Is a change in economic status associated with anxiety, depression and suicide ideation during the COVID-19 pandemic in South Korean adults?

BACKGROUND: Coronavirus disease 2019 (COVID-19) affected global economic changes and mental health outcomes. However, sex differences are unclear regarding the relationship between economic status change and mental health outcomes during the pandemic. Therefore, we investigated whether change in economic status is associated with depression, anxiety and suicidal ideation, based on sex. METHODS: We used data from the COVID-19 National Mental Health Survey 2021 in South Korea. We used the Generalized Anxiety Disorder (GAD) 7-item scale for measuring anxiety, the Patient Health Questionnaire-9 scale for measuring depression and self-reported questionnaires for investigating suicidal ideation and COVID-19-related suicidal ideation. RESULTS: Among 2000 participants, those with a worse economic status change had a 2.7-fold higher risk of GAD (prevalence ratio [PR], 2.70; 95% confidence interval [CI], 2.07-3.51); 2.5-fold higher depression risk (PR, 2.55; 95%CI, 2.05-3.18); 2.1-fold higher risk of suicidal ideation (PR, 2.09; 95%CI, 1.72-2.53); and 4.0-fold higher risk of COVID-19-related suicidal ideation (PR, 4.03; 95%CI, 2.78-5.83). Women whose economic status worsened had a 3.5-fold higher risk of COVID-19-related suicidal ideation (PR, 3.49; 95%CI, 2.01-6.06). CONCLUSION: Worse economic change is associated with negative mental health outcomes during the COVID-19 pandemic; particularly, women experiencing financial hardships during the pandemic had a higher risk of COVID-19-related suicidal ideation.

Affecting Factors of Secondhand Smoke Exposure in Korea: Focused on Different Exposure Locations.

Exposure to secondhand smoke (SHS) not only can cause serious illness, but is also an economic and social burden. Contextual and individual factors of non-smoker exposure to SHS depend on location. However, studies focusing on this subject are lacking. In this study, we described and compared the factors related to SHS exposure according to location in Korea. Regarding individual factors related to SHS exposure, a common individual variable model and location-specific variable model was used to evaluate SHS exposure at home/work/public locations based on sex. In common individual variables, such as age, and smoking status showed different relationships with SHS exposure in different locations. Among home-related variables, housing type and family with a single father and unmarried children showed the strongest positive relationships with SHS exposure in both males and females. In the workplace, service and sales workers, blue-collar workers, and manual laborers showed the strongest positive association with SHS exposure in males and females. For multilevel analysis in public places, only SHS exposure in females was positively related with cancer screening rate. Exposure to SHS in public places showed a positive relationship with drinking rate and single-parent family in males and females. The problem of SHS embodies social policies and interactions between individuals and social contextual factors. Policy makers should consider the contextual factors of specific locations and regional and individual context, along with differences between males and females, to develop effective strategies for reducing SHS exposure.

Egalitarian health policy preference and its related factors in Korea: national representative sample survey.

Recently in Korea, the commercialization of health services has come to the fore, and the issue of egalitarianism/universal coverage in health is a matter for debate. This study explored the extent of Korean citizen's preference for egalitarian health policies focusing on the provision of health care service, financing and related factors. The data came from the 2011 Korean General Social Survey (KGSS) and the International Social Survey Program (ISSP). The preference for an egalitarian health policy (dependent variable) was divided into a preference for an egalitarian health services provision (ES) and a willingness to contribute (WC) to it. Each index was linearly regressed with demographic factors, socioeconomic status, ideology, and health-related factors. ES was significantly associated with an individual's egalitarianism and political liberalism, having illness/disability, having no additional private health insurance, and their perception of health insurance coverage. WC was associated with age, sex, household income, education, egalitarianism, and their perception of health insurance coverage. There were evidently different factors between ES and WC, mainly socioeconomic factors. WC was strongly influenced by socioeconomic status, whereas ES seemed to be linked more closely to economic affordability. Moreover, the results showed that Korean citizens prefer ES but do not like WC. These results deserve great attention, and the authorities should keep it in perspective. If the government wants to make a successful attempt to change the healthcare system through public policy, it will need to take public preferences into account.

Individual and socioeconomic contextual effects on depressive symptom in Korea: multilevel analysis of cross-sectional nationwide survey.

This study was aimed to examine the relationship between individual, socioeconomic context and depressive symptom among Korean population. Data were the Korean Community Health Survey (KCHS), a nationwide survey collected from 253 local communities including 230,715 adults aged 19 yr or over. To identify depressive symptom, the Center for Epidemiologic Studies Depression scale (CES-D) was used. This study employed multilevel logistic regression to analyze the hierarchical data that included individual and community level variables. The results of this study showed that people in the highest level of community income had a higher risk of depressive symptom compared with people in the lowest (OR, 1.6; 95% CI, 1.4-1.9). In a chi-square test for trend, the prevalence of depressive symptom was significantly increased with increased level of community income among all groups of the family income (P<0.001). Moreover a significant interaction was found between household income and community mean income (OR, 0.98; 95% CI, 0.97-0.99). Among individual level variables, age, sex, education, income, living alone, and the number of illnesses were associated with depressive symptom. This study identified that the level of community income has an inverse association, and its effect is especially stronger among low income individuals.

Effect of a Primary Care-Based Chronic Disease Management Program for Hypertension Patients in South Korea.

Background: Recently, the South Korean government has adopted a primary-care-based chronic disease management program as a national task. This study aimed to evaluate this program by focusing on hypertension patients and examine the effect of this program on their health. Methods: Overall, 863 subjects who responded to a survey and 1,716 subjects in administrative data were included. Effects of the program were evaluated based on intermediate outcomes (motivation for self-management, changes in health behavior, medical service utilization, duration of consultation with physicians, and medication compliance) and outcomes (disease management, service satisfaction, and physician-patient relationship, change of blood pressure). Furthermore, we compared study participants' baseline systolic and diastolic blood pressure with corresponding measurements obtained at examinations conducted at 3 and 6 months after baseline measurements. Results: Patients' motivation for self-management of hypertension, health behaviors (smoking, drinking, and exercise), regular clinic visit, and medication compliance were improved after participating in the program. Furthermore, patients' blood pressure levels were decreased while their satisfaction with physician-patient relationships was increased. Conclusion: Primary-care-based chronic disease management program is effective for managing hypertension. Therefore, it is essential to reinforce the role of community-based primary care to improve the health of patients with hypertension.

Community Primary Care-Based Hypertension and Diabetes Management Program in Korea: Evaluation of Participating Patients and Doctors.

Background: This study was conducted to examine the effectiveness of a community-based primary care program focused on hypertension and diabetes in Korea. Methods: We selected patients and doctors who participated in the community-based primary care program as study subjects from Aug 2015 to Jan 2016. Patients and physicians completed a survey, and medical records were reviewed to obtain information regarding clinical variables. Change in the baseline recognition of diseases, motivation for changing health behavior, medical services utilization, doctor-patient relationship were assessed after participation in the program. Results: Both patients and physicians indicated there was improvement in recognition of disease, motivation for changing health behavior, medical services utilization, and doctor-patient relationship (All of recognition scores were above the median point). Patient health behavior such as exercise, smoking, drinking and diet and clinical variables (blood pressure and blood glucose and cholesterol level) also showed significant improvement. Conclusion: The community-based primary care program was found to be helpful in improving hypertension and diabetes patients' overall outcomes and their healthcare providers' behavior.

Sex Difference in the Socioeconomic Burden of Osteoporosis among South Koreans.

Background: The prevalence of osteoporosis is increasing with the aging of the population and the socioeconomic burden. The purpose of this study was to determine the socioeconomic burden of osteoporosis in Korea. Methods: The prevalence of osteoporosis was analyzed using 2017 National Patients Sample and Korea National Health and Nutrition Examination Survey data. Direct costs were divided into healthcare and non-healthcare costs, and indirect costs were calculated by assessing the cost of loss of productivity for labor loss due to disease. Results: The prevalence of osteoporosis diagnosis was 1.91% in total, which was 13 times higher in women than in men (3.57% vs. 0.26%). The socioeconomic cost of osteoporosis was 299.1 million USD based on main diagnosis, and the cost was 13 times higher in women than in men (277.6 vs. 21.5 million USD). The total cost based on main and secondary diagnosis was 981.8 million USD. Similarly, the cost was seven times higher in women than in men (862.4 vs. 119.4 million USD). Conclusions: Osteoporosis increases the socioeconomic burden of disease, and it is significantly higher in women than in men. The policy support for the implementation of prevention and management programs would be necessary to reduce the burden of osteoporosis.

Socioeconomic Burden of Disease Due to Asthma in South Korea.

This study aimed to estimate the socioeconomic burden of asthma in South Korea. The data were obtained from the National Patient Sample of 2014. The direct costs included health care and non-health care costs, and the indirect costs included loss of productivity. To estimate the prevalence of asthma, this study used both primary diagnoses and treatment-based criteria. The prevalence of asthma was 3.7% using primary diagnosis-based criteria. The total costs of asthma were $645.8 million. The direct and indirect costs were $553.9 million and $92.0 million, respectively. When the treatment-based criteria were applied, the prevalence decreased to 1.8% and the total costs decreased to $465.1 million. The direct and indirect costs were $394.9 million and $70.2 million, respectively. In the future, the cost of asthma, derived from various perspectives, should be regularly estimated and used as a basis for lowering the burden of disease due to asthma.

Effects of Community-Based Primary Care Management on Patients With Hypertension and Diabetes.

As the prevalence of chronic diseases is continuously increasing, the socioeconomic cost of those conditions in Korea is also rising. In order to effectively manage chronic diseases, the "Community-Based Primary Care Project" was implemented from 2014 to 2016 and focused on primary medical care and physician-led chronic disease management. The purpose of this study is evaluating the effects of the project through the DID (difference in difference) model. The project's database and the National Health Insurance claims database were both used to compare the project and control groups (n = 6092 vs 24 368). Results of the analysis show that medication adherence was increased more in the project group compared with the control group. Hospitalization days, outpatient days, and number of primary medical clinic visits increased more in the participant group than the control group. As the project showed an improvement in treatment persistence, it will be necessary to monitor for a longer period of time.

Spinopelvic Alignment by Different Surgical Methods in the Treatment of Degenerative Sagittal Imbalance of the Lumbar Spine.

STUDY DESIGN: A retrospective comparative study. OBJECTIVE: To compare pedicle subtraction osteotomy (PSO) and iliac fixation (ILF) without osteotomy as methods of correcting lumbar spine deformities due to degenerative sagittal imbalance (DSI) through the evaluation of the changes in spinopelvic alignment. SUMMARY OF BACKGROUND DATA: Many papers have reported the surgical results after PSO and ILF for patients with fixed adult deformities. However, little is known about the difference between PSO and ILF corrections of spinopelvic alignment in adults with DSI. METHODS: DSI patients who had undergone PSO or ILF with a minimum of 2-year follow-up (FU) were retrospectively studied in PSO (n=30) or ILF (n=25) groups. Lumbar lordosis (LL), thoracic kyphosis (TK), and sagittal vertical axis (SVA) were measured as spinal parameters and pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) were used as measurements of pelvic parameters. Clinical outcomes were evaluated using a visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores. RESULTS: There were no statistically significant differences between the PSO and ILF groups with regard to age and fused segments, but there were significant differences in operative time and estimated blood loss. Concerning spinal parameters, there were significant increases of LL and TK in PSO group immediate postoperatively (LL: P=0.014, TK: P=0.017) and at the 2-year FU (LL: P=0.021, TK: P=0.022), but no significant difference in SVA was evident between the 2 groups. Within the pelvic parameters, there was a significant increase of SS and decrease of PT in the ILF group immediate postoperatively (SS: P=0.013, PT: P=0.009) and at the 2-year FU (SS: P=0.024, PT: P=0.027), but the PI in both groups was not changed after surgery and there was no significant difference between 2 groups. VAS and ODI were significantly improved after surgery in both groups. CONCLUSIONS: The PSO group was better than the ILF group in the correction of the LL and TK, but not with regard to the pelvic parameters. The ILF group was superior in the correction of the pelvic orientation as compared with the PSO group when the PI was constant after surgery. Ultimately, ILF effectively achieves better correction of the pelvic parameters (SS and PT).

Burden of Disease Attributable to Secondhand Smoking in Korea.

This study aims to estimate the burden of disease (BOD) due to secondhand smoking (SHS) in Korea. SHS-related diseases were selected via systematic review. Population attributable fraction (PAF) was calculated by using standard formula. Disability adjusted life years (DALYs) were estimated using Statistical Office and Health Insurance data. SHS burden was calculated by multiplying nonsmoker's BOD with the PAF of SHS. Total BOD due to SHS was 44 143 DALYs with 57% from males and 43% from females. The highest percentage of SHS burden was due to stroke. BOD was highest in the 50s age group in both genders. Years of life lost contributed major part of BOD due to all diseases. SHS burden in Korea in 2013 was the highest among the high-income Asia Pacific group countries. Effective intervention policies with more focus on vulnerable groups like adults in their 50s should be implemented to control SHS-related burden.

Perception of Lay People Regarding Determinants of Health and Factors Affecting It: An Aggregated Analysis from 29 Countries.

BACKGROUND: This study aimed to evaluate the perception of lay people regarding determinants of health at global level and factors affecting it. METHODS: Data was collected from International Social Survey Program (ISSP) and World Bank website. Multilevel regression analysis was done and lay people's perception regarding health behavior, environment, poverty and genes as health determinants was assessed. Various socio demographic factors were used as independent variables. RESULTS: The highest percentage of people agreed environment as determinant of health. An inverse relationship was observed between GNI quartiles and an individual's agreement with poverty, health behavior, and environment as health determinant. There was a significant negative association of females with health damaging behavior (P<0.05) and positive association with environment and genes (P<0.05) as health determinants. Elderly people agreed with poverty as determinant of health (P<0.05). GNI was negatively related to environment (P<0.05) and poverty (P<0.05) as health determinant. CONCLUSION: The common public is now becoming aware of a broadened concept of health and people belonging to different backgrounds have different perceptions regarding determinants of health. Our results show that highest percentage of people agreed with environment as determinant of health, which is consistent with scientific view of increased burden of disease, caused by environmental factors. Thus, tailored health programs and policies that address an individual's specific problems are likely to induce a change in behavior and attitude, hence decreasing the disease burden.

Risk Factors of Cardiovascular Disease and Their Related Socio-Economical, Environmental and Health Behavioral Factors: Focused on Low-Middle Income Countries- A Narrative Review Article.

BACKGROUND: In order to decrease the burden of cardiovascular disease (CVD), social determinants for CVD risk factors have been extensively studied in developed countries. However, few studies about them have been performed in low-middle-income countries. This study describes factors related to CVD risk factors in low-middle-income countries at a national level. METHODS: Data were assembled from international databases for 47 low-middle-income countries and were collected from various sources including WHO, World Bank, and previous studies. Coefficient estimates between male and female CVD risk factor prevalence and each independent variable were calculated via linear regression. RESULTS: Statistically significant inverse associations were observed between adult literacy rate and systolic blood pressure, blood glucose. Pump price for gasoline was negatively associated with blood glucose also. Associations for female unemployment, adult literacy rate, paved roads and urban population, alcohol and western diet were positively associated with CVD risk factors. Unemployment, urban population and alcohol were positively associated with CVD risk factors in males. CONCLUSION: The effectiveness of intervention program for the prevention of cardiovascular disease in populations in developing countries should be explored, and more attention should be given to women.

Data mining application in customer relationship management for hospital inpatients.

OBJECTIVES: This study aims to discover patients loyal to a hospital and model their medical service usage patterns. Consequently, this study proposes a data mining application in customer relationship management (CRM) for hospital inpatients. METHODS: A recency, frequency, monetary (RFM) model has been applied toward 14,072 patients discharged from a university hospital. Cluster analysis was conducted to segment customers, and it modeled the patterns of the loyal customers' medical services usage via a decision tree. RESULTS: Patients were divided into two groups according to the variables of the RFM model and the group which had significantly high frequency of medical use and expenses was defined as loyal customers, a target market. As a result of the decision tree, the predictable factors of the loyal clients were; length of stay, certainty of selectable treatment, surgery, number of accompanying treatments, kind of patient room, and department from which they were discharged. Particularly, this research showed that when a patient within the internal medicine department who did not have surgery stayed for more than 13.5 days, their probability of being a classified as a loyal customer was 70.0%. CONCLUSIONS: To discover a hospital's loyal patients and model their medical usage patterns, the application of data-mining has been suggested. This paper suggests practical use of combining segmentation, targeting, positioning (STP) strategy and the RFM model with data-mining in CRM.

Selecting the best prediction model for readmission.

OBJECTIVES: This study aims to determine the risk factors predicting rehospitalization by comparing three models and selecting the most successful model. METHODS: In order to predict the risk of rehospitalization within 28 days after discharge, 11 951 inpatients were recruited into this study between January and December 2009. Predictive models were constructed with three methods, logistic regression analysis, a decision tree, and a neural network, and the models were compared and evaluated in light of their misclassification rate, root asymptotic standard error, lift chart, and receiver operating characteristic curve. RESULTS: The decision tree was selected as the final model. The risk of rehospitalization was higher when the length of stay (LOS) was less than 2 days, route of admission was through the out-patient department (OPD), medical department was in internal medicine, 10th revision of the International Classification of Diseases code was neoplasm, LOS was relatively shorter, and the frequency of OPD visit was greater. CONCLUSIONS: When a patient is to be discharged within 2 days, the appropriateness of discharge should be considered, with special concern of undiscovered complications and co-morbidities. In particular, if the patient is admitted through the OPD, any suspected disease should be appropriately examined and prompt outcomes of tests should be secured. Moreover, for patients of internal medicine practitioners, co-morbidity and complications caused by chronic illness should be given greater attention.