Disparities in prostate cancer diagnosis, treatment, and survival among men with disabilities: Retrospective cohort study in South Korea.

BACKGROUND: Disparities in cancer care have not been well documented for individuals with disability. OBJECTIVE: To investigate potential disparities in the diagnosis, treatment, and survival of prostate cancer (PC) patients according to disability status. METHODS: A retrospective cohort study using disability registration data linked to Korean National Health Insurance and national cancer registry data. Totals of 7924 prostate cancer cases among patients with disabilities (diagnosed between 2005 and 2013) and 34,188 PC patients without disability were included. RESULTS: While overall PC stage distribution at diagnosis was similar, unknown stage was more common in patients with severe disabilities compared to those without disabilities (18.1% vs. 16.2%, respectively). People with disabilities were less likely to undergo surgery (33.1% vs. 38.6%, respectively; adjusted odds ratio [aOR] 0.79, 95% confidence interval [CI] 0.74-0.84), and more likely to receive androgen deprivation therapy (ADT) (57.9% vs. 55%, respectively; aOR 1.10, 95% CI 1.04-1.16) compared to those without disabilities. This was more evident for people with severe brain/mental impairment (aORs 0.29 for surgery; 1.52 for ADT). Patients with disabilities had higher overall mortality (adjusted hazard ratio [aHR] 1.20; 95% CI, 1.15-1.25), but only slightly higher PC-specific mortality after adjustment for patient factors and treatment (aHR 1.11, 95% CI 1.04-1.18) than people without disability. CONCLUSIONS: PC patients with disabilities underwent less staging work-up and were more likely to receive ADT than surgical treatment. Overall mortality of PC patients with disabilities was greater than those of PC patients without disability, but PC-specific mortality was only slightly worse.

Healthy but unhappy? Cross-national comparative analysis of depressive symptoms in Japanese vs. Korean elders.

BACKGROUND: Japan and South Korea, two neighbouring countries in East Asia, enjoy the highest life expectancies in the world, yet suffer paradoxically from high suicide rates. AIM: We sought to conduct a cross-national comparative analysis of depressive symptoms among older adults in Japan vs. Korea, focusing particularly on poverty and physical health status. METHODS: We used nationally representative samples aged 65 and over from the Comprehensive Survey of Living Conditions in Japan and the Korean Community Health Survey in South Korea. Multivariate logistic regression models were conducted to examine if equivalized household income, poor self-rated health, disability and comorbidity (number of diseases) were associated with depressive symptoms, adjusting for age, education, marital status, alcohol use, smoking and living alone. RESULTS: Older Japanese adults with poor self-rated health and disability were more likely to report depressive symptoms, but income level was not significantly associated with mental distress. By contrast, among older Korean people, depressive symptoms were strongly patterned by household income level, as well as poor self-rated health, disability, and comorbidity. CONCLUSION: Poor physical health status was correlated with depressive symptoms among both Japanese and Korean seniors. However, income level was associated with depressive symptoms among only Korean elders, but not Japanese. Thus, the current generation of older Japanese adults appears to enjoy (relative) financial security, longevity, and mental wellbeing. By contrast, older Koreans experience high levels of mental distress, especially if they are financially insecure.

Age and gender patterns in associations between lifestyle factors and physical performance in older Korean adults.

PURPOSE: To investigate age and gender patterns in associations between lifestyle factors and physical performance in community-dwelling older Korean adults. DESIGN AND METHODS: A cross-sectional study was conducted in a population-based sample of an urban area. Randomly sampled older Korean adults (n=664; mean age, 74.6 years) participated. Data on current physical activity level and doing exercise, social participation and hobbies, smoking status, drinking status, sleep quality, and physical performance were obtained. Binary logistic regression analyses were used to identify the age and gender patterns in associations between various lifestyle factors and physical performance. RESULTS: In younger (age <85 years) men, significant predictors of poor physical performance by logistic regression analysis after adjusting for covariates were current physical activity time, doing exercise, and engagement in social activities. In younger women, current physical activity time and sleep quality were related to poor physical performance. In older (age ≥ 85 years) men, family gatherings were a significant factor. In older women, no lifestyle factor assessed showed a significant relationship with poor physical performance. CONCLUSION: Interventions implemented to modify lifestyle factors need to focus on age and gender subgroups in the elderly population. Lifestyle modification should be emphasised as a targeted treatment program for Korean adults aged <85 years.

Cross-national gender differences in the socioeconomic factors associated with smoking in Australia, the United States of America and South Korea.

OBJECTIVES: We compared rates of smoking among those aged 45 years and older in Australia, the United States of America and South Korea, and examined cross-national gender differences in key socioeconomic differentials in smoking. METHODS: We conducted weighted analyses on cross-sectional data from nationally representative surveys conducted in 2006. RESULTS: Current smoking was more prevalent for males than females in all countries; the gender difference was largest in Korea. Being unpartnered increased the likelihood of smoking in all countries, while greater wealth reduced it. In Korea, these effects interacted with gender; both indicators showed larger differentials among women than men. Lower educational attainment increased the likelihood of smoking for all groups except Korean women, among whom high school educated women were less likely to smoke than the tertiary educated. CONCLUSIONS: Our findings support a cultural interpretation of gender differences in smoking: in countries with low gender empowerment, gender differences in smoking are greater. With increasing divorce and female tertiary education rates in nations like Korea, we highlight the need for health promotion messages targeted towards older and more educated women.

Effectiveness of aquatic exercise for obese patients with knee osteoarthritis: a randomized controlled trial.

OBJECTIVE: To design an aquatic exercise (AQE) and land-based exercise (LBE) program to enhance knee function and reduce body fat in patients with obesity and knee osteoarthritis and to investigate the effectiveness of AQE and LBE on body fat, functional fitness, and functional status. SETTING: Outpatient clinic at a Seoul National University Bundang Hospital. PARTICIPANTS: Obese patients with knee osteoarthritis were recruited from patients who visited the rehabilitation, orthopedic surgery, and geriatric outpatient clinics at the hospital. Study participants were limited to those who met the following criteria: body mass index more than 25 kg/m(2), abdominal circumference more than 90 cm (men) or 85 cm (women), clinically diagnosed osteoarthritis with Kellgren-Lawrence scale 2 or higher on radiographic studies, and independent ambulation state. METHODS: Participants were randomly allocated into 3 groups: AQE (n = 26), LBE (n = 25), and the control group (n = 24). Exercise interventions were conducted 3 times a week for 8 weeks. OUTCOME MEASURES: Body fat analysis, brief pain inventory, Western Ontario and McMaster Universities' osteoarthritis index, Short Form-36 questionnaire, and knee isokinetic tests were evaluated to assess changes in body fat composition, pain, physical function, and quality of life before and after the exercise program. RESULTS: Although no significant difference was found in general characteristics among the 3 groups before exercise, body fat proportion in the AQE group decreased significantly (mean +/- SD, from 34.4 +/- 4.7 to 33.3 +/- 4.7; P = .031) after intervention. The body mass index was slightly reduced after intervention, but it was not statistically significant. The AQE group showed significant improvements in pain, disability, and quality of life. Notably, the change in pain interference in the AQE group (mean +/- SD, from 25.8 +/- 15.1 to 18.8 +/- 13.1; P = .009) was greater than that of the LBE group. Both exercise groups showed significant improvements in Western Ontario and McMaster Universities' osteoarthritis index disability compared with the control group. CONCLUSIONS: AQE had an advantage in controlling the interference with activity because of pain. AQE may be an effective tool for patients with obesity who have difficulties with active exercise due to knee osteoarthritis.

Trends in the health status of older Koreans.

Several recent studies have suggested that mortality, disability, and self-rated health in older Americans have improved in last decade, but data from rapidly aging Asians remain sparse, and it is unclear that improvement extends to various health outcomes among older Korean populations. Trends in mortality, morbidity, disability, health behavior, and self-rated health in older Koreans were assessed. Data were obtained from the National Death Statistics (1983-2006) and three representative and repeated cross-sectional nationwide surveys: the National Elderly Activity Status and Welfare Needs Survey, the National Long-term Care Needs Survey, and the Korean National Health and Nutrition Examination Survey. All-cause mortality and disability decreased rapidly among older Koreans over the survey years, although some dimensions of health, including mortality from cancer, ischemic heart disease, and diabetes mellitus, have continued to deteriorate during this same period. Data on self-rated health have also confirmed this trend toward diminished health status. These results are not consistent with the theory of compression of morbidity. Given the complexity and controversies characterizing health changes in the older population, continuing examination of the latest information about various aspects of mortality, disability, morbidity, and health behavior is necessary for the development of future improvements in healthy life expectancies in older Koreans.

Functional status and calcaneal quantitative ultrasound measurements among the oldest old people living in rural areas of Korea.

The number of very elderly people is increasing worldwide, so that the prevention of fractures and disability in this frail population has become a growing concern. This study evaluated the association between functional status and bone health in the oldest old. The study participants were of a very elderly population comprising 170 rural community dwellers, aged 80-107 years. Quantitative ultrasound (QUS) measurements were performed on both heels. Functional status was assessed by evaluating activities of daily living (ADL) and instrumental activities of daily living (IADL). Data on sociodemographic characteristics and potential risk factors, including medical history, smoking, alcohol intake, exercise, and physical activities were collected by trained interviewers. Generalized multiple linear regression suggested that disability was significantly associated with calcaneal QUS in the oldest old. After adjusting for the effect of potential covariates, such as age, gender, education level, weight, smoking, and physical activity level, the lowest tertile score groups of ADL and IADL were associated with a decrease in stiffness index (SI) T-score of calcaneal QUS. A complete ADL deficit was associated with a low QUS (adjusted beta vs. independent group=-1.17, 95% confidence interval=-2.01 to -0.33). Evidence of disability as an associated factor on bone health provides important insight to devise strategies for preventing or delaying further disablement among the elderly.

Socioeconomic disparities in breast cancer screening among US women: trends from 2000 to 2005.

OBJECTIVES: This study describes trends in the socioeconomic disparities in breast cancer screening among US women aged 40 or over, from 2000 to 2005. We assessed 1) the disparities in each socioeconomic dimension; 2) the changes in screening mammography rates over time according to income, education, and race; and 3) the sizes and trends of the disparities over time. METHODS: Using data from the Behavioral Risk Factor Surveillance System (BRFSS) from 2000 to 2005, we calculated the age-adjusted screening rate according to relative household income, education level, health insurance, and race. Odds ratios and the relative inequality index (RII) were also calculated, controlling for age. RESULTS: Women in their 40s and those with lower relative incomes were less likely to undergo screening mammography. The disparity based on relative income was greater than that based on education or race (the RII among low-income women across the survey years was 3.00 to 3.48). The overall participation rate and absolute differences among socioeconomic groups changed little or decreased slightly across the survey years. However, the degree of each socioeconomic disparity and the relative inequality among socioeconomic positions remained quite consistent. CONCLUSIONS: These findings suggest that the trend of the disparity in breast cancer screening varied by socioeconomic dimension. Continued differences in breast cancer screening rates related to income level should be considered in future efforts to decrease the disparities in breast cancer among socioeconomic groups. More focused interventions, as well as the monitoring of trends in cancer screening participation by income and education, are needed in different social settings.

The relationship between social participation and self-rated health by sex and age: a cross-sectional survey.

BACKGROUND: Social participation contributes to better health and has been regarded as an important component of quality of life. Despite its importance, social participation significantly decreases as age advances. Social participation may vary by sex and age and, consequently, may have different influences on health by age and sex. Few studies have examined how sex and age affect individual health status in this regard. OBJECTIVES: This paper focuses on whether the association between self-rated health and social participation differs between men and women, and among age groups. DESIGN: The study was based on cross-sectional analysis of data from the 2003 Social Statistics Survey. SETTINGS: This survey was conducted in South Korea. PARTICIPANTS: The survey respondents were 59,202 Koreans aged 25 and over. The sample population comprised each household member of 33,000 sample households who were selected by multistage probability sampling of household registries based on geographic area, sex and age group. METHODS: Face-to-face interviews were nationally conducted. Multiple logistic regression analysis was performed to examine factors that associated social participation with self-rated health, and the adjusted odds ratios (ORs) were presented, together with their 95% confidence intervals (CIs). The model included various individual socioeconomic characteristics, health behaviors, and morbidity variables, such as marital status, education level, housing tenure, employment status, smoking status, alcohol intake, number of restricted activity days, and bed days. RESULTS: For both sexes, self-rated good health was strongly associated with social participation levels in all age groups. The influence of social participation increased as age advanced. Particularly among elderly women, those who had participated in more than two activities had more than twice the odds of self-rated good health of those who did not participate in any activities. CONCLUSIONS: Social participation significantly decreases as people age, however, the influence of social participation on health status increases with age. This study has shown that social participation, which is an individual psychological resource, is important for health in all age groups, notwithstanding that the effect of social participation differs by age and sex. Social participation should be a basic consideration in the field of community nursing intervention, especially for the elderly and women's health promotion. Promoting social participation by individuals may lead to better health, and may therefore be an effective strategy for enhancing health.

[Trend of socioeconomic inequality in participation in cervical cancer screening among Korean women].

OBJECTIVES: While cervical cancer is one of the leading cancers among women worldwide, there are a number of effective early detection tests available. However, the participation rates in cervical cancer screening among Korean women remain low. After the nationwide efforts in 1988 and thereafter to encourage participation in cervical cancer screening, few studies have investigated the effects of socioeconomic inequality on participation in cervical cancer screening. The purpose of this study was to investigate 1) the level of socioeconomic disparities in receiving cervical cancer screening by age group and 2) if there was an improvement in reducing these disparities between 1995 and 2001. METHODS: Using data from the Korean National Health Status, Health Behavior and Belief Survey in 1995, and the Korean National Health and Nutrition Examination Surveys from 1998 and 2001 (sample sizes of 2,297, 3,738, and 3,283), age-standardized participation rates were calculated according to education level, equivalized household income, and job status. Odds ratios and the relative inequality index (RII) were also calculated after controlling for age. RESULTS: Women with lower education levels were less likely to attend the screening test, and the disparities by education level were most pronounced among women aged 60 years and older. The RIIs among women 60 years and older were 3.64, 4.46, and 8.64 in 1995, 1998, and 2001, respectively. Higher rates of participation were reported among those in the highest income category, which was more notable among the middle aged women (40s and 50s). An inconsistent trend in the rate of participation in cervical cancer screening by occupational level was found. CONCLUSIONS: Indicators of socioeconomic position seem to have varying impacts on the inequalities in the rates of participation in cervical cancer screening according to age group. These results demonstrate the need for more aggressive and age-based interventions and policy programs to eliminate the remaining inequalities.

[Awareness, treatment, and control rates of hypertension and related factors of awareness among middle aged adult and elderly in Chuncheon: Hallym Aging Study(HAS)].

OBJECTIVES: To estimate the awareness, treatment and control rate, as well as to identify the awareness-related factors for hypertension. METHODS: The study participants were 482 adults (men 206, women 276), aged 45 or over, diagnosed with hypertension and living in Chuncheon. The awareness rate was defined as the proportion of persons among those with hypertension who had previously been diagnosed by a physician. The treatment rate was defined as the proportion of persons who had used anti-hypertensive medication, among those who were aware of their hypertension. The control rate was defined as the proportion of persons who kept blood pressure normal, among those who had been treated for their hypertension. Multivariable logistic regression analysis was carried out for the awareness related factors using SAS VER 8.1. RESULTS: The awareness, treatment, and control rate were 55.8% (53.4% for men; 57.6% for women), 89.6% (87.2% for men; 91.2% for women), and 34.4% (28.1% for men; 38.6% for women), respectively. The awareness related factors included a family history of hypertension (odds ratio[OR], 5.63; 95% confidence interval[95% CI]=1.53-20.72), smoking([Ex; OR 0.38, 95% CI= 0.15- 0.96)], [Current; OR 0.28, 95% CI=0.10-0.80]), and alcohol intake ([Ex; OR 3.22, 95% CI 1.03-10.09],[Current; OR 3.36, 95% CI=1.30-8.71]) for men, and education(OR 2.23, 95% CI=1.10-4.53), body mass index(OR 2.72, 95% CI=1.13-6.53), and self-rated health(OR 2.38, 95% CI=1.07-5.30) for women. CONCLUSIONS: The awareness rate of hypertension among the middle aged and elderly in Chuncheon was 55.8%. The related factors of awareness were gender specific. Further studies are needed to elucidate the putative reasons for these gender differences.

[Prevalence and associated factors of osteoporosis among postmenopausal women in Chuncheon: Hallym Aging Study (HAS)].

OBJECTIVES: A community-based, cross-sectional survey was conducted to determine theprevalence of osteoporosis and to evaluate the effects of body composition, health behaviors and reproductive history on bone density in postmenopausal women. METHODS: The study subjects were 362 postmenopausal women, aged 45 years old or over, who were invited to the hospital. Information on their socio-demographic characteristics and the potential risk factors such as their past medical history, smoking, alcohol intake, exercise, diet and menstrual/reproductive histories were collected by trained interviewers. Weight, height, the body mass index (kg/m2), and body composition variables were measured. Bone mineral density of the lumbar spine was measured by dual energy X-ray absorptiometry (DXA). RESULTS: The prevalence of osteoporosis was 30.6% in the 45-64 years old women, 52.5% in the elderly women aged 65-74, and 68.7% in the women aged 75 years or over. After adjustment for the effect of potential covariates, those women in the highest 25% (4th quartile) of the lean body mass are less likely to have osteoporosis (aOR=0.31, 95% CI=0.12-0.76), compared with the lowest quartile group. More parity also had significantly detrimental effects on osteoporosis. CONCLUSIONS: These findings suggest that the prevalence of osteoporosis in postmenopausal women increased with age from 46.3% of those aged 45-64 to 68.7% for those aged 75 and over. Lean body mass and parity appeared significant contributor to bone mineral density in postmenopausal women in this population.