Satisfaction with local healthcare services and medical need among hypertensive patients: a nationwide study.

BACKGROUND: Investigating the factors associated with unmet medical needs is important since it can reflect access to healthcare. This study examined the relationship between the unmet medical needs of patients with hypertension and their satisfaction with the healthcare services available in their neighborhoods. METHODS: Data were from the 2021 Korean Community Health Survey. The sample included individuals aged 19 years who were diagnosed with hypertension. The main outcome measure was unmet medical need. The relationship between the outcome measure and independent variables were analyzed using multivariate logistic regressions, along with a subgroup analysis based on whether patients were currently receiving treatment for hypertension. RESULTS: Unmet medical needs were found in 4.3% of the study participants. A higher likelihood of unmet medical needs was found in individuals not satisfied with the healthcare services at proximity (adjusted OR = 1.69, 95% CI: 1.49-1.92) compared to those satisfied with services nearby. Similar tendencies were found regardless of whether individuals were currently receiving treatment for hypertension, although larger differences were found between groups in participants who were currently not receiving treatment. CONCLUSIONS: The findings infer the need to consider patient satisfaction with nearby healthcare services in implementing public health policies that address unmet medical need in patients with hypertension.

A comprehensive study of deaths due to exposure to humidifier disinfectant in Korea: focusing on medical records, assessment of exposure to humidifier disinfectants, and causes of death.

OBJECTIVES: We aimed to determine the characteristics of the deceased victims of deaths caused by exposure to humidifier disinfectants, and present the distribution of the victims' data submitted for damage application, demographic characteristics, imaging findings, characteristics of humidifier disinfectant exposure, and distribution of the causes of death. METHODS: An integrated database of victims was established using the medical records data of 1,413 victims submitted during the application for death damage caused by exposure to humidifier disinfectants, and the demographic characteristics, medical records, imaging findings, exposure characteristics, and cause of death were examined. RESULTS: The average numbers of data submissions of each applicant for death damage were 3.0 medical use records. A total of 608 (43.0%) victims had more than one finding of acute, subacute, or chronic interstitial lung diseases. The average daily and cumulative use times of the victims were 14.40 and 24,645.81 hours, respectively, indicating greater exposure in this group than in the survivors. The humidifier disinfectants' components comprised polyhexamethylene guanidine (72.8%), chloromethylisothiazolinone/methylisothiazolinone (10.5%), other components (15.0%), and oligo-[2-(2-ethoxy)-ethoxyethyl] guanidine chloride (1.5%). The components' distribution was 67.8% for single-component use, which was higher than that in the survivors (59.8%). The distribution of the causes of death were: respiratory diseases (54.4%), neoplasms (16.8%), and circulatory diseases (6.3%). Other interstitial lung diseases (65.5%) were the most common cause of death among those who died due to respiratory diseases. CONCLUSIONS: Careful discussions of appropriate remedies should be conducted based on a comprehensive understanding of the characteristics of the deceased victims, considering their specificities and limitations.

Evaluation of the South Korean national long-term care insurance-funded cognitive function training programme for older people with mild dementia.

OBJECTIVES: despite the extensive literature on the effectiveness of cognitive training, its effectiveness has not been demonstrated within a population-based long-term care system. To provide cognitive training services to older people with mild dementia, Korea introduced a special dementia rating, as a long-term care grades, in the national long-term care insurance in July 2014. These services are only offered to those with the special dementia rating. This study evaluated the national long-term care insurance-funded cognitive function training programme for older people with mild dementia. METHODS: data were derived from the Korean National Health Insurance Elderly Cohort database between 2008 and 2015. We compared changes in function between the intervention (n = 352) and control (n = 1952) groups before (2014) and after (2015) introduction of the cognitive function training programme. Difference-in-differences analysis was performed, to compare changes in each score between the intervention and control groups before and after introduction of the cognitive function training programme. RESULTS: introduction of the cognitive function training programme was associated with significantly less cognitive function decline in the intervention group than in the control groups (ß = -3.39; standard errors [SE] = 1.14; P = 0.003). A subgroup analysis revealed that this effect increased in subjects in the youngest group, low income bracket, who had a primary caregiver, who were supported in multiple activities of daily living by the primary caregiver, or who were not living alone. CONCLUSIONS: introduction of the cognitive function training programme was associated with positive effects on cognitive function.

Employment status and unmet dental care needs in South Korea: a population-based panel study.

OBJECTIVES: This study was designed to evaluate whether employment status is associated with the experience of unmet dental care needs. METHODS: A total of 4620 workers were retrieved from Korea Health Panel data (2010-2013), and potential relationships were explored among their income levels, changes in employment and unmet dental care needs. RESULTS: Among the 4620 workers, 17.3% said they had failed at least once to get dental treatment or check-up, despite their needs. Precarious workers and those not in employment were more likely to experience unmet dental care needs due to economic burden compared with permanent workers (OR 1.36, 1.40, respectively). In addition, people in low-income group were 4.46 times more likely to experience unmet dental care needs caused by economic burden, compared with those with the highest income. CONCLUSION: This disparity means that precarious workers and those not in employment are more likely to face barriers in obtaining needed health services. Given the insecure employment status of low income people, meeting their healthcare needs is an important consideration.

Association between eating behaviour and diet quality: eating alone vs. eating with others.

BACKGROUND: To discover the association between eating alone and diet quality among Korean adults who eat alone measured by the mean adequacy ratio (MAR), METHODS: The cross-sectional study in diet quality which was measured by nutrient intakes, indicated as MAR and nutrient adequacy ratio (NAR) with the Korean National Health and Nutrition Examination Survey (KNHANES) VI 2013-2015 data. Study population was 8523 Korean adults. Multiple linear regression was performed to identify the association between eating behaviour and MAR and further study analysed how socioeconomic factors influence the diet quality of those who eat alone. RESULTS: We found that the diet quality of people who eat alone was lower than that of people who eat together in both male (ß: - 0.110, p = 0.002) and female participants (ß: - 0.069, p = 0.005). Among who eats alone, the socioeconomic factors that negatively influenced MAR with the living arrangement, education level, income levels, and various occupation classifications. CONCLUSIONS: People who eat alone have nutrition intake below the recommended amount. This could lead to serious health problems not only to those who are socially disadvantaged but also those who are in a higher social stratum. Policy-makers should develop strategies to enhance diet quality to prevent potential risk factors.

The relationship between catastrophic health expenditure and health-related quality of life.

OBJECTIVES: The objective of our study was to investigate the relationship between catastrophic health expenditure (CHE) and health-related quality of life (HRQoL) in general population. METHODS: We used Korean Health Panel Survey data from 2011 to 2013, which included data from 8850 baseline participants of 19 years of age or older. We defined CHE as total annual out-of-pocket health payment that was 40% greater than the household's capacity to pay. HRQoL was measured using the EuroQol-visual analogue scale (EQ-VAS). We used generalized estimating equations to perform a longitudinal regression analysis. RESULTS: A total of 4.5% of the participants (n = 398) experienced CHE. Those with CHE tended to have a lower EQ-VAS index score compared with those without CHE (ß: - 1.34, p = 0.013). A subgroup analysis revealed that individuals experiencing CHE had significant decreases as the number of chronic diseases increased (three or more, ß: - 1.85, p = 0.014). CONCLUSIONS: Catastrophic health expenditure influences HRQoL, which was more pronounced in patient with chronic disease. The efforts should focus on people who suffer from excessive health expenditures and chronic diseases.

Projection of Breast Cancer Burden due to Reproductive/Lifestyle Changes in Korean Women (2013-2030) Using an Age-Period-Cohort Model.

PURPOSE: The aim of this study was to estimate the burden of breast cancer that can be attributed to rapid lifestyle changes in South Korea in 2013-2030. MATERIALS AND METHODS: An age-period-cohort model was used to estimate the incidence and mortality. The Global Burden of Disease Study Group methodwas used to calculate the years of life lost and years lived with disability in breast cancer patients using a nationwide cancer registry. The population attributable riskswere calculated using meta-analyzed relative risk ratios and by assessing the prevalence of risk factors. RESULTS: Women's reproductive/lifestyle changes, including advanced maternal age at first childbirth (from 37 to 85 disability-adjusted life years [DALYs] per 100,000 person-years), total period of breastfeeding (from 22 to 46 DALYs per 100,000 person-years), obesity (from 37 to 61 DALYs per 100,000 person-years), alcohol consumption (from 19 to 39 DALYs per 100,000 person-years), oral contraceptive use (from 18 to 27 DALYs per 100,000 person-years), and hormone replacement therapy use (from 2 to 3 DALYs per 100,000 person-years) were identified as factors likely to increase the burden of breast cancer from 2013 to 2030. Approximately, 34.2% to 44.3% of the burden of breast cancer could be avoidable in 2030 with reduction in reproductive/lifestyle risk factors. CONCLUSION: The rapid changes of age structure and lifestyle in South Korea during the last decade are expected to strongly increase the breast cancer burden over time unless the risk factors can be effectively modified.

Association between re-admission rate and hospital characteristics for ischemic heart disease.

OBJECTIVE: Hospital re-admission is considered an important marker of patient health outcomes and healthcare system performance. Korea introduced the Korean Diagnosis Procedure Combination (KDPC) for all regional public hospitals in July 2012. This study examined re-admission rates within 30 days to assess whether the hospital payment system is associated with the re-admission rate, focusing on ischemic heart disease. METHODS: A cross-sectional study was conducted using national claims data for 2013. We analyzed data of patients with a major diagnosis of ischemic heart disease who were admitted to general hospitals with more than 500 beds in Korea. Of the eight general hospitals, two that have been operating under the new Korean payment system were public hospitals using the KDPC, and the remaining six were private general hospitals with fee for service (FFS) systems. Multiple logistic regression analysis was used to identify associations between re-admission rate and hospital characteristics. RESULTS: The study analyzed 4,290 cases (889 cases in KDPC and 3,401 cases in FFS). The 30-day unplanned re-admission rate was higher in KDPC than in FFS (7.9% vs 5.6%, respectively). The unplanned re-admission odds ratios of KDPC was 1.74. CONCLUSIONS: KDPC had higher 30-day unplanned re-admissions rates than did FFS.

Association between home-visit nursing utilization and all-cause hospitalization among long-term care insurance beneficiaries: A retrospective cohort study.

BACKGROUND: Ensuring and improving long-term care services that use limited healthcare resources more efficiently is a major concern for many aging societies. OBJECTIVES: The aim of this study was to investigate the relationship between use of home-visit nursing services and all-cause hospitalization in a home-visit nursing-recommended group. DESIGN: A retrospective cohort study. SETTING: Population-based sample of long-term care insurance beneficiaries from the long-term care insurance 2002-2013 claims database in South Korea. PARTICIPANTS: Long-term care insurance beneficiaries who need one or more types of nursing care were defined as the home-visit nursing -recommended group (n=4173). MEASUREMENTS: The dependent variable in this study was all-cause hospitalization in the home-visit nursing-recommended population. Multivariate Cox proportional hazards regression analysis was used to identify the association between home-visit nursing service use and all-cause hospitalization. RESULTS: A total of 3.8% of the subjects used home-visit nursing services. When participants who used home-visit nursing services were set as the reference group, participants who did not use home-visit nursing services had a higher risk of hospitalization (hazard ratio [HR]=1.25, 95% confidence interval [CI]=1.07-1.47). Additionally, participants who did not use home-visit nursing services and who did not have a caregiver showed a marked increase in the risk of hospitalization (HR=6.81, 95% CI=1.17-39.66). Participants who did not use home-visit nursing services with greater comorbidity showed a considerable increase in risk of hospitalization (HR=1.36, 95% CI=1.09-1.70). CONCLUSIONS: Non-use of home-visit nursing services was associated with an increased risk of all-cause hospitalization in the home-visit nursing-recommended population. The present results suggest that the use of home-visit nursing services reduced the risk of hospitalization. Moreover, home-visit nursing may play an essential role in reducing hospitalization risk in the absence of caregiver support.

Breakfast consumption and depressive mood: A focus on socioeconomic status.

Skipping breakfast can be potentially harmful because breakfast consumption is considered one of the important health-related behaviors that benefit physical and mental health. As the rate of depression has increased recently, we investigated the association between the frequency of eating breakfast and depression in adults. We obtained the data from the 2013 Korean Community Health Survey; a total of 207,710 survey participants aged 20 years or over were studied. Participants were categorized into three groups by the frequency of breakfast consumption as follows: "seldom," "sometimes," and "always." We performed a multiple logistic regression to investigate the association between breakfast consumption and depressive mood. Subgroup analyses were conducted by stratifying socioeconomic variables controlling for variables known to be associated with depressive symptoms. Participants who had breakfast seldom or sometimes had higher depressive symptoms than those who always ate breakfast ("seldom": OR = 1.43, 95% CI 1.36-1.52; "sometimes": OR = 1.32, 95% CI 1.23-1.40). Subgroup analyses showed that this association was more marked in those who were 80 years or older, those who had low household income, or those with elementary school education level or less. The result of this study suggests that lack of breakfast consumption is associated with depression among adults with different socioeconomic factors.

The association between objective income and subjective financial need and depressive symptoms in South Koreans aged 60 and older.

AIM: This study aimed to investigate the effect of the gap between objective income and subjective financial need on depressive symptoms in individuals aged 60 and older. METHODS: Data from the 2011 and 2013 Korean Retirement and Income Study were used. A total of 4891 individuals aged 60 and older were included at baseline. The Generalized Estimating Equation model was used to examine the association between the gap in objective income and subjective financial need and the presence of depressive symptoms, which were measured using the Center for Epidemiological Studies Depression Scale. RESULTS: Compared to individuals in the middle objective income-middle subjective financial need group, individuals in the low-low category (odds ratio (OR): 1.30, 95% confidence interval (CI): 1.04-1.61) and the low-middle category (OR: 1.26, 95%CI: 1.09-1.45) showed a statistically significant higher likelihood of having depressive symptoms. In contrast, participants in the middle-low (OR: 0.74, 95%CI: 0.54-0.99), high-low (OR: 0.50, 95%CI: 0.34-0.73), high-middle (OR: 0.74, 95%CI: 0.63-0.87), and high-high categories (OR: 0.74, 95%CI: 0.55-0.99) were less likely to exhibit depressive symptoms. Additionally, the lower likelihood of depressive symptoms found in middle- and high-income groups with lower levels of subjective financial need was strong among individuals with chronic disease. CONCLUSIONS: Differences in the prevalence of depressive symptoms generally exist between individuals of the same income category depending on perceived income adequacy. Therefore, it is important to consider discrepancies in objective income and subjective financial need when assessing risk factors for depressive symptoms in older populations.

Association between unmet healthcare needs and health-related quality of life: a longitudinal study.

Background: As life expectancy has increased overall, health-related quality of life is now more important than ever. This is especially relevant in countries such as South Korea that are concerned about unmet healthcare needs and health-related quality of life (HRQoL). Thus, we investigated the relationship between unmet healthcare needs and HRQoL in the general population. Methods: We used data from the 2011 to 2013 Korea Health Panel Survey, which included data from 8150 baseline participants of 19 years of age or older. We measured HRQoL using the EQ-5D and EQ-VAS indices. In addition, we used generalized estimating equations to perform a longitudinal regression analysis. Results: Approximately 13.1% of the participants (n = 1068) experienced unmet healthcare needs. Individuals with unmet healthcare needs due to economic hardship tended to have lower values than those without unmet healthcare needs for EQ-5D and EQ-VAS indices (EQ-5D: -2.688, P < 0.0001; EQ-VAS: -5.256, P < 0.0001). Additionally, when stratified by gender, both male and female subjects who had unmet healthcare needs and low economic status had a drastic decrease in HRQoL regardless of the reasons for their unmet healthcare needs. Conclusions: Unmet healthcare needs influences HRQoL, which was more pronounced in economically vulnerable groups. Thus, interventions to address HRQoL problems should focus on implementing a guarantee of healthcare services for economically vulnerable groups.

Quality of life and national pension receipt after retirement among older adults.

AIM: As the aging population (including baby boomers) retires, its members face the problem of retirement security. Social security, including the national pension, is the most important source of retirement security and thus directly affects the well-being of retired older adults. We investigated the relationship between national pension receipt and quality of life (QoL) among Koreans aged 60 years or older. METHODS: We used data from the Korean Longitudinal Study of Aging obtained in 2006-2012 from 340 baseline individuals who had retired. We measured QoL using a visual analog scale. A generalized estimating equations model was used to carry out a longitudinal regression analysis on longitudinal data. RESULTS: When participants who received a national pension were used as the reference group, those participants who did not receive a national pension had a QoL of -4.40 (SE = 1.73; P = 0.0109). Additionally, individuals without a national pension and with a low household income showed the most drastic decrease in QoL (-10.42; SE = 4.53; P = 0.0214). Individuals without a national pension and with a low wealth level showed a considerable decrease in QoL compared with individuals with national pension and with a low wealth level (-8.34; SE = 4.14; P = 0.0438). CONCLUSIONS: National pension receipt among retired older adults influences QoL, and the present results suggest that guaranteed income is very important to retired older adults with a low economic status. Thus, we require national pension schemes that aim to address retirement security for these individuals. Geriatr Gerontol Int 2017; 17: 1205-1213.

The impact of living arrangements on quality of life among Korean elderly: findings from the Korean Longitudinal Study of Aging (2006-2012).

PURPOSE: To investigate the impact of different living arrangements on quality of life (QoL) and health-related quality of life (HRQoL) in the elderly. METHODS: We used data from the first to fourth wave of the Korean Longitudinal Study of Aging. Using the first wave as a baseline, the data included 5050 individuals aged 60 years and older with at least one living child. QoL and HRQoL were measured using a visual analogue scale developed by the Korean Labor Institute that bears similarity to the EQ-VAS. Living arrangements were categorized based on household composition (single household, one-generation household, two-generation household, and three-generation household) and the marital status of a cohabiting adult child. A generalized estimating equation was used to examine the association between living arrangements and QoL/HRQoL. RESULTS: Compared to elderly individuals living in three-generation families with a married child, those in a single household (QoL: ß = -2.67 [P = 0.001]; HRQoL: ß = -2.24 [P = 0.007]), those living in a three-generation family with an unmarried adult child (QoL: ß = -5.19 [P < 0.0001]; HRQoL: ß = -3.41 [P < 0.0001]), and those living in a two-generation family with an unmarried adult child (QoL: ß = -2.88 [P < 0.0001]; HRQoL: ß = -2.80 [P < 0.0001]) were more likely to have lower QoL and HRQoL. These associations were particularly strong for women and individuals in the lowest equivalent household income group. CONCLUSION: It is necessary to devise government programs not only for elderly individuals living alone, but also for those living with an unmarried adult child; elderly persons who are female and part of the lowest equivalent household income group must receive particular attention.

Does relationship satisfaction and financial aid from offspring influence the quality of life of older parents?: a longitudinal study based on findings from the Korean longitudinal study of aging, 2006-2012.

BACKGROUND: Quality of life (QoL) in old age is of major importance because the global population is aging rapidly. Offspring support, including financial and emotional support, is important in later life and directly affects the wellbeing of elderly individuals. The aim of this study was to examine the relationship between QoL in older parents and offspring support. METHODS: We used baseline data from the 2006-2012 Korean Longitudinal Study of Aging, from 3,274 individuals aged 65 years or older. We measured the individual's QoL using a visual analog scale and included both relationship satisfaction and regular economic support as variables. A generalized estimating equation (GEE) model was used to perform longitudinal regression analysis on the data. RESULTS: Regarding the QoL of older parents, those with an unsatisfying relationship with their offspring had a QoL of -21.93 (SE = 0.55; P < 0.0001) compared to those with satisfying offspring relationships. Those receiving no regular financial aid from their offspring had a QoL of -0.92 (SE = 0.38; P = 0.0171) compared to those who received such economic support. Combination effects were observed, with cases living alone - and having poor offspring relationships and no regular financial support from their offspring - showing the most drastic decrease in QoL (-23.46; SE = 1.03; P < 0.0001). CONCLUSIONS: Offspring support influences the QoL of elderly individuals, and Korean children appear to play a crucial role in the QoL of their (older) parents. Considering that the role of offspring is rapidly diminishing due to industrialization policies, initiatives are required to revitalize offspring support for elderly parents.

Low socioeconomic status and suicidal ideation among elderly individuals.

BACKGROUND: Suicide rates are high among elderly individuals experiencing socioeconomic insecurity. Socioeconomic security is of critical importance for elderly individuals and directly affects mental health, including suicidal behavior. Thus, we investigated the relationship between socioeconomic status and suicidal ideation in elderly individuals. METHOD: We conducted a cross-sectional study using data on 58,590 individuals 65 years of age or older from the Korean Community Health Survey 2013. Logistic regression analysis was used to identify relationships between socioeconomic factors (food insecurity, household income, and living arrangement) and suicidal ideation in the elderly population. RESULTS: The study included 58,590 participants (24,246 males and 34,344 females). Of those, 2,847 males and 6,418 females experienced suicidal ideation. Participants with food insecure were more likely to experience suicidal ideation than were those who were food secure (males: OR = 1.60; 95% CI, 1.34-1.90; females: OR = 1.54; 95% CI, 1.38-1.72). We found a similar pattern among participants with a low household income and those living alone. Additionally, male and female subjects who were food insecure and living alone or food insecure and had a low household income showed a marked increase in suicidal ideation. CONCLUSION: Our findings suggest that low socioeconomic status is associated with an increased risk of suicidal ideation among the elderly. Furthermore, intervention programs that address the prevalence of elderly suicide, particularly among those who are socioeconomically disadvantaged, are needed.

The effect of childhood and current economic status on depressive symptoms in South Korean individuals: a longitudinal study.

BACKGROUND: Mental health inequality along the economic strata is prominent in South Korea, particularly as intergenerational material transfer is becoming increasingly important in gaining economic status. Therefore, this study aimed to investigate the relationship between current and childhood economic status and depressive symptoms in adults aged 20 or above. METHODS: This study used data from the Korean Welfare Panel Study (KOWEPS), 2010 to 2013. A total of 9,645 individuals aged 20 years or above without depressive symptoms in 2010 were analyzed. The effect of childhood and current economic status, categorized into low, middle, and high groups, on depressive symptoms was investigated using hierarchical logistic regression models. Depressive symptoms were measured using the Center for Epidemiological Studies Depression (CES-D 11) scale. Subgroup analysis was performed based on education level. RESULTS: Compared to the middle current-middle childhood economic status group, the low-low group (OR: 1.88, CI: 1.61-2.20), low-middle group (OR: 1.68, CI: 1.43-1.98), and low-high group (OR: 1.64, CI: 1.34-2.01) were more likely to have depressive symptoms. The high-low group (OR: 0.68, CI: 0.55-0.84), high-middle group (OR: 0.67, CI: 0.56-0.81), and high-high group (OR: 0.45, CI: 0.27-0.75) were less likely to have depressive symptoms. This trend was generally maintained with regard to education level, but the effects were not statistically significant in the high current economic status groups among participants with a university degree or above. CONCLUSION: Low current economic status was associated with a higher likelihood of depressive symptoms. In particular, the low current-low childhood economic status group showed the highest likelihood of depressive symptoms, suggesting the adverse mental health effects of prolonged poverty. Therefore, the findings reveal that mental health inequalities are present along the economic strata and require proper addressing of the mental health of lower income individuals.

Association between reduction in copayment and gastric cancer patient concentration to the capital area in South Korea: NHI cohort 2003-2013.

Since 2004, the South Korean government has introduced a policy that decreases copayment for cancer patients by strengthening public coverage in the National Health Insurance (NHI) system (first phase=copayment for outpatient care from 30% to 20%; second phase=copayment for total medical expenditures from 20% to 10%; third phase=copayment for total medical expenditures from 10% to 5%). We aimed to investigate the relationship between the policy introduction and patient visits to hospitals in the capital area. We used data from the NHI Cohort 2003-2013, which included all medical claims (7193 cases) filed for 2124 patients who visited the hospital due to stomach cancer, and performed a segmented Poisson regression analysis. Of all hospital visits, 40.6% of patients were from the capital area. After the introduction of the second phase of the policy, there was an increase in patient concentration in the capital area, although there were no significant effects on patient concentration during the first and third phases of the policy. In conclusion, our findings suggest that the introduction of a policy that reduces copayment for cancer patients had a substantial impact on patient concentration in the capital area. Therefore, health policymakers should consider effective alternatives including efficient allocation of medical resources or support for the more vulnerable population as flexible benefit plans to aid healthcare utilization by cancer patients.