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8 "Multilevel analysis"
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Associations of Socioeconomic Status With Depression and Quality of Life in Patients With Hypertension: An Analysis of Data From the 2019 Community Health Survey in Korea
Hye Ri Kim, Mia Son
J Prev Med Public Health. 2022;55(5):444-454.   Published online August 24, 2022
DOI: https://doi.org/10.3961/jpmph.22.214
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  • 127 Download
AbstractAbstract AbstractSummary PDF
Objectives
We aimed to identify the factors related to depression and quality of life in patients with hypertension by using multilevel regression analysis.
Methods
In 2019, 229 043 participants in the Korean Community Health Survey were selected as the study group. Individual factors were identified using data from the 2019 Community Health Survey. Regional factors were identified using data from the National Statistical Office of Korea. Multilevel regression analysis was conducted to find individual and local factors affecting depression and quality of life in patients with hypertension and to determine any associated interactions.
Results
As individual factors in patients with hypertension, women, those with lower education-levels, recipients of basic livelihood benefits, and those with poor dietary conditions showed stronger associations with depression and quality of life. As regional factors and individual-level variables in patients with hypertension, lower gross regional personal income, fewer doctors at medical institutions, and lower rates of participation in volunteer activities presented stronger associations with depression and quality of life. In addition, the associations of depression with gross regional personal income, the number of doctors at medical institutions, and dietary conditions were significantly stronger in patients with hypertension than in patients without hypertension. The associations of gender and employment status with quality of life were also significantly greater.
Conclusions
Policy interventions are needed to adjust health behaviors, prevent depression, and improve quality of life for patients with hypertension, especially for those with the risk factors identified in this study.
Summary
Korean summary
2019년 지역사회건강조사, 대한민국 통계청 자료를 통해, 다수준 회귀분석을 이용하여 고혈압 환자의 우울 및 삶의 질과 관련된 요인을 파악한 결과, 비고혈압 집단 대비 고혈압 환자의 지역총소득, 의료기관 종사 의사수, 식생활 형편이 우울과 연관성이 유의미하게 컸고, 성별, 직업수준이 삶의 질과 연관성이 유의미하게 컸다.
Contextual and Individual Determinants of Mental Health: A Cross-sectional Multilevel Study in Tehran, Iran
Homeira Sajjadi, Gholamreza Ghaedamini Harouni, Hassan Rafiey, Mohammadreza Vaez-Mahdavi, Meroe Vameghi, Seyed Hossein Mohaqeqi Kamal
J Prev Med Public Health. 2020;53(3):189-197.   Published online April 14, 2020
DOI: https://doi.org/10.3961/jpmph.19.150
  • 3,690 View
  • 150 Download
  • 4 Crossref
AbstractAbstract PDF
Objectives
Our aim was to answer the following questions: (1) Can mental health variance be partitioned to individual and higher levels (e.g., neighborhood and district); (2) How much (as a percentage) do individual-level determinants explain the variability of mental health at the individual-level; and (3) How much do determinants at the neighborhood- or district-level explain the variability of mental health at the neighborhood- or district-level?
Methods
We used raw data from the second round of the Urban Health Equity Assessment and Response Tool in Tehran (in 2012-2013, n=34 700 samples nested in 368 neighborhoods nested in 22 districts) and the results of the official report of Tehran’s Center of Studies and Planning (in 2012-2013, n=22 districts). Multilevel linear regression models were used to answer the study questions.
Results
Approximately 40% of Tehran residents provided responses suggestive of having mental health disorders (30-52%). According to estimates of residual variance, 7% of mental health variance was determined to be at the neighborhood-level and 93% at the individual-level. Approximately 21% of mental health variance at the individual-level and 49% of the remaining mental health variance at the neighborhood-level were determined by determinants at the individual-level and neighborhood-level, respectively.
Conclusions
If we want to make the most effective decisions about the determinants of mental health, in addition to considering the therapeutic perspective, we should have a systemic or contextual view of the determinants of mental health.
Summary

Citations

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  • This is the place: a multi-level analysis of neighbourhood correlates of adolescent wellbeing
    Jose Marquez, Neil Humphrey, Louise Black, Sophie Wozmirska
    Social Psychiatry and Psychiatric Epidemiology.2024; 59(6): 929.     CrossRef
  • Parental Objective, Subjective, and Contextual Socioeconomic Status and Children's Mental Health in Iran: The Mediating Effect of the Subjective Measure
    Ardavan Mohammad Aghaei, Lawrence Wissow, Ramin Mojtabai, Hadi Zarafshan, Zahra Shahrivar, Amir Hossein Nikzad, Vandad Sharifi
    Iranian Journal of Psychiatry and Behavioral Sciences.2023;[Epub]     CrossRef
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    Seyed Hossein Mohaqeqi Kamal, Mehdi Basakha, Sabina Alkire
    Ageing and Society.2022; : 1.     CrossRef
  • Measuring and exploring mental health determinants: a closer look at co-residents’ effect using a multilevel structural equations model
    Hend Gabr, Mohammed Baragilly, Brian H. Willis
    BMC Medical Research Methodology.2022;[Epub]     CrossRef
The Association Among Individual and Contextual Factors and Unmet Healthcare Needs in South Korea: A Multilevel Study Using National Data
Seung Eun Lee, Miyeon Yeon, Chul-Woung Kim, Tae-Ho Yoon
J Prev Med Public Health. 2016;49(5):308-322.   Published online September 7, 2016
DOI: https://doi.org/10.3961/jpmph.16.035
  • 8,034 View
  • 206 Download
  • 14 Crossref
AbstractAbstract PDF
Objectives
The objective of this study is to investigate associations between contextual characteristics and unmet healthcare needs in South Korea after accounting for individual factors.
Methods
The present study used data from the 2012 Korean Community Health Survey (KCHS) of 228 902 adults residing within 253 municipal districts in South Korea. A multilevel analysis was conducted to investigate how contextual characteristics, defined by variables that describe the regional deprivation, degree of urbanity, and healthcare supply, are associated with unmet needs after controlling for individual-level variables.
Results
Of the surveyed Korean adults, 12.1% reported experiencing unmet healthcare needs in the past. This figure varied with the 253 districts surveyed, ranging from 2.6% to 26.2%. A multilevel analysis found that the association between contextual characteristics and unmet needs varied according to the factors that caused the unmet needs. The degree of urbanity was associated with unmet need due to “financial burden” (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.42 to 0.66 for rural vs. metropolitan), but not unmet need due to “service not available when needed.” There were no significant associations between these unmet need measures and regional deprivation. Among individual-level variables, income level showed the highest association with unmet need due to “financial burden” (OR, 5.63; 95% CI, 4.76 to 6.66), while employment status showed a strong association with unmet need due to “service not available when needed.”
Conclusions
Our finding suggests that different policy interventions should be considered for each at-risk population group to address the root cause of unmet healthcare needs.
Summary

Citations

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  • Satisfaction with local healthcare services and medical need among hypertensive patients: a nationwide study
    Woorim Kim, Yeong Jun Ju, Soon Young Lee
    BMC Public Health.2024;[Epub]     CrossRef
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    Min-Jeong Park, Mi-Young Chung, Verda Salman
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    Hye-Eun Lee, Jeongbae Rhie
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    Epidemiology and Health.2022; 44: e2022107.     CrossRef
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    Eunkyoung Bae, Jeongok Park, Eunyoung Jung
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    Bola Lukman Solanke
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    Ji-Young Han, Hyeon-Sook Park
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    Jung A. Choi, Oksoo Kim
    International Journal of Environmental Research and Public Health.2021; 18(13): 6862.     CrossRef
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    Purity Njagi, Jelena Arsenijevic, Wim Groot
    BMC Health Services Research.2020;[Epub]     CrossRef
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    Dong-Woo Choi, Sang Ah Lee, Doo Woong Lee, Jae Hong Joo, Kyu-Tae Han, SeungJu Kim, Eun-Cheol Park
    BMJ Open Diabetes Research & Care.2020; 8(1): e000729.     CrossRef
  • Neighborhood Deprivation and Unmet Health Care Needs: A Multilevel Analysis of Older Individuals in South Korea
    Seung Eun Lee, Miyeon Yeon, Chul-Woung Kim, Tae-Ho Yoon, Dongjin Kim, Jihee Choi
    Osong Public Health and Research Perspectives.2019; 10(5): 295.     CrossRef
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    Youngmi Kang, Heesook Son
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Dental Care Utilization for Examination and Regional Deprivation
Cheol-Sin Kim, Sun-Young Han, Seung Eun Lee, Jeong-Hee Kang, Chul-Woung Kim
J Prev Med Public Health. 2015;48(4):195-202.   Published online July 23, 2015
DOI: https://doi.org/10.3961/jpmph.15.026
  • 23,810 View
  • 111 Download
  • 7 Crossref
AbstractAbstract PDF
Objectives
Receiving proper dental care plays a significant role in maintaining good oral health. We investigated the relationship between regional deprivation and dental care utilization.
Methods
Multilevel logistic regression was used to identify the relationship between the regional deprivation level and dental care utilization purpose, adjusting for individual-level variables, in adults aged 19+ in the 2008 Korean Community Health Survey (n=220 258).
Results
Among Korean adults, 12.8% used dental care to undergo examination and 21.0% visited a dentist for other reasons. In the final model, regional deprivation level was associated with significant variations in dental care utilization for examination (p<0.001). However, this relationship was not shown with dental care utilization for other reasons in the final model.
Conclusions
This study’s findings suggest that policy interventions should be considered to reduce regional variations in rates of dental care utilization for examination.
Summary

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  • Utilization of dental care among adult populations: a scoping review of applied models
    Ashkan Negintaji Zardak, Mostafa Amini-Rarani, Ibrahim Abdollahpour, Faezeh Eslamipour, Bahareh Tahani
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    Hosung Shin, Han-A Cho, Bo-Ra Kim
    International Journal of Environmental Research and Public Health.2021; 18(8): 3859.     CrossRef
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    Kyung-Yi Do, Sook Moon
    International Journal of Environmental Research and Public Health.2020; 17(6): 1906.     CrossRef
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    Song-Yi Kim, Nam-Hee Kim
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    Shiho Kino, Eduardo Bernabé, Wael Sabbah
    Journal of Public Health Dentistry.2017; 77(3): 244.     CrossRef
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    Seung Eun Lee, Miyeon Yeon, Chul-Woung Kim, Tae-Ho Yoon
    Journal of Preventive Medicine and Public Health.2016; 49(5): 308.     CrossRef
  • Dental care utilization in the west of Iran: a cross-sectional analysis of socioeconomic determinants
    Satar Rezaei, Esmail Ghahramani, Mohammad Hajizadeh, Bijan Nouri, Sheno Bayazidi, Fatemah Khezrnezhad
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Civic Participation and Self-rated Health: A Cross-national Multi-level Analysis Using the World Value Survey
Saerom Kim, Chang-yup Kim, Myung Soon You
J Prev Med Public Health. 2015;48(1):18-27.   Published online January 27, 2015
DOI: https://doi.org/10.3961/jpmph.14.031
  • 11,047 View
  • 144 Download
  • 4 Crossref
AbstractAbstract PDF
Objectives
Civic participation, that which directly influences important decisions in our personal lives, is considered necessary for developing a society. We hypothesized that civic participation might be related to self-rated health status.
Methods
We constructed a multi-level analysis using data from the World Value Survey (44 countries, n=50 859).
Results
People who participated in voting and voluntary social activities tended to report better subjective health than those who did not vote or participate in social activities, after controlling for socio-demographic factors at the individual level. A negative association with unconventional political activity and subjective health was found, but this effect disappeared in a subset analysis of only the 18 Organization for Economic Cooperation and Development (OECD) countries. Moreover, social participation and unconventional political participation had a statistically significant contextual association with subjective health status, but this relationship was not consistent throughout the analysis. In the analysis of the 44 countries, social participation was of borderline significance, while in the subset analysis of the OECD countries unconventional political participation was a stronger determinant of subjective health. The democratic index was a significant factor in determining self-rated health in both analyses, while public health expenditure was a significant factor in only the subset analysis.
Conclusions
Despite the uncertainty of its mechanism, civic participation might be a significant determinant of the health status of a country.
Summary

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  • Effect of social capital, social support and social network formation on the quality of life of American adults during COVID-19
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Influence of the Nursing Practice Environment on Job Satisfaction and Turnover Intention
Sang-Yi Lee, Chul-Woung Kim, Jeong-Hee Kang, Tae-Ho Yoon, Cheoul Sin Kim
J Prev Med Public Health. 2014;47(5):258-265.   Published online September 12, 2014
DOI: https://doi.org/10.3961/jpmph.14.002
  • 11,982 View
  • 186 Download
  • 12 Crossref
AbstractAbstract PDF
Objectives
To examine whether the nursing practice environment at the hospital-level affects the job satisfaction and turnover intention of hospital nurses. Methods: Among the 11 731 nurses who participated in the Korea Health and Medical Workers’ Union’s educational program, 5654 responded to our survey. Data from 3096 nurses working in 185 general inpatient wards at 60 hospitals were analyzed using multilevel logistic regression modeling. Results: Having a standardized nursing process (odds ratio [OR], 4.21; p<0.001), adequate nurse staffing (OR, 4.21; p<0.01), and good doctor-nurse relationship (OR, 4.15; p<0.01), which are hospital-level variables based on the Korean General Inpatients Unit Nursing Work Index (KGU-NWI), were significantly related to nurses’ job satisfaction. However, no hospital-level variable from the KGU-NWI was significantly related to nurses’ turnover intention. Conclusions: Favorable nursing practice environments are associated with job satisfaction among nurses. In particular, having a standardized nursing process, adequate nurse staffing, and good doctor-nurse relationship were found to positively influence nurses’ job satisfaction. However, the nursing practice environment was not related to nurses’ turnover intention.
Summary

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Factors Affecting Public Prejudice and Social Distance on Mental Illness: Analysis of Contextual Effect by Multi-level Analysis
Hyeongap Jang, Jun-Tae Lim, Juhwan Oh, Seon-Young Lee, Yong-Ik Kim, Jin-Seok Lee
J Prev Med Public Health. 2012;45(2):90-97.   Published online March 31, 2012
DOI: https://doi.org/10.3961/jpmph.2012.45.2.90
  • 9,990 View
  • 136 Download
  • 13 Crossref
AbstractAbstract PDF
Objectives

While there have been many quantitative studies on the public's attitude towards mental illnesses, it is hard to find quantitative study which focused on the contextual effect on the public's attitude. The purpose of this study was to identify factors that affect the public's beliefs and attitudes including contextual effects.

Methods

We analyzed survey on the public's beliefs and attitudes towards mental illness in Korea with multi-level analysis. We analyzed the public's beliefs and attitudes in terms of prejudice as an intermediate outcome and social distance as a final outcome. Then, we focused on the associations of factors, which were individual and regional socio-economic factors, familiarity, and knowledge based on the comparison of the intermediate and final outcomes.

Results

Prejudice was not explained by regional variables but was only correlated with individual factors. Prejudice increased with age and decreased by high education level. However, social distance controlling for prejudice increased in females, in people with a high education level, and in regions with a high education level and a high proportion of the old. Therefore, social distance without controlling for prejudice increased in females, in the elderly, in highly educated people, and in regions with a high education and aged community.

Conclusions

The result of the multi-level analysis for the regional variables suggests that social distance for mental illness are not only determined by individual factors but also influenced by the surroundings so that it could be tackled sufficiently with appropriate considering of the relevant regional context with individual characteristics.

Summary

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English Abstract
Impact of Health Insurance Type on the Quality of Hemodialysis Services: A Multilevel Analysis.
Jin Hee Jung, Soon Man Kwon, Kyoung Hoon Kim, Seon Kyoung Lee, Dong Sook Kim
J Prev Med Public Health. 2010;43(3):245-256.
DOI: https://doi.org/10.3961/jpmph.2010.43.3.245
  • 4,813 View
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AbstractAbstract PDF
OBJECTIVES
This study aims to compare quality indicators for the hemodialysis services between patients with health insurance and those with medical aid. METHODS: This study used data from sampled hospitals that provided a hemodialysis service. A total of 2287 patients were selected, and the information for hemodialysis service has been granted from medical record reviews. A multi-level regression analysis was used to examine the differences in process and outcome indicators for hemodialysis between patients with health insurance and those with medical aid. Process indicators were defined as: frequency of hemodialysis, hemodialysis time, erythropoietin (EPO) use, measurement of hemodialysis dose at least once a month, measurement of phosphate at least once every three months, and measurement of albumin at least once every three months. Outcome indicators were defined as: hemodialysis adequacy, anemia management, blood pressure management, and calcium, phosphate and nutrition management. The total scores for outcome indicators ranged from 0 (worst) to 4 (best). RESULTS: There was a significant difference in the measurement of hemodialysis dose at least once a month between patients with health insurance and those with medical aid (OR 0.66, 95% CI=0.43-0.99). However, frequency of hemodialysis, hemodialysis time, EPO use, measurement of phosphate at least once every three months, measurement of albumin at least once every three months, hemodialysis adequacy management, Hb> or =11 g/dL, blood pressure within the range of 100-140/60-90 mmHg, calcium x phosphate< or =55 g2/dL2 and albumin> or =4 g/dL were not significantly different between the groups. CONCLUSIONS: There were no significant differences in outcome indicators for hemodialysis between the groups. Further studies are warranted into the mechanism that results in no differences in the outcome indicators for hemodialysis.
Summary

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JPMPH : Journal of Preventive Medicine and Public Health