Cancer-free Life Expectancy in Small Administrative Areas in Korea and Its Associations with Regional Health Insurance Premiums.

BACKGROUND: To determine the priorities and resource allocation of community cancer-related health policies, it is necessary to measure cancer-related health indicators and the burden of cancer by region. This study calculated the cancer-free life expectancy at the eup/myeon/dong level (small administrative units in South Korea) for the first time, and analyzed its association with regional health insurance premiums. METHODS: We used aggregate data from the 2008-2017 National Health Information Database provided by the National Health Insurance Service. Cancer-free life expectancy was calculated by applying Sullivan's method to mortality and cancer prevalence by age group and sex for the 10-year period in 3,396 eups/myeons/dongs. Correlation analyses were performed to analyze the relationship between cancer-free life expectancy and regional health insurance premiums. RESULTS: Cancer-free life expectancy in eups/myeons/dongs of metropolitan areas tended to be higher than in non-metropolitan areas. However, some eups/myeons/dongs of non-metropolitan areas showed quite a high cancer-free life expectancy, especially for females. The median values of differences between cancer-free life expectancy and life expectancy at the eup/myeon/dong level (total: 1.6 years, male: 1.8 years, female: 1.4 years) indicated that a person's healthy life can be shortened by a number of years due to cancer. The association of cancer-free life expectancy by eup/myeon/dong with the regional health insurance premium was statistically significant (ß = 1.0, P < 0.001) and more prominent for males (ß = 1.3, P < 0.001) than for females (ß = 0.5, P < 0.001). The relationship between the regional health insurance premium and the burden of cancer (life expectancy minus cancer-free life expectancy) was also statistically significant (ß = 0.2 for the total population, ß = 0.2 for males, and ß = 0.1 for females, all P values < 0.001). CONCLUSION: This study showed a significant regional gap with regard to cancer-free life expectancy and the burden of cancer at the eup/myeon/dong level. This work makes a meaningful contribution by presenting new and firsthand summary measures of cancer-related health across small areas in Korea. The results will also help the authorities to evaluate the effectiveness of local cancer management projects in small administrative areas and determine regional priorities for implementing cancer control policies.

A taxonomy of hospitals based on partnerships for population health management.

BACKGROUND: Hospitals face growing pressures and opportunities to engage with partner organizations in efforts to improve population health at the community level. Variation has been observed in the degree to which hospitals develop such partnerships. PURPOSE: The aim of this study was to generate a taxonomy of hospitals based on their partnerships with external organizations, employing the theoretical notion of organizations' focus on exploration versus exploitation. METHODOLOGY: With 1,238 valid cases from the 2015 American Hospital Association Population Health Survey, our study uses items asking about the level of partnership strength for 36 named partner types. Excluding three variables with low reliability, 33 variables are classified into six partner groups by factor analysis. Then, cluster analysis is conducted to generate a taxonomy of hospitals based on their partnerships with the six partner groups. FINDINGS: Of 1,238 hospitals, 26.1% are classified as exploratory hospitals that develop more collaborative relationships with partners outside the medical sector. Exploitative hospitals (18.3%) focus on relationships with traditional medical sector partners. Ambidextrous hospitals (27.0%) develop partnerships both in and outside the medical sector. Finally, independent hospitals (28.6%) do not establish strong partnerships. Larger hospitals, not-for-profit hospitals, and teaching hospitals are more likely to be classified as exploratory. PRACTICE IMPLICATIONS: The four-cluster taxonomy can provide hospital and health system leaders and managers with a better understanding of the wide variation in partnerships that hospitals establish and insights into their different strategic options with regard to partnership development.

Effects of ultrasound on the structural, physicochemical, and emulsifying properties of aquafaba extracted from various legumes.

This study investigated the effect of ultrasound (20-60 min, 40 kHz, 280 W) on the structural, physicochemical, and emulsifying properties of aquafaba extracted from various legumes (chickpea [CH], yellow soybean [YSB], black soybean [BSB], small black bean [SBB]). The hydrophobic amino acids and protein secondary structures (α-helix, random coil) significantly increased with sonication time (p < 0.05). The particle size of aquafaba was reduced by ultrasound (p < 0.05). A total of 27 volatile compounds were identified. Most volatiles increased with sonication time, and beany flavor was lowest in CH and SBB. The EAI, ESI, adsorbed proteins, and zeta-potential increased, while emulsion droplet size decreased in all legumes by ultrasound. The overall emulsifying properties were the highest in SBB sonicated for 40 min. This study discusses the applicability of ultrasound to aquafaba and provides insights into the functional properties and potential of aquafaba as a plant-based natural emulsifier.

Occupational inequalities in mortality in Korea: an analysis using nationally representative mortality follow-up data from the late 2000s and after.

Many Korean and international studies have found higher mortality rates and poorer health conditions among manual workers than among non-manual workers. However, a recent study using unlinked data argued that since the economic crisis in Korea in the late 2000s, the mortality estimates of male Korean non-manual workers have been higher than those of manual workers. Our work using individually linked data from the late 2000s and after aimed to examine mortality inequality by occupational class. We analyzed Korea National Health and Nutrition Examination Survey data that were individually linked to cause-of-death data. Cox regression analysis was used to identify the hazard ratios for mortality by occupational class. Of 11,766 males aged between 35 and 64, 397 died between 2007 and 2018: 142 died from cancer, 68 from cardiovascular disease, 88 from external causes, and 99 from other causes. After controlling for age, the mortality estimates for manual workers were 1.85 times higher than those for upper non-manual workers (p<0.05). We observed no evidence of reversed mortality inequality among occupational classes in Korea since the 2000s; this previously reported finding might have been due to numerator-denominator bias arising from the use of unlinked data.

Analysis of factors contributing to occupational health inequality in Korea: a cross-sectional study using nationally representative survey data.

BACKGROUND: Despite the consensus that higher occupational classes tend to have better health and lower mortality rates, one study has reported reversed occupational gradients in mortality rates among Korean men after the economic crisis in the late 2000s. To examine these patterns of health inequality in more detail, we investigated the tendency of occupational gradients in socioeconomic position and multiple pathway indicators known to affect mortality in Korea. METHODS: We used data from 4176 men aged 35-64 in Korea derived from the 2007-2009 and 2013-2015 Korean National Health and Nutrition Examination Surveys. We compared the age-standardized prevalence and age-adjusted mean values of each contributing factor to health inequality among occupational groups, which are divided into upper non-manual workers, lower non-manual workers, manual workers, and others. Contributing factors included childhood and adulthood socioeconomic position indicators, biological risk factors, health behaviors, psychosocial factors, and work environment. RESULTS: Upper non-manual workers had prominently higher levels of education, income, parental education, and economic activity than lower non-manual and manual workers. The rates of smoking and high-risk alcohol consumption were lower, and the rate of weight control activities was higher, in the non-manual classes. Further, the rates of depression and suicidal ideation were lower, and perceptions of the work environment were more favorable, among non-manual workers than among their manual counterparts. CONCLUSIONS: We detected occupational inequality in a wide range of socioeconomic positions and pathway indicators in Korea with consistently favorable patterns for upper non-manual workers. These occupational gradients do not support the previously reported reversed pattern of higher mortality rates in non-manual groups versus in the manual job class in Korea.