Journal of Preventive Medicine and Public Health

Volume 35(1); February 2002

Original Articles

Socioeconomic Costs of Obesity for Korean Adults.: Baek Geun Jeong, Ok Ryun Moon, Nam Soon Kim, Jae Heon Kang, Tae Ho Yoon, Sang Yi Lee, Sin Jae Lee; Korean J Prev Med. 2002;35(1):1-12.

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Abstract PDF: OBJECTIVE
To estimate the socioeconomic costs of obesity in Korea, 1998. METHODS: The 1998 National Health and Nutrition Examination Survey (1998 NHNES) data was used and 10,880 persons who had taken health examinations were selected for study. Essential hypertension, NIDDM (non insulin-dependent diabetes mellitus), dyslipidemia, osteoarthritis, coronary heart disease, stroke were included as obesity related disease. The data of direct costs of obesity was obtained from the National Federation of Medical Insurance. The category of indirect costs was the loss of productivity caused by premature death and admission, time costs, traffic costs, nursing fees due to obesity. Multiple logistic regression model was developed to estimate prevalence odds ratio by obesity class adjusted demographic and socio-ecnomic factors and calculate PAF (Population Attributable Fraction) of obesity on obesity related disease. And we finally calculated the socioeconomic costs of obesity in relation to BMI with PAF. RESULTS: The direct costs of obesity were 2,126 billion~965 billion Won in considering out of pocket payment to uninsured services, and the indirect costs of obesity were 2,099 billion~1,086 billion Won. Consequently, in considering out of pocket payment to uninsured services, the socioeconomic costs of obesity were 4,225 billion~2,050 billion Won, which corresponded to about 0.094% ~0.046% of GDP and 1.88%~0.91 of total health care costs in Korea. CONCLUSIONS: Obesity represents a major health problem with significant economic implications for the society. This results are conservative estimates as far as all obesity related disease and all health care and indirect costs were not included due to missing information. Further studies are needed to caculate socioeconomic costs of obesity more exactly.; Summary

Therapeutic Compliance and Its Related Factors of Lung Cancer Patients.: Si Hyun Nam, Sin Kam, Jae Yong Park, Sang Chul Chae, Moon Seob Bae, Moo Chul Shin, Min Hae Yeh; Korean J Prev Med. 2002;35(1):13-23.

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Abstract PDF: OBJECTIVES
To investigate the therapeutic compliance and its related factors in lung cancer patients. METHODS: The subjects of this study comprised 277 patients first diagnosed with lung cancer at Kyungpook National University Hospital between Jan 1999 and Sept 1999. Of these, 141 (50.9%) participated in the study by properly replying to structured questionnaires. The data was analyzed using a simplified Health Decision Model. This model includes categories of variables covering therapeutic compliance, health beliefs, patient preferences, knowledge and experience, social interaction, sociodemographic and clinical characteristics. RESULTS: The therapeutic compliance rate of the 141 study subjects was 78.0%. An analysis of health beliefs and patient preferences revealed health concern (p<0.05), dependency on medicine (p<0.05), perceived susceptibility and severity (p<0.05) as well as preferred treatment (p<0.01) as factors related to therapeutic compliance. Factors from the sociodemographic characteristics and clinical factors that were related to therapeutic compliance were age (p<0.01), monthly income (p<0.05), histological type (p<0.05) and clinical stage (p<0.05) of cancer. CONCLUSIONS: In order to improve therapeutic compliance in lung cancer patients it is necessary to educate the aged, low-income patients, or patients who have small cell lung cancer or lung cancer of an advanced stage for which surgery is not indicated. Additionally, it is essential for medical personnel to have a deep concern about patients who have poor lifestyles, a low dependency on medicine, or a high perceived susceptibility and severity. Practically, early diagnosis of lung cancer and thoughtful considerations of low-income patients are important. By means of population-based education in a community, we may promote attention to health and enhance the early diagnosis of lung cancer.; Summary

Pesticides and Cancer Incidence: The Kangwha Cohort Study.: Jae Woong Sull, Sang Wook Yi, Tae Yong Sohn, Sun Ha Jee, Chung Mo Nam, Heechul Ohrr; Korean J Prev Med. 2002;35(1):24-32.

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Abstract PDF: OBJECTIVE
Few studies have examined the relationship between the risk of cancer and exposure to pesticides in Korea or in other East Asian that have until recently used chlorophenoxy herbicides. The aim of this study was to evaluate the relationship between the exposure to pesticides and cancer incidence. METHODS: We conducted a prospective cohort study with a follow-up period of 13 years (1985-1998). The subjects included 2,687 male and 3,589 female Kangwha Island residents, Koreans aged fifty-five or more as of March 1985, who received a personal health interview and completed a health examination survey. A Cox proportional hazards models were used to estimate relative risks (RR). RESULTS: At baseline, the mean age of the study participants in 1985 was 66.4 for males and 67.1 for females. During the 13 years follow-up, a total of 300 incidents of cancer in males and 146 in females developed. In males, the total cancer incidence in the highest group was RR, 1.4 (95% CI=1.0-1.9), p for trend=0.041, for digestive organ cancer incidence in the highest group, RR, 1.5 (95% CI=1.0-2.3), p for trend=0.057, for stomach cancer incidence in the highest group, RR, 1.6 (95% CI=0.9-2.8), p for trend=0.094, for gallbladder cancer incidence in the highest group, RR, 9.1 (95% CI=1.1-77.0), p for trend=0.014 were elevated according to the higher frequency of pesticide use per year. In particular, the risk of gallbladder cancer was very high. Although not significant, the risk of liver cancer was higher than in the non-exposed group (in the highest group, RR, 2.0 (95% CI=0.7-5.9)). In females, although not significant, breast cancer incidence in the highest exposure group was higher than in the non-exposed group (in the highest group, RR, 4.7 (95% CI=0.8-27.9)). CONCLUSIONS: This study demonstrates that Korean farmers who use pesticides, particularly males, have a significantly higher total cancer incidence, particularly from digestive organ cancers such as, stomach, gallbladder, and liver cancer. In particular, the risk of gallbladder cancer was very high.; Summary

Evaluation of Measles Vaccine Effectiveness in a Community Outbreak.: Byung Chan Park, Hae Kwan Cheong, Sue Kyung Park; Korean J Prev Med. 2002;35(1):33-40.

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Abstract PDF: OBJECTIVE
From an analysis of a community outbreak of measles in Youngju, Gyeongbuk, in March 2000, the authors evaluated the effectiveness of the measles vaccination and its determinants to provide an epidemiologic basis for the establishment of a vaccination policy. METHODS: Information was collected regarding the vaccinations from the health records of four primary schools and through a questionnaire survey of the parents of students in two middle and two high schools (N=4638). Measles cases were surveyed from the patient list of each school and from case reports in the public health center. The attack rate and vaccine effectiveness of measles was evaluated by school; grade; frequency, region, and institution of vaccination. RESULTS: The attack rate of measles, 6.3% among the total subjects, was higher in middle school students (15.8%) than in primary (2.0%, p<0.05) and high school students (8.9%, p<0.05). The attack rate of the unvaccinated group was 4.6-fold higher than the vaccinated group in primary schools (p<0.05). Vaccine effectiveness was 83.2% among lower graders of primary schools, 34.0% among higher graders of primary schools, 26.1% in middle schools, and -7.0% in high schools. In multiple logistic regression analysis, grade in school (odds ratio, 0.77; 95% CI=0.67-0.87) and frequency of vaccination (odds ratio, 0.57; 95% CI=0.37-0.88) were significant predictors of the outcome. CONCLUSIONS: We concluded that the explosive outbreak of measles in this area resulted from both inadequate vaccination coverage and secondary failure of vaccination. There was no evidence of any effect of the cold chain system on the vaccine failure.; Summary

Drug Utilization Review of Antiulcerative Agents in Korean Elderly Inpatients.: Wonsik Lee, Seung Mi Lee, Hye Won Koo, Byung Joo Park; Korean J Prev Med. 2002;35(1):41-48.

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Abstract PDF: OBJECTIVES
To review the drug prescription pattern of antiulcerative agents for elderly inpatients. METHODS: The study population comprised inpatients of community hospitals who were members of the Korean Elderly Pharmacoepidemiologic Cohort (KEPEC), aged 65 years or over, beneficiaries of the Korea Medical Insurance Corporation (KMIC) and residing in Busan city in 1993. The drug prescription information was collected from the claims data of hospitals where the cohort members received medical care between January 1993 and December 1994. The information included personal identification, age, gender, diagnosis, drug dosage, date of hospital admission and name of medical institutions where the study subjects received drug prescriptions. The data analysis produced outcomes in terms of distribution of antiulcerative agents by class and by medical institution and trend of relative prescription. Analysis was also performed in terms of combined prescriptions of antiulceratives and drugs that could induce risk from drug interaction with antiulceratives. RESULTS: The number of patients prescribed antiulcerative agents was 1,059 (64.9%) male and 1,724 (65.5%) female among the total inpatients. An antacid and composite agent was the most frequently prescribed antiulcerative agent (70.8%), followed by H2 antagonist (16.0%). Among the potential drugs that could induce risk from drug interaction with the antiulcerative agents, diazepam was the most frequently prescribed. The proportion of diazepam co-prescription was 22.5% of the total cimetidine prescriptions and 14.5% of the total omeprazole prescriptions. CONCLUSIONS: Antiulcerative drugs were frequently prescribed in the elderly inpatients. The adverse drug reaction could possibly be due to drug interaction. The study results could be used as fundamental data for further drug utilization review of antiulcerative agents.; Summary

Factors Affecting the Use of Medical Services by Workers with Respiratory Diseases.: Yeon Soon Ahn, Jae Seok Song, Seong Kyu Kang, Ho Keun Chung; Korean J Prev Med. 2002;35(1):49-56.

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Abstract PDF: OBJECTIVES
To identify the relationship between the use of medical services by workers with three types of respiratory diseases (total respiratory diseases, acute upper respiratory infections and chronic lower respiratory diseases) and exposure to hazardous agents after controlling for other factors affecting medical services use, such as characteristics of the enterprises (scale, industry type) and employee demographics (sex, age). METHODS: The study population comprised 28,882 workers who had undergone general or special medical examinations at the industrial health center at least once between Jan 1995 and Dec 1997 and had possessed medical insurance during the period. We combined medical examination data with medical insurance data in order to analyze the relationship between exposure to hazardous agents and respiratory diseases. RESULTS: Among the 28,882 study subjects, 17,454 employees (60.4%) used medical services more than once during 3-year study period, owing to more than one kind of respiratory diseases. In logistic regression analysis, sex, age and the size of the enterprises proved to be significant variables on the use of medical services for all three types of respiratory disease: The use of medical services increased with employee age. Women used more medical services than men and the employees in the large-scale enterprises used more services than employees in small-scale enterprises. However, exposure to dust or organic solvents did not affect medical service use due to total respiratory diseases or acute upper respiratory infections. Only in the case of chronic lower respiratory diseases did workers exposed to dusts (OR=1.12, 95% CI=1.01 -1.24) or organic solvents (OR=1.19, 95% CI=1.05-1.35) use more medical services than those not exposed. CONCLUSIONS: Workers exposed to dusts or organic solvents are particularly apt to suffer from chronic lower respiratory diseases and use medical services more often than those not exposed. That is, chronic exposure to hazardous agents such as dusts and organic solvents is believed to be harmful and to cause respiratory symptoms and diseases.; Summary

The Relationship of Social Class and Health Behaviors with Morbidity in Korea.: Mia Son; Korean J Prev Med. 2002;35(1):57-64.

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Abstract PDF: OBJECTIVE
To explore the relationship of social class and health behaviors with self-reported morbidity. METHODS: The 1995 General Household Survey in Korea was used to investigate self-reported morbidity. Logistic regression was used to examine the relationship of social class and health behaviors with self-reported chronic disease and perceived general health. RESULTS: For chronic disease and general perceived health, age adjusted odds ratios were higher for manual workers, lower-educated group as well as those in the lower income group; this held true for both men and women. Health behaviours had little effect on the relationship between social class and morbidity. The relationship between health behaviors and morbidity was very weak. The lower social class expressed higher levels of negative health behaviors, although this relationship appeared to be very weak in Korea. CONCLUSIONS: This study suggests that an understanding of health differentials that addresses the issue of social inequalities in Korea is required.; Summary

Prediction of HIV and AIDS Incidence Using a Back-calculation Model in Korea.: Ju Young Lee, Jin Soo Hwang, Un Yeong Goh, Mee Kyung Kee, Jee Yun Kim; Korean J Prev Med. 2002;35(1):65-71.

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Abstract PDF: OBJECTIVE
To estimate the status of HIV infection and AIDS incidence using a back-calculation model in Korea. METHODS: Back-calculation is a method for estimating the past infection rate using AIDS incidence data. The method has been useful for obtaining short-term projections of AIDS incidence and estimating previous HIV prevalence. If the density of the incubation periods is known, together with the AIDS incidence, we can estimate historical HIV infections and forecast AIDS incidence in any time period up to time t. In this paper, we estimated the number of HIV infections and AIDS incidence according to the distribution of various incubation periods RESULTS: The cumulative numbers of HIV infection from 1991 to 1996 were 708~1,426 in Weibull distribution and 918~1,980 in Gamma distribution. The projected AIDS incidence in 1997 was 16~25 in Weibull distribution and 13~26 in Gamma distribution. CONCLUSIONS: The estimated cumulative HIV infections from 1991 to 1996 were 1.4~4.0 times more than notified cumulative HIV infections. Additionally, the projected AIDS incidence in 1997 was less than the notified AIDS cases. The reason for this underestimation derives from the very low level of HIV prevalence in Korea. Further research is required for the distribution of the incubation period of HIV infection in Korea, particularly for the effects of combination treatments.; Summary

Investigation of Health Hazards in the Underground Storage Facilities of Ginger Roots.: Hyun Sul Lim, Geun Ryang Bae; Korean J Prev Med. 2002;35(1):72-75.

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To evaluate the health hazards in the underground storage facilities of ginger roots. METHODS: The authors reviewed the emergency rescue records from the Seosan fire department over the period Jan 1, 1996 to Aug 31, 1999. The atmospheres in 3 different underground storage locations were analyzed for O2, CO2, CO, H2S and NH4. RESULTS: From the emergency records, we were able to identify 20 individuals that had been exposed to occupational hazards in the underground storage facilities. Among these 20 cases, 13 were due to asphyxiation (resulting in 7 deaths) and 7 were due to falls. In the first atmospheric tests, performed on Feb 25, 1998, the O2 level inside the underground storage facility, located about 5~6 meters below the surface, was 20.6% and the CO2 level was about 1,000 ppm. CO, H2S and NH4 were not detected. In the second tests on Jul 6, 1999, measurements of the O2 level at 3 meters below the surface in two different storage locations were 15.3 and 15.1%. And the O2 levels inside the storage facilities were 12.2 and 12.1%. The CO2 level was above 5,000 ppm (beyond upper limits of measurement). CO, H2S and NH4 were not detected. CONCLUSIONS: We conclude that asphyxiation in the underground storage facilities for ginger roots was not due to the presence of toxic gases such as CO, H2S and NH4, but rather the exclusion of oxygen by carbon dioxide was responsible for causing casualties. For the development of a hazard free working environment, safety education as well as improvements in storage methods are needed.; Summary

The Relationships of Occupational Class, Educational Level and Deprivation with Mortality in Korea.: Mia Son; Korean J Prev Med. 2002;35(1):76-82.

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Abstract PDF: OBJECTIVE
To investigate the relationships of occupational class, educational level and deprivation with mortality in Korea. METHODS: This study used existing South Korean national data on occupation, educational level, and deprivation and death. Mortality was investigated using registered death data from 1993 to 1997 obtained from the Korean National Statistics Office (NSO) with denominators drawn from the 1995 Census. Statistical analysis consisted of poisson regression modeling and multilevel analysis. RESULTS: The lower occupational class (manual workers) group had a higher mortality rate than the higher occupational class (non-manual workers) group. Educational level, and deprivation were both inversely related withand mortality. Occupation was strongly associated with education. Area-based deprivation indicators and individual indices for social class made an independent contribution to the mortality risk. CONCLUSIONS: The findings of this study suggests that the relationships of occupational class, educational level and deprivation with mortality appears to be stronger in Korea than in European countries.; Summary

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