Journal of Preventive Medicine and Public Health

Original Articles

Factors Influencing Suicidal Ideation According to the Deprivation Indices of Different Regions in Korea: Yun-Young Kim, Hyung-Joo Park; J Prev Med Public Health. 2023;56(1):88-94. Published online January 31, 2023; DOI: https://doi.org/10.3961/jpmph.22.356

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Objectives
This study examined how deprivation differed by region and the effect those differences had on suicidal ideation among the local population.
Methods
Data collected over 10 years (2012-2021) in the Korea Welfare Panel Study were organized into 3 categories: metropolitan, city, and rural. A panel analysis was conducted on the impact of deprivation indices, socio-demographic characteristics, and life satisfaction on suicidal ideation in each category.
Results
Income, divorce status, family relationship satisfaction, and medical deprivation had a significant impact on suicidal ideation in metropolitan areas, whereas these variables did not have significant effects in rural areas. In other words, income, family, and medical support were more impactful in city areas.
Conclusions
Although the deprivation index was higher in rural areas than in city areas due to an aging population and reduced income levels, the mental health of rural residents was found to be generally better than that of city residents. The possibility that this is related to the strength of relationships within the respective communities should be considered in light of recent discussions on relational welfare.

Summary

Korean summary
본 연구는 지역별 박탈수준을 살펴보고 각 지역에서 5개 박탈영역이 자살 생각에 미치는 영향을 조사하였다. 연구결과, 고령화와 소득수준 감소로 농촌지역이 도시지역보다 박탈지수가 높았지만 농촌지역 주민의 자살생각은 도시지역보다 낮은 것으로 나타났다. 이는 최근 관계적 복지에 관한 논의에 비추어 각 지역사회 내의 관계강화와 관련이 있을 가능성을 고려해야 한다.

Citations

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Associations between changes in deprivation and alcohol use disorder: a nationwide longitudinal study
Dan Bi Kim, Jae Hyeok Lim, Ji Su Ko, Min Jeong Joo, Eun-Cheol Park, Suk-yong Jang
Alcohol and Alcoholism.2024;[Epub] CrossRef
Factors of Capital on Depression in Older Adulthood: A Comparison of Urban and Rural Regions in Korea
MinYoung Bae, YunYoung Kim, Ijin Hong
Healthcare.2023; 11(21): 2850. CrossRef

A Multi-level Analysis of Factors Affecting Participation in Health Screenings in Korea: A Focus on Household and Regional Factors: So Yoon Park, Young-jeon Shin; J Prev Med Public Health. 2022;55(2):153-163. Published online October 27, 2021; DOI: https://doi.org/10.3961/jpmph.21.268

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Abstract Summary PDF Supplementary Material

Objectives
This study divided the factors that affect participation in health screenings into individual, household, and regional levels and conducted a multi-level analysis to identify the factors related to participation in health screenings.
Methods
Participants from the 2017 Community Health Survey were classified into 2 groups (under 40 and 40 or older). A multi-level logistic regression analysis was conducted to identify the factors that affected participation in health screenings.
Results
The screening rate of the participants was 69.7%, and it was higher among participants aged 40 and older (80.3%) than it was among participants younger than 40 (49.8%). At the individual level, the factors that influenced participation in health screenings included age, economic activity, smoking status, physician-diagnosed hypertension, and a moderate or high physical activity level. At the household level, the odds ratio of participation in health screenings was high for participants who lived in single-person households, lived with a spouse, earned a high monthly household income, and were not beneficiaries of national basic livelihood security. At the regional level, the odds ratio at the 95% confidence interval level of participation in health screenings was high for participants who had trust in the local community and lived in an area with a proportionally high social welfare budget.
Conclusions
This study analyzed nationalwide data and confirmed that individual, household, and regional characteristics affected participation in health screenings. Therefore, policies that prioritize the improvement of regional level factors and especially household level factors are likely to be the most effective for improving the screening rate.

Summary

Korean summary
이 연구는 건강검진 수검 여부에 영향을 미치는 요인을 개인, 가구, 지역수준으로 나누어 다수준 분석을 통해 분석하였다. 건강검진 수검여부에 개인 특성뿐만 아니라 개인을 둘러싼 가구와 지역의 특성도 영향을 미친다는 것을 확인하였다. 영향요인들의 유의성을 바탕으로, 건강검진 수검률 향상을 위한 정책을 수립할 때 지역수준 요인뿐만 아니라 특별히 가구수준 요인을 개선할 수 있는 정책을 우선하는 것이 효과적일 것이다.

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Necessity of Analyzing the Korea Community Health Survey Using 7 Local Government Types
Seowoo Park, Haibin Bai, Jae-ryun Lee, Soomin Kim, Hyemin Jung, Jin Yong Lee
Journal of Preventive Medicine and Public Health.2025; 58(1): 83. CrossRef
Understanding Cancer Screening Behavior in South Korea: A Biopsychosocial Approach to Regional Differences
Yoon-Hee Cho, Joohyun Lee
Healthcare.2025; 13(6): 664. CrossRef
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Myeunghee Han
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Kyoung-Nam Kim, Kyungsik Kim, Sangjun Lee, Sue K. Park
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Socioeconomic Predictors of Diabetes Mortality in Japan: An Ecological Study Using Municipality-specific Data: Tasuku Okui; J Prev Med Public Health. 2021;54(5):352-359. Published online August 14, 2021; DOI: https://doi.org/10.3961/jpmph.21.215

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Abstract PDF Supplementary Material

Objectives
The aim of this study was to examine the geographic distribution of diabetes mortality in Japan and identify socioeconomic factors affecting differences in municipality-specific diabetes mortality.
Methods
Diabetes mortality data by year and municipality from 2013 to 2017 were extracted from Japanese Vital Statistics, and the socioeconomic characteristics of municipalities were obtained from government statistics. We calculated the standardized mortality ratio (SMR) of diabetes for each municipality using the empirical Bayes method and represented geographic differences in SMRs in a map of Japan. Multiple linear regression was conducted to identify the socioeconomic factors affecting differences in SMR. Statistically significant socioeconomic factors were further assessed by calculating the relative risk of mortality of quintiles of municipalities classified according to the degree of each socioeconomic factor using Poisson regression analysis.
Results
The geographic distribution of diabetes mortality differed by gender. Of the municipality-specific socioeconomic factors, high rates of single-person households and unemployment and a high number of hospital beds were associated with a high SMR for men. High rates of fatherless households and blue-collar workers were associated with a high SMR for women, while high taxable income per-capita income and total population were associated with low SMR for women. Quintile analysis revealed a complex relationship between taxable income and mortality for women. The mortality risk of quintiles with the highest and lowest taxable per-capita income was significantly lower than that of the middle-income quintile.
Conclusions
Socioeconomic factors of municipalities in Japan were found to affect geographic differences in diabetes mortality.

Summary

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Worldwide burden and trends of diabetes among people aged 70 years and older, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019
Shimin Jiang, Tianyu Yu, Dingxin Di, Ying Wang, Wenge Li
Diabetes/Metabolism Research and Reviews.2024;[Epub] CrossRef
The Effect of Neighborhood Deprivation on Mortality in Newly Diagnosed Diabetes Patients: A Countrywide Population-Based Korean Retrospective Cohort Study, 2002–2013
Kyoung-Hee Cho, Juyeong Kim, Young Choi, Tae-Hyun Kim
International Journal of Environmental Research and Public Health.2022; 19(7): 4324. CrossRef
Depression, cognitive dysfunction and other factors associated with 5-year overall mortality in type 2 diabetes mellitus: a pilot prospective observational study
E. G. Starostina, M. N. Volodina, I. V. Starostin
Diabetes mellitus.2022; 25(4): 327. CrossRef

The Impact of an Emergency Fee Increase on the Composition of Patients Visiting Emergency Departments: Hyemin Jung, Young Kyung Do, Yoon Kim, Junsoo Ro; J Prev Med Public Health. 2014;47(6):309-316. Published online November 24, 2014; DOI: https://doi.org/10.3961/jpmph.14.044

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Abstract PDF: Objectives
This study aimed to test our hypothesis that a raise in the emergency fee implemented on March 1, 2013 has increased the proportion of patients with emergent symptoms by discouraging non-urgent emergency department visits.
Methods
We conducted an analysis of 728 736 patients registered in the National Emergency Department Information System who visited level 1 and level 2 emergency medical institutes in the two-month time period from February 1, 2013, one month before the raise in the emergency fee, to March 31, 2013, one month after the raise. A difference-in-difference method was used to estimate the net effects of a raise in the emergency fee on the probability that an emergency visit is for urgent conditions.
Results
The percentage of emergency department visits in urgent or equivalent patients increased by 2.4% points, from 74.2% before to 76.6% after the policy implementation. In a group of patients transferred using public transport or ambulance, who were assumed to be least conscious of cost, the change in the proportion of urgent patients was not statistically significant. On the other hand, the probability that a group of patients directly presenting to the emergency department by private transport, assumed to be most conscious of cost, showed a 2.4% point increase in urgent conditions (p<0.001). This trend appeared to be consistent across the level 1 and level 2 emergency medical institutes.
Conclusions
A raise in the emergency fee implemented on March 1, 2013 increased the proportion of urgent patients in the total emergency visits by reducing emergency department visits by non-urgent patients.; Summary

English Abstracts

Impact of DRG Payment on the Length of Stay and the Number of Outpatient Visits After Discharge for Caesarean Section During 2004-2007.: Changwoo Shon, Seolhee Chung, Seonju Yi, Soonman Kwon; J Prev Med Public Health. 2011;44(1):48-55.; DOI: https://doi.org/10.3961/jpmph.2011.44.1.48

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Abstract PDF

OBJECTIVES
The purpose of this study was to examine the impact of Diagnosis-Related Group (DRG)-based payment on the length of stay and the number of outpatient visits after discharge in for patients who had undergone caesarean section. METHODS: This study used the health insurance data of the patients in health care facilities that were paid by the Fee-For-Service (FFS) in 2001-2004, but they participated in the DRG payment system in 2005-2007. In order to examine the net effects of DRG payment, the Difference-In-Differences (DID) method was adopted to observe the difference in health care utilization before and after the participation in the DRG payment system. The dependent variables of the regression model were the length of stay and number of outpatient visits after discharge, and the explanatory variables included the characteristics of the patients and the health care facilities. RESULTS: The length of stay in DRG-paid health care facilities was greater than that in the FFS-paid ones. Yet, DRG payment has no statistically significant effect on the number of outpatient visits after discharge. CONCLUSIONS: The results of this study that DRG payment was not effective in reducing the length of stay can be related to the nature of voluntary participation in the DRG system. Only those health care facilities that are already efficient in terms of the length of stay or that can benefit from the DRG payment may decide to participate in the program.

Summary

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The effects of DRGs-based payment compared with cost-based payment on inpatient healthcare utilization: A systematic review and meta-analysis
Zhaolin Meng, Wen Hui, Yuanyi Cai, Jiazhou Liu, Huazhang Wu
Health Policy.2020; 124(4): 359. CrossRef
Effects of a mandatory DRG payment system in South Korea: Analysis of multi-year nationwide hospital claims data
Jae Woo Choi, Seung-Ju Kim, Hye-Ki Park, Sung-In Jang, Tae Hyun Kim, Eun-Cheol Park
BMC Health Services Research.2019;[Epub] CrossRef
Early Impact on Outpatients of Mandatory Adoption of the Diagnosis‐Related Group‐Based Reimbursement System in Korea on Use of Outpatient Care: Differences in Medical Utilization and Presurgery Examination
Seung Ju Kim, Kyu‐Tae Han, Woorim Kim, Sun Jung Kim, Eun‐Cheol Park
Health Services Research.2018; 53(4): 2064. CrossRef
The effect of competition on the relationship between the introduction of the DRG system and quality of care in Korea
Seung Ju Kim, Eun-Cheol Park, Sun Jung Kim, Kyu-Tae Han, Euna Han, Sung-In Jang, Tae Hyun Kim
The European Journal of Public Health.2016; 26(1): 42. CrossRef
Impact of payment system change from per-case to per-diem on high severity patient's length of stay
Sung-In Jang, Chung Mo Nam, Sang Gyu Lee, Tae Hyun Kim, Sohee Park, Eun-Cheol Park
Medicine.2016; 95(37): e4839. CrossRef
The Effect of Mandatory Diagnosis-Related Groups Payment System
Jae-Woo Choi, Sung-In Jang, Suk-Yong Jang, Seung-Ju Kim, Hye-Ki Park, Tae Hyun Kim, Eun-Cheol Park
Health Policy and Management.2016; 26(2): 135. CrossRef
Is the Hospital Caseload of Diagnosis Related Groups Related to Medical Charges and Length of Stay?
Jin-Mi Kwak, Kwang-Soo Lee
The Korean Journal of Health Service Management.2014; 8(4): 13. CrossRef
Perspectives on cost containment and quality of health care in the DRG payment system of Korea
Jaewook Choi
Journal of the Korean Medical Association.2012; 55(8): 706. CrossRef
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Educational Differences in Health Care Utilization in the Last Year of Life among South Korean Cancer Patients.: Soo Young Choo, Sang Yi Lee, Chul Woung Kim, Su Young Kim, Tae Ho Yoon, Hai Rim Shin, Ok Ryun Moon; J Prev Med Public Health. 2007;40(1):36-44.; DOI: https://doi.org/10.3961/jpmph.2007.40.1.36

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Abstract PDF

OBJECTIVES
There have been few studies examining the differences in health care utilization across social classes during the last year of life. Therefore, in this study we analyzed the quantitative and qualitative differences in health care utilization among cancer patients across educational classes in their last year of life, and derived from it implications for policy. METHODS: To evaluate health care utilization by cancer patients in the last year of life, Death certificate data from 2004 were merged with National Health Insurance data (n=60,088). In order to use educational level as a social class index, we selected the individuals aged 40 and over as study subjects (n=57,484). We analyzed the differences in the medical expenditures, admission days, and rates of admission experience across educational classes descriptively. Multiple regression analysis was conducted to evaluate the association between medical expenditures and independent variables such as sex, age, education class, site of death and type of cancer. RESULTS: The upper educational class spent much more on medical expenditures in the last one year of life, particularly during the last month of life, than the lower educational class did. The ratio of monthly medical expenditures per capita between the college class and no education class was 2.5 in the last 6-12 months of life, but the ratio was 1.6 in the last 1 month. Also, the lower the educational class, the higher the proportion of medical expenditures during the last one month of life, compared to total medical expenditures in the last one year of life. The college educational class had a much higher rate of admission experiences in tertiary hospitals within Seoul than the other education classes did. CONCLUSIONS: This study shows that the lower educational classes had qualitative and quantitative disadvantages in utilizing health care services for cancer in the last year of life.

Summary

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Socioeconomic differences in the perception of inequalities in healthcare utilization and health in South Korea
Nayeon Kim, Hye-won Yun, Juwon Park, Fatima Nari, Hee Jin Wang, Jae Kwan Jun, Kui Son Choi, Mina Suh
Preventive Medicine Reports.2023; 36: 102445. CrossRef
Cross-National Differences in Wealth Inequality in Health Services and Caregiving Used Near the End of Life
Jennifer A. Ailshire, Cristian A. Herrera, Eunyoung Choi, Margarita Osuna, Elina M. Suzuki
SSRN Electronic Journal .2022;[Epub] CrossRef
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Inuk Hwang, Dong Wook Shin, Kyoung Hee Kang, Hyung Kook Yang, So Young Kim, Jong-Hyock Park
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Barriers to Cancer Care, Perceived Social Support, and Patient Navigation Services for Korean Breast Cancer Patients
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Tae Ho Yoon, Sang-Yi Lee, Chul-Woung Kim, Su Young Kim, Baek-Geun Jeong, Hyeung-Keun Park
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Original Articles

Species Differences in Effect of Ethanol to Urinary Metabolites Excretion of Trichloroethylene in Mice and Rats.: Eun Yong Kang, Jung Duck Park, Yeon Pye Hong, Im Won Chang; Korean J Prev Med. 1998;31(4):680-691.

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Abstract PDF: This study was conducted to examine the species differences in the urinary excretion of trichloroethanol(TCE-OH) and trichloroacetic acid(TCA) of trichloroethylene(TCE) metabolites and the effect of ethanol on these metabolites in mice and rats. TCE administered to Male Sprague Dawley rats and ICR mice as a single oral dose(100, 200, 500, 1,000 or 2,000 mg/kg body weight) and ethanol(3.0 g/kg body weight) was taken orally 12 hours before TCE administration. The metabolites in urine were measured 0, 12, 24, 36 and 48 hours after TCE administration. The results of metabolite excretion were as follows; Total trichlorocompounds(TTC) in urine increased with TCE dose in mice while increased only below dose of 1,000 mg/kg TCE in rats. The net excretion of TCE metabolites was significantly greater in mice than rats, although the proportion of TCE-OH to TCA was not different between mice and rats. These findings indicate that mice were internally exposed to significantly higher concentration of TCE metabolites than rats and this trend appeared to be more prominent with the increase of TCE dose. Ethanol increased significantly TCE-OH in urine of rats while the increase of TCE-OH induced by ethanol was not significant in mice, and didn't increase TCA of urine in both of rats and mice. This result suggests that the effect of ethanol on TCE metabolism may be due to the increase of TCE-OH.; Summary

A Comparative Study on Medical Utilization between Urban and Rural Korea.: Kyungshik Joo, Hanjoong Kim, Sunhee Lee, Hyeyoung Min; Korean J Prev Med. 1996;29(2):311-330.

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Abstract PDF: This study was designed to compare the level of medical utilization between the urban and rural areas of Korea and to explain the differences between the two regions. Data from the National Health Interview survey performed by the korean Institute of Health & social Affairs in 1992 were used for this study utilizing a sample size of 21,841 people. The level of medical utilization such as the number of physician visits and the number of hospital admissions was compared between the regions with ANOVA. Various determinants for medical use were also compared by univariate analysis. Statistical models which included enabling factors, predisposing factors, need factors and region were constructed for bivariate analysis in order to further elucidate the level of medical utilization. The results were as follows: 1. There was greater medical use, both in terms of physician visits and inpatient care in the rural areas in spite of insufficient health resources. The particular reasons for higher medical utilization in rural areas were attributed to a higher number of initial physician visits as well as a longer the length of stay per hospital admission. Therefore, indicators representing the degree of met need (utilization/need) showed no significant difference between rural and urban areas in spite of the fact that the medical need is larger in rural areas. 2. Use of public health facilities received a significant portion of physician visits in the rural area. The government's effort to enhance primary health care through health centers, health subcenters and the nurse practitioner's post in rural areas has contributed to the increase of access to medical care in the rural areas. 3. There were some differences in the socio-demographic characteristics between two regions; There were more elderly people over the age of 65; unstable marital status, less education and lower incomes also characterized the rural areas. Therefore, among rural people, there were more predisposing factors for medical use. Additionally, need factors such as poor self-reported health status and high morbidity level were also high in the rural area. 4. In contrast it was learned that, the supply of health resources was mostly concentrated in the urban areas except for public health facilities. Therefore, geographical access to medical care was lower in the rural area both in terms travel time and travel cost. 5. The coefficient of the region variable was insignificant in the regression model which controlled the supply factor only However, utilization was significantly higher in urban areas if the model included predisposing factors and need factors in addition to the supply factor. The results were interpreted as rural people have greater medical needs.; Summary

English Abstract

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

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

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