4% to 65.7%. Several risk factors such as maternal age, previous history of cesarean section, placenta previa, placental abruption, malpresentation, amniotic fluid abnormality, gestational anemia, infant body weight, pregnancy-induced hypertension, and chorioamnionitis were found to have statistically significant effects on the mode of delivery. It was confirmed that information about most of these risk factors was able to be collected through the national health insurance claims database in Korea. Performance of the risk-adjustment model was good (c statistic=0.815, Hosmer-Lemeshow test=0.0621). Risk factor adjustment did lead to some change in the rank of hospital cesarean section rates. The crude rates of three hospitals were beyond 95% confidence intervals of the predicted rates. CONCLUSIONS: Considering that cesarean section rates in Korean hospitals are too high, it is apparent that some policy interventions need to be introduced. The concept and methodology of risk adjustment should be used in the process of health policy development to lower the cesarean section rate in Korea.; Summary

Analysis of the Abstracts of Cancer Related Articles Published from 1990 to 1996 in Korea.: Chang Yup Kim, Young Ho Khang, Young Sung Lee, Chul Whan Kang, Keun Young Yoo, Gilwon Kang, Beom Man Ha; Korean J Prev Med. 2001;34(3):200-210.

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Abstract PDF: OBJECTIVE
To explore the status of cancer research in the Republic of Korea. METHODS: Thirty-eight medical journals, published in Korea between 1990 and 1996, were reviewed for abstracts relating to cancer research. Of the 5,899 eligible abstracts related to cancer, 4,732 were collected and evaluated. RESULTS: Including first author and first two co-authors, a total of 7,427 authors were identified. Those who published an average of one or more article per one year were defined as cancer researchers for this study. This group, however, accounted for a small proportion of the total (3.1%). Analysis of the selected abstracts showed that the study goals in more than half focused on pathophysiologic mechanisms. Studies that were designed to use causal relationships such as cohort studies and randomized controlled trials were rare. A greater number of analytic and experimental studies were found in abstracts published by the cancer researcher group. More advanced study designs that explored causal relationships and analytic procedures were found in abstracts published later than those abstracts published from 1990 to 1992. CONCLUSION: Our findings show that researchers who published more articles adopted more advanced study designs. This study provides primary data that can be used to compare the status of cancer research in future studies.; Summary

Relationship between Percutaneous Transluminal Coronary Angioplasty Volume and Associated Immediate Outcome.: Young Ho Khang, Yong Ik Kim, Chang Yup Kim, Young Sung Lee, Sunmean Kim, Jin Seok Lee, Byung Hee Oh; Korean J Prev Med. 2001;34(1):9-20.

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Abstract PDF: OBJECTIVES
To explore the relationship between Percutaneous Transluminal Coronary Angioplasty (PTCA) volume and the associated immediate outcome. METHODS: A total of 1,379 PTCAs were performed in 25 hospitals in Korea between October 1 and December 31 in 1997. Data from 1,317 PTCAs (95.5%) were collected through medical record abstraction. Inter-observer reliability of the data was examined using the Kappa statistic on a subsample of 110 PTCA procedures from five hospitals. Intra-observer reliability of the data was also examined. PTCA success and immediate adverse outcomes were selected as the outcome variables. A successful PTCA was defined as a case that shows less than 50% diameter stenosis and more than 20% reduction of diameter stenosis. Immediate adverse outcomes included deaths during the same hospitalization, emergency coronary artery bypass graft (CABG) within 24 hours after PTCA, and acute myocardial infarction within 24 hours after PTCA. The numbers of PTCAs performed in 1997 per hospital were used as the volume variables. RESULTS: Without adjusting for patient risk factors that may affect outcomes, procedures at high volume hospitals (200 cases per year) had a greater success rate (P=0.001) than low volume hospitals. There was a marginally significant difference (P=0.070) in major adverse outcome rates between high and low volume hospitals. After adjusting for risk factors, there were significant differences in procedural failure and major adverse outcome rates between high and low volume hospitals. CONCLUSIONS: After adjusting for patient clinical risk factors, the hospital volume of PTCA was associated with immediate outcomes. It is recommended that a PTCA volume per year be established in order to improve the immediate outcome of this procedure in Korea.; Summary

Health Behaviors Related to Hypertension in Rural Population of Korea.: Chang Yup Kim, Kun Sei Lee, Young Ho Khang, Jun Yim, Yong Jun Choi, Hae Kook Lee, Kyung Ho Lee, Yong Ik Kim; Korean J Prev Med. 2000;33(1):56-68.

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Abstract PDF: OBJECTIVES
To describe health behaviors related to hypertension in rural population of Korea and focused to identify inappropriate awareness, treatment, and control of hypertension. METHODS: We surveyed 5,517 adults (2,288 males, 3,229 females) older than 30 years in 58 rural areas, purposely sampled nationwide from December 1996 to February 1997. Blood pressure was checked twice at the time of the first visit. For those who showed high blood pressure using the JNC-6 criteria at their initial visit, we followed up their blood pressure one week later. Also information on the health behavior related to hypertension was collected through the person-to-person interview using structured questionnaire at the first visit. RESULTS: For the past one year, females had more experiences of checking their blood pressure than males (77.3% versus 69.5%, p=0.001). Through the results of consecutively checked blood pressure, only 51.7% of the hypertensives were aware of their condition. Of the hypertensives who aware of their condition, 44.4% did not receive any medication and/or recommendation. And 50.4% of the hypertensives who had anti-hypertensive medication were classified as still having hypertensive blood pressure by 160/95 mmHg criteria. Of the medicated, 54.8% were found to take medication regularly for the past six months. Among the medicated, only 11.4% knew the name of anti-hypertensive drug they had. CONCLUSIONS: 'Rule of halves', which works in the situation of no special efforts for hypertension control, was identified. This study showed that much efforts to control hypertension would be required in the rural population of Korea.; Summary

Complementary and Alternative Medicine Use in Korea: Prevalence, Pattern of Use, and Out-of-pocket Expenditures.: Sang Il Lee, Young Ho Khang, Moo Song Lee, Hee Jo Koo, Weechang Kang, Changgi D Hong; Korean J Prev Med. 1999;32(4):546-555.

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Abstract PDF: OBJECTIVES
To determine the prevalence, pattern, and out-of-pocket expenditure of complementary and alternative medicine (CAM) utilization in Korean adult population. METHODS: We conducted a representative telephone survey of 2,042 persons aged 18 or older. Data about any health problem, details of their use of medical doctors(MDs) offices/hospitals/ pharmacies services and CAM during the preceding 12 months were collected with structured questionnaire. RESULTS: The utilization rate of CAM among Korean adults was 29% in one year. A total of 231 kinds of CAM was identified from this survey. Annual out-of-pocket expenditure associated with CAM use in 1998 amounted to pound $1.88 billion and was comparable to 40.8% of out-of-pocket expenditure paid for MDs offices/ hospitals/pharmacies services. Among those(N=424) who paid for both MDs offices/hospitals/pharmacies services and CAM, 35.8% paid more for CAM. CAM gave more satisfaction than western medicine to those who had experience of both types of therapy. About half of CAM users were willing to recommend CAM to others. Disclosure rate to physician among CAM users was not high(40.6%). CONCLUSION: CAM became a popular source of health care in Korea. Korean spent a substantial amount of out-of-pocket money on CAM without any public control. Because CAM use is likely to be increased rapidly through lay referral system, health policy makers and health professionals should pay more attention to CAM for making appropriate utilization of CAM.; Summary

An Application of Delphi Method to the Assessment of Current Status of Cancer Research.: Young Ho Khang, Seok Jun Yoon, Gil Won Kang, Chang Yup Kim, Keun Young Yoo, Young Soo Shin; Korean J Prev Med. 1998;31(4):844-856.

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Abstract PDF: Globally, cancer research has been considered one of the most important field of biomedical researches. Recently, in Korea, there are increasing concerns about cancer research and the development of national cancer control programme. For the efficient investment in cancer research at the national level, strategic approach is needed based on the nationwide information about current status of research. However even the basic data on cancer research have not been systematically collected, and are not available when necessary. The aim of this study is to assess current status of cancer research. For this purpose, this study applied two round Delphi method in which fifteen experts in cancer research fields participated. They rated each items on the initial list at the first round, and modified their responses at the second round. Panels responded that pathogenesis of cancer, research and development of cancer drug, and oncogene, etc. are the most urgent and important research fields. They assessed national level of cancer research as being 49.6% of the world highest level. Coefficient of variation tended to be lowered with the iteration. Predictive stability was evaluated to be lower in items of urgency than in items of importance and research level. Although this study shares the same limitations in the selection of the experts with many other Delphi studies, it provides a primary data that would be required to plan the national strategy of the cancer research.; Summary

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