Journal of Preventive Medicine and Public Health

English Abstract

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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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.

Summary

Citations

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Original Articles

A Study on the Indoor-Outdoor NO2 Levels and Personal Exposures to NO2 with Analysis of Factors Affecting the NO2 Concentrations: Centering on Urban Homes and Housewives.: Jin Ho Chun, Chae Un Lee, Joon Youn Kim, Yo Han Chung; Korean J Prev Med. 1988;21(1):132-151.

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Abstract PDF: This study was conducted to establish the control program for preventing unfavorable health effects of nitrogen dioxide(NO2) exposure in homes by preparing the fundamental data for evaluation of relationships between NO2 levels and influencing factors through measurements of indoor-outdoor NO2 levels and personal NO2 exposures for housewives with questionnaire survey on 172 homes in Pusan area from April to June, 1987. NO2 measurements were made by using diffusion tube samplers(Palmes tube NO2 sampler) for one week at 4 sites in homes ; kitchen(KIT), bedroom(BED), living room(LIV), outdoor(OUT) and near the collar housewives(personal exposure livel, PNO). The details of questionnaire were number of household members(FAM), number of regular smokers(SMOKER), daily number of meals eaten(MEAL), type of housing units(HOUSE), location of house with distance from the heavy traffic roads as walking time(DIST), and of kitchen(KAREA), kind of cooking fuels(FUEL), cooking time of each meal(CTIME), usage of kitchen fan for cooking(FAN), type of heating facilities(HEAT) and so on of subject homes. The obtained results were as follows : 1) The mean NO2 level was significantly higher at indoors than outdoors(p<0.01) and the kitchen NO2 level was the highest with 33.7+/-13.6ppb(9.5-81.5ppb). The mean personal exposure level of NO2 for housewives was 20.6+/-8.8ppb(3.1-46.9ppb). 2) The mean indoor NO2 level was significantly higher in the group of household members above 5 than below 4(p<0.05), in detached dwellings than apartments(p<0.001), within 5 minutes of distance than over 5 minutes(p<0.001), in the group of unusing fan(p<0.001), in the group of longer cooking time(p<0.001), and it was in order of coal briquette, gas, electricity and oil by kind of cooking fuels(p<0.05). 3) Variables showing significant correlation(p<0.001) with indoor NO2 level were kitchen NO2 level(r=0.8677), cooking time(r=0.5921), outdoor NO2 exposure level(r=0.4615), usage of kitchen fan(r=0.3573) and location of house(r=-0.2988). 4) As a result of multiple regression analysis, the most significant influencing variable to the kitchen NO2 level was cooking time [KIT=-0.378+/-11.772(CRIME)+0.298(OUT)+3.102(FAN)], it was kitchen NO2 level to the indoor NO2 level [IND = 6.996+0.458 (KIT) + 0.230 (OUT) - 1.127 (KAREA)], and it was indoor NO2 level to the personal NO2 exposure level [PNO=15.562+0.729(IND)-4.542(DIST)-0.200(KIT)]. 5) It was recognized that artificial ventilation in the kitchen, suppression of unnecessary combustion and replacement of cooking fuel, as much as possible, were effective means for decreasing indoor NO2 levels in homes.; Summary

A cohort study on blood zinc protoporphyrin concentration of workers in storage battery factory.: Man Joong Jeon, Joong Jeong Lee, Joon Sakong, Chang Yoon Kim, Jung Man Kim, Jong Hak Chung; Korean J Prev Med. 1998;31(1):112-126.

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Abstract PDF: To investigate the effectiveness of the interventions in working environment and personal hygiene for the occupational exposure to the lead, the blood zinc protoporphyrin(ZPP) concentrations of 131 workers ( 100 exposed subjects and 31 controls ) of a newly established battery factory were analyzed. They were measured in every 3 months up to 18 months. Air lead concentration (Pb-A) of the workplaces was also checked for 3 times in 6 months interval from August 1987. Environmental intervention included the local exhaust ventilation and vacuum cleaning of the floor. Intervention of the personal hygiene included the daily change of clothes, compulsory shower after work and hand washing before meal, prohibition of cigarette smoking and food consumption at the work site and wearing mask. Mean blood ZPP concentration of the controls was 16.45+/-4.83 microgram/dashliter at the preemployment examination and slightly increased to 17.77+/-5.59 microgram/dashliter after 6 months. Mean blood ZPP concentration of the exposed subjects who were employed before the factory was in operation (Group A) was 17.36+/-5.20 microgram/dashliter on employment and it was increased to 23.00+/-13.06 microgram/dashliter after 3 months. The blood ZPP concentration was increased to 27.25+/-6.40 microgram/dashliter on 6 months (p<0.01) after the employment which was 1 month after the initiation of intervention program. It did not increase thereafter and ranged between 25.48 microgram/dashliter and 26.61 microgram/dashliter in the subsequent 4 results. Mean blood ZPP concentration of the exposed subjects who were employed after the factory had been in operation but before the intervention program was initiated (Group B) was 14.34+/-6.10 microgram/dashliter on employment and it was increased to 28.97+/-7.14 microgram/dashliter (p<0.01) in 3 months later(1 month after the intervention). The values of subsequent 4 tests were maintained between 26.96 microgram/dashliter and 27.96 microgram/dashliter. Mean blood ZPP concentration of the exposed subjects who were employed after intervention program had been started (Group C) was 21.34+/-5.25 microgram/dashliter on employment and it was gradually increased to 23.37+/-3.86 microgram/dashliter (p<0.01) after 3 months, 23.93+/-3.64 microgram/dashliter after 6 months, 25.50+/-3.01 microgram/dashliter (p<0.01) after 9 months, and 25.50+/-3.10 microgram/dashliter after 12 months. Workplaces were classified into 4 parts according to Pb-A. The Pb-A of part I, the highest areas, were 0.365 microgram/m4, and after the intervention the levels were decreased to 0.216 microgram/m4 and 0.208 microgram/m4 in follow-up test. The Pb-A of part II which was resulted in lower value than part I was decreased from 0.232 microgram/m4 to 0.148 microgram/m4, and 0.120 microgram/m4 after the intervention. The Pb-A of part III was tested after the intervention and resulted in 0.124 microgram/m4 in January 1988 and 0.081 microgram/m4 in August 1988. The Pb-A of part IV was also tested after the intervention and resulted in 0.110 microgram/m4 in August 1988. There was no consistent relationship between Pb-A and blood ZPP concentration. The blood ZPP concentration of the group A and B workers in the part of the highest Pb-A were lower than those of the workers in the parts of lower Pb-A. The blood ZPP concentration of the workers in the part of the lowest Pb-A increased more rapidly. The blood ZPP concentration of the group C workers was the highest in part III. These findings suggest that the intervention in personal hygiene is more effective than environmental intervention, and it should be carried out from the first day of employment and to both the exposed subjects, blue color workers and the controls, white color workers.; Summary

Relationship Between The Biological Lead Exposure Indices And Air Lead Concentrations Measured By Personal Air Samplers.: Haeng Ryeol Lee, Jung Man Kim, Kap Yull Jung, Joon Youn Kim; Korean J Prev Med. 1993;26(1):65-73.

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Abstract PDF: This study was carried out to evaluate the relationship between the biological lead exposure indices and air lead concentrations measured by personal air samplers. The 72 occupationally lead exposed workers were observed and the biological lead exposure indices chosen for this study were blood lead(PuB), urine lead(PbU), zinc protoporphyrin in whole blood(ZPP), gamma-aminolevulinic acid in urine(ALAU), gamma-aminolevulinic acid dehydratase activity(ALAD), coproporphyrin in urine(CPU) and hemoglobin(Hb). The workers were divided into four groups by air lead concentrations: Group I; under 0.05 mg/m3, Group II; 0.05-0.10 mg/m3, Group III; 0.10-0.15 mg/m3 and Group IV; and over 0.15 mg/m3. For evaluation the relationship between the biological lead exposure indices and air lead concentrations was used as correlation coefficients. The results obtained were as follows: 1. In Group I, II, III and IV, the mean value of PbB were 25.45+/-1.84 microgram/dl, 27.87+/-3.53 microgram/dl, 31.21+/-1.76 microgram/dl and 47.02+/-13.96 microgram/dl. Between Group IV and other groups showed statistically significant difference(p<0.05). 2. There was an increasing tendency of PbB, PbU, ALAU and ZPP according to the increase the mean air lead concentration, while ALAD has decreasing tendency. CPU and Hb did not show any constant tendency. 3. Correlation coefficients between PbB, PbU, ZPP, ALAU, ALAD, CPU, Hb and air lead concentration were 0.95, 0.83, 0.89, 0.72, -0.83, 0.51 and -0.45 respectively, and regression coefficient between PbB(Y) and PbA(X) was Y=126.8746X+16.9996(P<0.01).; Summary

Exposed level of workers in the factory next to a led recycling factory.: Jin Ha Kim, Duk Hee Lee, Yong Hwan Lee; Korean J Prev Med. 1996;29(3):693-700.

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Abstract PDF: The purpose of this study was to determine whether workers at a factory next to a lead recycling factory in Pusan, were affected by lead contamination. The mean air lead concentration of lead recycling factory was 0.21mg/m3(TWA=0.05mg/m3). Thirty-nine male workers of Factory A, Cr. plating factory next to the lead recycling factory were exposed group and a comparison group, 62 male workers of Factory B were selected from another Cr. plating factory about 8.5km away from lead recycling factory. Air lead concentration of each workplace was checked for 4 times from August 5 to August 20 in 1995 by low volume air sampler. Each subject was interviewed about age, life-style, smoking, work history, and residence etc, and venous blood was drawn for lead measurement by graphite furnace atomic absorption spectrometry. We have observed that air lead concentration and blood lead concentration of Factory A was higher than Factory B(2.6 +/- 1.6 Vs. 1.2 +/- 0.2 microgram/m3, 14.9 +/- 1.6 Vs. 12.2 +/- 1.6 microgram/dl). We believe that other environmental lead sources such as transportation and residence did not affect air lead and blood lead concentration differences of both factory. We concluded that high air lead and blood lead concentration of Factory A were caused by lead contamination generated by the neighboring lead recycling factory.; Summary

Blood Lead, Manganese, Aluminium and Silicon Concentrations in Korean Adults.: Jung Man Kim, Jung Mo Ahn, Won Sul Kim, Jung Il Kim, Hai Rim Shin, Kap Yeol Jung, Joon Youn Kim; Korean J Prev Med. 2000;33(2):157-164.

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Abstract PDF: OBJECTIVES
This study was performed to determine the reference values of blood lead, manganese, aluminium, and silicon in healthy adults. METHODS: The subjects were 132 (67 male and 65 female), and classified to three age groups (< or =39, 40~49, and 50< or =). Blood lead, manganese and aluminium were analyzed by atomic absorption spectrophotometer, and blood silicon was analyzed by direct current plasma optical emission spectrometer. RESULTS: Blood lead levels(geometric mean, S.D) were (3.49, 1.70) microgram/dL in male and (3.04, 1.65) microgram/dL in female, but the difference is not significant, and there was no significant difference between age groups. Mean blood manganese level was 0.99+/-0.41 microgram/dL, and there was no significant difference between sex or age groups. Mean blood aluminium level was 0.59+/-0.35 microgram/dL, and there was no significant difference between sex or age groups. Mean blood silicon level was 54.41+/-27.64 microgram/dL in male and 43.34+/- 23.51 microgram/dL in female, and the level in male was significantly higher than that in female (p<0.05). There was significant difference between age groups, and the oldest showed the highest level in male (p<0.05), but no significant difference between age groups in female. CONCLUSIONS: Authors hope that this study would provide basic data for determining reference values and evaluating health effects.; Summary

Cohort Observafion of Blood Lead Concentration of Storage Battery Workers.: Chang Yoon Kim, Jung Man Kim, Gu Wung Han, Jung Han Park; Korean J Prev Med. 1990;23(3):324-337.

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Abstract PDF: To assess the effectiveness of the interventions in working environment and personal hygiene for the occupational exposure to the lead, 156 workers (116 exposed subjects and 40 controls) of a newly established battery factory were examined for their blood lead concentration (Pb-B) in every 3 months up to 18 months. Air lean concentration (Pb-A) of the workplaces was also checked for 3 times in 6 months interval from August 1987. Environmental intervention included the local exhaust ventilation and vacuum cleaning of the floor. Intervention of the personal hygiene included the daily change of clothes, compulsory shower after work and hand washing before meal, prohibition of cigarette smoking and food consumption at the work site and wearing mask. Mean Pb-B of the controls was 21.97 +/- 33.6 microgram/dl at the preemployment examination and slightly increased to 22.75 +/- 3.38 microgram/dl after 6 months. Mean Pb-B of the workers who were employed before the factory was in operation (Group A) was 20.49 +/- 3.84 microgram/dl on employment and it was increased to 23.90 +/- 5.30 microgram/dl after 3 months <(P<0.01). Pb-B was increased to 28.84 +/- 5.76 microgram/dl 6 months after the employment which was 1 month after the initiation of intervention program. It did not increase thereafter and ranged between 26.83 microgram/dl and 28.28 microgram/dl in the subsequent 4 tests. Mean Pb-B of the workers who were employed after the factory had been operation but before the intervention program was initiated (Group B) was 16.58 +/- 4.53 microgram/dl before the exposure and it was increased to 28.82 +/- 5.66 microgram/dl (P<0.01) in 3 months later (1 month after the intervention). The values of subsequent 4 tests remained between 26.46 and 28.54 microgram/dl. Mean Pb-B of the workers who were employed after intervention program had been started (Group C) was 19.45 +/- 3.44 microgram/dl at the preemployment examination and gradually increased to 22.70 +/- 4.55 microgram/dl after 3 months (P<0.01), 23.68 +/- 4.18 microgram/dl after 6 months, and 24.42 +/- 3.60 microgram/dl after 9 months. Work stations were classified into 4 parts according to Pb-A. The Pb-A of part I, the highest areas, were 0.365 mg/m3, and after intervention the levels were decreased to 0.216 mg/m3 and 0.208 mg/m3 in follow-up tests. The Pb-A of part II was decreased from 0.232 mg/m3 to 0.148 mg/m3, and 0.120 mg/m3 after the invention. Pb-A of part III and IV was tested only after intervention and the Pb-A of part III were 0.124 mg/m3 in January 1988 and 0.081 mg/m3 in August 1988. The Pb-A of part IV, not stationed at one place but moving around, was 0.110 mg/m3 in August 1988. There was no consistent relationship between Pb-B and Pb-A. Pb-B of the group A and B workers in the part of the highest Pb-A were lower than those of the workers in the parts of lower Pb-A. Pb-B of the workers in the part of the lowest Pb-A increased more rapidly. Pb-B of group C workers was the highest in part I and the lowest in part IV. These findings suggest that Pb-B is more valid method than Pb-A for monitoring the health of lead workers and intervention in personal hygiene is more effective than environmental intervention.; Summary

Lead Concentrations of Pigeon's Tissue as Indicator of Lead pollution in Air and Soil.: Yung Woo Byun, Tae Yoon Hwang, Jung Jeung Lee, Chang Yoon Kim, Jong Hak Chung; Korean J Prev Med. 1996;29(1):15-26.

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Abstract PDF: It has been studied that a variety of fauna and flora are sensitive biological indicators which reflect the severity of regional pollution of heavy metals, but in the center of part of Taegu city the controversial issue of lead poisoning attributable to the atmosphere which contains an increased concentrations of lead has been raised recently, it is usually hard to find suitable plants or animal in the areas with heavy traffic. Pigeons are ubiquitous in and around Taegu city area, inhabiting even the most densely populated areas with heavy traffic with its small body size, high metabolic turnover, and rather limited mobility, a pigeon, as a biological indicator is expected. This study was conducted to monitor lead pollution in the Taegu and kyongju city in Korea. We measured the lead content of the various tissue of three groups of feral pigeon(Columbia livia) and soil and atmospheric lead concentration. First group was obtained io heavy traffic area in Taegu City, the second group was obtained a park in Taegu city and the third group was obtained light traffic area in kyongju city. The air and soil lead concentration of heavy traffic area in Taegu city was 0.11 microgram/m2, 4.96 microgram/g, that of park in Taegu city was 0.05 microgram/m3, 2.65 microgram/g and that of light traffic area in kyonngju city was 0.03 microgram/m3, 0.01 microgram/g. The lead content of lung, blood, kidney, femur and liver of feral pigeons in heavy traffic area in Taegu city was significantly higher than pigeons obtained in a park in Taegu city and low traffic density area in Kyonfju city(p<0.01). But stomach lead content of three group did not reflect a significant difference. In this study positive correlation was found between atmospheric lead concentrations and the concentration of lead in the pigeon's lung(r=0.5040, p<0.001), blood(r=0.3322, p<0.01), kidney(r=0.4824, p<0.001), femur(r=0.7214, p<0.001) and liverer (r=0.4836, p<0.01). we can also found positive correlation between soil lead concentrations and the concentration of lead in the pigeon's femur(r=0.4850, p<0.001), kidney(r=0.4850, p<0.001) and liver(r=0.4386, p<0.01). In the pigeon`s tissue there were significant correlations between concentration of lead in the blood and kidney(r=0.4818, p<0.001), femur(r= 0.6157, p<0.001) and liver(r=0.3889, p<0.001). In conclusion, at the heavy traffic area in Taegu city, lead concentrations found in the atmosphere and soil are reflected in the lead concentrations of different tissue of urban pigeons. It is suggested that the tissue of pigeons can be good biological indicators of environmental lead pollution.; Summary

Atmospheric concentration and mutagenicity of organic pollutants of suspended particulate in Seoul.: Dong Chun Shin, Yong Chung, Young Hahn Moon, Jae Hoon Roh; Korean J Prev Med. 1990;23(1):43-56.

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Abstract PDF: To evaluate the difference of concentration and mutagenicity of organic pollutants between residential and traffic area of Seoul, air samples were collected in Bulkwang (residential) and Shinchon (traffic) area. Samples were analyzed to measure the concentration of extractable organic matters (EOM) and their subfractions and mutagenicites were tested using Salmonella typhimurium TA 98. The concentrations of polycyclic aromatic hydrocarbons (PAHs) were also measured by gas-chromatography and compared between two areas. The results were as follows ; 1. While the concentration of total suspended particulate (TSP) in residental area was below the environmental standard in annual average, the concentration in traffic area was above the standard and was up to its maximum 256 microgram/m3 in November. The difference of TSP concentrations in both areas of each month was statistically significant (P<0.05). 2. The concentration of fine particle in traffic area was significantly higher compare to that in residential area and showed statistically significant monthly difference in both areas (P<0.05). The proportion of concentration of fine particle to TSP was 55-68%. 3. Mean concentrations of EOM in residential and traffic areas were 4.3 microgram/m3 and 5.3 microgram/m3 respectively. The proportion of amount of EOM from fine particle to EOM from TSP was 70-88%. 4. While the percentage of polar neutral organic compounds (POCN) of fine particle in Bulkwang's sample was higher compare to Shinchon's sample, the percentage of aliphatic compounds of fine particle in Shinchon's sample was higher compare to Bulkwang's sample. The percentages of PAH fraction were as low as 6-10% in both areas. 5. The mutagenic activity of unit concentration of organic matters extracted from fine particle was higher compare to that of coarse particle and was increased when metabolically activated with S9. Mutagenicities with metabolic activation calculated by unit air volume were significantly different between residential and traffic area, 17 revertants/m3 and 22 revertants/m3 respectively. 6. The concentrations of benzo(a)pyrene in fine particle of traffic and residential areas were 3.10 microgram/m3 and 2.02 microgram/m3 respectively. Sixteen PAHs were higher in samples of traffic area compare to residential area and also concentrations of PAHs in fine particle were higher compare to coarse particle.; Summary

A Study on the Effect of Improvement in Work Environment and of Segregation in a Fluorescent Lamp Manufacturing Factory.: Soung Hoon Chang, Kwang Jong Kim; Korean J Prev Med. 1989;22(4):474-479.

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Abstract PDF: This research was conducted to evaluate the effect of improvement in work environment and of segregation in a fluorescent lamp manufacturing factory. Among the total of 80 workers, 8 workers whose mercury concentration in urine reached a hazardous level (200-299 microgram/l) were moved to mercury free workplace. The follow-up examination for their mercury concentration in urine was done three times; on May 3, 1988, September 1, 1988 and April 3, 1989. The results were as follows: 1. Mercury concentration in the air was reduced from 0.140 to 0.107 mg/m3 in 4 months, and to 0.087 mg/m3 in one year after environmental improvement in workplace. However the level still exceeded the Threshold Limit Value. 2. The geometric mean of urinary mercury concentration among 80 workers was 173.0 microgram/l (5.1~458.6 microgram/l). The distribution of workers according to urinary mercury concentration showed that 9 workers (11.2%) were above the mercury poisoning level (300 microgram/l), 24 workers (30.0%) were 200-299 microgram/l, 35 workers (43.8%) were 50-199 microgram/l, and 12 workers (15.0%) were below 50 microgram/l. 3. Among the 24 workers whose urinary mercury concentration was 200-299 microgram/l, 8 were able to be followed up. Their mean urinary mercury concentration before segregation was 244.9 microgram/l, but decreased to 151.4 microgram/l in four months, 128.8 microgram/l in six months, and 46.8 microgram/l in one year after segregation.; Summary

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