Journal of Preventive Medicine and Public Health

Original Article

Classification of Healthy Family Indicators in Indonesia Based on a K-means Cluster Analysis: Herti Maryani, Anissa Rizkianti, Nailul Izza; J Prev Med Public Health. 2024;57(3):234-241. Published online May 5, 2024; DOI: https://doi.org/10.3961/jpmph.23.497

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Abstract Summary PDF: Objectives
Health development is a key element of national development. The goal of improving health development at the societal level will be readily achieved if it is directed from the smallest social unit, namely the family. This was the goal of the Healthy Indonesia Program with a Family Approach. The objective of the study was to analyze variables of family health indicators across all provinces in Indonesia to identify provincial disparities based on the status of healthy families.
Methods
This study examined secondary data for 2021 from the Indonesia Health Profile, provided by the Ministry of Health of the Republic of Indonesia, and from the 2021 welfare statistics by Statistics Indonesia (BPS). From these sources, we identified 10 variables for analysis using the k-means method, a non-hierarchical method of cluster analysis.
Results
The results of the cluster analysis of healthy family indicators yielded 5 clusters. In general, cluster 1 (Papua and West Papua Provinces) had the lowest average achievements for healthy family indicators, while cluster 5 (Jakarta Province) had the highest indicator scores.
Conclusions
In Indonesia, disparities in healthy family indicators persist. Nutrition, maternal health, and child health are among the indicators that require government attention.; Summary

Key Message
This paper explores disparities in family health status across provinces using cluster analysis with the K-means approach applied to 10 family health indicator variables. Secondary data analysis was used from the 2021 Indonesian Health Profile and statistics on people’s welfare. The study identified five distinct clusters, each with different characteristics. Papua and West Papua demonstrate the lowest average level in terms of healthy family indicators, whereas DKI Jakarta shows the greatest indicator level. To eliminate the disparities, the government should prioritize the following indicators: maternal health, infant health, and nutrition.

English Abstract

High Risk Groups in Health Behavior Defined by Clustering of Smoking, Alcohol, and Exercise Habits: National Heath and Nutrition Examination Survey.: Kiwon Kang, Joohon Sung, Chang yup Kim; J Prev Med Public Health. 2010;43(1):73-83.; DOI: https://doi.org/10.3961/jpmph.2010.43.1.73

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OBJECTIVES
We investigated the clustering of selected lifestyle factors (cigarette smoking, heavy alcohol consumption, lack of physical exercise) and identified the population characteristics associated with increasing lifestyle risks. METHODS: Data on lifestyle risk factors, sociodemographic characteristics, and history of chronic diseases were obtained from 7,694 individuals > or =20 years of age who participated in the 2005 Korea National Health and Nutrition Examination Survey (KNHANES). Clustering of lifestyle risks involved the observed prevalence of multiple risks and those expected from marginal exposure prevalence of the three selected risk factors. Prevalence odds ratio was adopted as a measurement of clustering. Multiple correspondence analysis, Kendall tau correlation, Man-Whitney analysis, and ordinal logistic regression analysis were conducted to identify variables increasing lifestyle risks. RESULTS: In both men and women, increased lifestyle risks were associated with clustering of: (1) cigarette smoking and excessive alcohol consumption, and (2) smoking, excessive alcohol consumption, and lack of physical exercise. Patterns of clustering for physical exercise were different from those for cigarette smoking and alcohol consumption. The increased unhealthy clustering was found among men 20-64 years of age with mild or moderate stress, and among women 35-49 years of age who were never-married, with mild stress, and increased body mass index (>30 kg/m2). CONCLUSIONS: Addressing a lack of physical exercise considering individual characteristics including gender, age, employment activity, and stress levels should be a focus of health promotion efforts.

Summary

Citations

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Evaluation Studies

An Evaluation of Sampling Design for Estimating an Epidemiologic Volume of Diabetes and for Assessing Present Status of Its Control in Korea.: Ji Sung Lee, Jaiyong Kim, Sei Hyun Baik, Ie Byung Park, Juneyoung Lee; J Prev Med Public Health. 2009;42(2):135-142.; DOI: https://doi.org/10.3961/jpmph.2009.42.2.135

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Abstract PDF

OBJECTIVES
An appropriate sampling strategy for estimating an epidemiologic volume of diabetes has been evaluated through a simulation. METHODS: We analyzed about 250 million medical insurance claims data submitted to the Health Insurance Review & Assessment Service with diabetes as principal or subsequent diagnoses, more than or equal to once per year, in 2003. The database was re-constructed to a 'patient-hospital profile' that had 3,676,164 cases, and then to a 'patient profile' that consisted of 2,412,082 observations. The patient profile data was then used to test the validity of a proposed sampling frame and methods of sampling to develop diabetic-related epidemiologic indices. RESULTS: Simulation study showed that a use of a stratified two-stage cluster sampling design with a total sample size of 4,000 will provide an estimate of 57.04% (95% prediction range, 49.83 - 64.24%) for a treatment prescription rate of diabetes. The proposed sampling design consists, at first, stratifying the area of the nation into "metropolitan/city/county" and the types of hospital into "tertiary/secondary/primary/clinic" with a proportion of 5:10:10:75. Hospitals were then randomly selected within the strata as a primary sampling unit, followed by a random selection of patients within the hospitals as a secondly sampling unit. The difference between the estimate and the parameter value was projected to be less than 0.3%. CONCLUSIONS: The sampling scheme proposed will be applied to a subsequent nationwide field survey not only for estimating the epidemiologic volume of diabetes but also for assessing the present status of nationwide diabetes control.

Summary

Citations

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Diabetes Epidemics in Korea: Reappraise Nationwide Survey of Diabetes "Diabetes in Korea 2007"
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Original Articles

Comparison of Efficiency between Individual Randomization and Cluster Randomization in the Field Trial.: Hye Won Koo, Min Jeong Kwak, Youngjo Lee, Byung Joo Park; Korean J Prev Med. 2000;33(1):51-55.

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Abstract PDF: OBJECTIVES
In large-scale field trials, randomization by cluster is frequently used because of the administrative convenience, a desire to reduce the effect of treatment contamination, and the need to avoid ethical issues that might otherwise arise. Cluster randomization trials are experiments in which intact social unit, e.g., families, schools, cities, rather than independent individuals are randomly allocated to intervention groups. The positive correlation among responses of subjects from the same cluster is in matter in cluster randomization. This thesis is to compare the results of three randomization methods by standard error of estimator of treatment effect. METHODS: We simulated cholesterol data varing the size of the cluster and the level of the correlation in clusters and analyzed the effect of cholesterol-lowering agent. RESULTS: In intra-cluster randomization the standard error of the estimator of treatment effect is smallest relative to that in inter-cluster randomization and that in individual randomization. CONCLUSIONS: Intra-cluster randomization is the most efficient in its standard error of estimator of treatment effect but other factor should be considered when selecting a specific randomization method.; Summary

Characteristics of health lifestyle patterns by the quantification method.: Soon Young Lee, Seon Woo Kim; Korean J Prev Med. 1998;31(1):72-81.

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Abstract PDF: The purpose of this study was to investigate the relation between health behavior patterns and demographic, socio-economic characteristics, health status, health information in Korea. The quantification method through canonical correlation analysis was conducted to the data from Korea National Health Survey in 1995, which consisted of 5,805 persons. The health lifestyle patterns were quantified as good diet lifestyle, passive lifestyle to the negative direction and drinker lifestyle, smoker lifestyle, hedonic lifestyle and fitness lifestyle to the positive direction. The covariate were related to health lifestyle patterns in the order of sex, age, marital status, occupation, health information, economic status, level of physical labour, health status. Characteristics of male, age below 50, married, blue colored worker, no health information, low in economic status, heavy level of physical labour, and poor in health status were positively related to drinker lifestyle, smoker lifestyle, hedonic lifestyle, fitness lifestyle sequentially.; Summary

Association of Hypertension with Cluster of Obesity, Abnormal glucose and Dyslipidemia in Korean Urban Population.: Kang Sook Lee, Jung A Kim, Jung Il Park; Korean J Prev Med. 1998;31(1):59-71.

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Abstract PDF: To examine the association of hypertension with cluster of obesity, abnormal glucose and dyslipidemia in Korean urban population, we conducted this cross-sectional study among 3027 men and 2127 women age 20-85 years who visited a prevention center between May 1991 and June 1995 for a multiphasic health check at St. Mary's Hospital, Seoul. By the self-administered questionnaire, the informations of educational attainments, monthly income, alcohol consumption, cigarette smoking, and physical excercise level were obtained. Height, weight, and blood pressure were measured by a trained nurse. The fasting blood sugar(FBS), total cholesterol, high density lipoprotein (HDL) cholesterol and triglyceride were tested by enzyme method. Low density lipoprotein (LDL) cholesterol was calculated by 'total cholesterol - HDL cholesterol - triglyceride/5'. For testing the differences of cardiovascular risk factors between hypertension and normotension group, t-test and x2 test were performed and for the age adjusted odds ratios of hypertension in persons with obesity, abnormal glucose, and dyslipidemia compared with normal, logistic regression was performed by using SAS pakage programme. The results obtained were as follows: 1. Age, weight, body mass index, blood glucose, total cholesterol, low density lipoprotein, triglyceride of hypertension group in men and women were significantly higher than normotension group, but height and high density lipoprotein of hypertension group only in women significantly lower than normotension group. The frequency of obesity (body mass index > or =25 kg/m2), abnormal glucose (> or = 120 mg/dl), hypercholesterolemia (> or =240 mg/dl), lower HDL cholesterol (<45 mg/dl in women only), higher LDL cholesterol (> or =160mg/dl), and hypertriglyceridemia (> or =250 mg/dl) in hypertension group of men and women were significantly higher than normotension group. 2. Systolic and diastolic blood pressure were negatively correlated with hight, but positively with age, weight, BMI, total cholesterol, LDL cholesterol, and triglyceride in men and women. And BMI was positively correlated with fasting blood sugar, total cholesterol, LDL cholesterol and triglyceride but negatively with HDL cholesterol. 3. The odds ratios of hypertension were as follows in men and women : among persons who were obese compared with those nonobese, 2.53 (95% Confedence Intervals [C.I.] 2.08-3.07) and 2.22 (95%C.I. 1.71-2.87); among persons who were abnormal glucose compared with those normoglycemic, 1.43 (95%C.I 1.13-1.82) and 2.01 (95%C.I 1.36-2.94); and among persons who were dyslipidemia (hypercholesterolemia or lower HDL cholesterol or higher LDL cholesterol or hypertriglyceridemia) compared with those normal lipid, 1.59 (95%C.I 1.30-1.95) and 1.51 (95%C.I 1.16-1.96). After combined more than one risk factor, the odds ratios were increased. Among persons with cluster of obesity, abnormal glucose, and dyslipidemia, the odds ratio of hypertension was 2.25 (95%C.I 1.47-3.37) in men and 3.02 (95%C.I 1.71-5.30) in women. In conclusion, it was suggested that hypertension was associated with cluster of obesity, abnormal glucose, dyslipidemia in this Korean urban population.; Summary

Health Behavior Patterns of Korean.: Soon Young Lee, Seon Woo Kim, Ju Won Park; Korean J Prev Med. 1997;30(1):181-194.

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Abstract PDF: The purpose of this study was to identify population subgroups with similar patterns of diet quality, physical activity, alcohol consumption and cigarette smoking of Korean. The cluster analysis was conducted using the data from Korea National Health Survey(KNHS) in 1995, which consisted of 5,805 persons. We identified six health behavior typologies: 32.9% of the sample had a good diet but sedentary activity level(good diet lifestyle), 7.2% had high activity level but less diet quality(fitness lifestyle). Individuals in the passive lifestyle cluster(39.1%) had no active health promoting activities but tended to avoid risk taking health behavior such as cigarette smoking and alcohol drinking. 1.1% of the sample were in a drinking cluster, 17.2% in a smoking cluster and 2.5% had a hedonic lifestyle characterized by heavy drinking and smoking. The other characteristics of these lifestyle clusters could be presented by demographic and socioeconomic factors.; Summary

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