• 지역사회간호학회지
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• 제25권3호
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• pp.217-224
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• 2014

Purpose: This study aimed to assess the levels of and relationships among health literacy, knowledge about diabetes, and self-care activities in the Korean low-income elderly with diabetes and to identify factors influencing the self-care activities of this vulnerable population. Methods: This study surveyed a total of 151 low-income elderly patients with diabetes registered at 16 Visiting Health Care Services in B City, Korea. Health literacy was measured with the Newest Vital Sign. Diabetes knowledge was measured with the Diabetes Knowledge Test. The Summary of Diabetes Self-care Activities Questionnaire was used to assess diabetes self-care activities. A stepwise multiple regression analysis was conducted to identify significant factors influencing diabetes self-care activities in these patients. Results: In the regression model, diabetes knowledge (${\beta}=.322$, p<.001), exercise (${\beta}=.337$, p<.001), and experiences of diabetes education (${\beta}=.241$, p=.001) were significantly associated with increased diabetes self-care activities in low-income elderly patients with diabetes when gender, education, health literacy, and subjective health state were controlled. Conclusion: To improve diabetes self-care activities in the low-income elderly with diabetes, it is important to develop a customized program considering their knowledge, exercise, and diabetes education experience.

• 보건행정학회지
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• 제31권1호
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• pp.114-124
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• 2021

Background: In this study, we aimed to investigate the interaction effects of individual socioeconomic status and regional deprivation on the onset of diabetes complications and diabetes-related hospitalization among type 2 diabetes patients. Methods: Korean National Health Insurance Service National Sample Cohort data from 2002 to 2013 were used. A total of 50,954 patients newly diagnosed with type 2 diabetes from 2004 to 2012 and aged 30 years or above were included. We classified patients into six groups according to individual income level and neighborhood deprivation: 'high in advantaged,' 'high in disadvantaged,' 'middle in advantaged,' 'middle in disadvantaged,' 'low in advantaged,' and 'low in disadvantaged.' We calculated hazard ratios (HR) of onset of diabetes complication and diabetes-related hospitalization using the Cox proportional hazard model, with the reference group as diabetes patients with high income in advantaged regions. Results: In terms of the interaction effects of individual income level and regional socioeconomic level, even with the same low individual income level, the group with a high regional socioeconomic level (low in advantaged) showed low HRs for the onset of diabetes complication (HR, 1.04; 95% confidence interval [CI], 1.00-1.08) compared to the 'low in disadvantaged' group (HR, 1.10; 95% CI, 1.05-1.16). In addition, the 'high in advantaged' group showed slightly higher HRs for the onset of diabetes complication (HR, 1.06; 95% CI, 1.00-1.11) compared to the 'low in advantaged' and it appeared to be associated with slight mitigation of the risk of diabetes complication. For the low-income level, the patients in disadvantaged regions showed the highest HRs for diabetes-related hospitalization (HR, 1.29; 95% CI, 1.19-1.41) compared to the other groups. Conclusion: Although we need to perform further investigations to reveal the mechanisms that led to our results, interaction effects individual socioeconomic status and regional deprivation might be associated with on onset of diabetes complications and diabetes-related hospitalization among type 2 diabetes patients.

• 보건행정학회지
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• 제20권1호
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• pp.125-136
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• 2010

Objectives: The purpose of this study is to analyze the proportion of fundus examination of DM patients for preventing microvascular complication and to examine the factors related to fundus examination in DM patients. Methods: This study used 2005 Korean national health and nutrition survey data. We selected all 1,129 diabetes mellitus patients from the data. And we choose 8 factors related to diabetes mellitus patients. These are sex, age group, type of residential area(rural or urban), education level, income level, comorbidity with hypertension, current insulin use, and duration of suffering from DM. We have analysed these factors by whether he had been examined fundus or no through Chi-square and logistic regression analysis. Results: Female DM patients have tendency to get more fundus examination than Male DM patients. And Young patients, patients who live in urban area, well educated patients, high income patients, comorbidity with hypertension, patients have got the insulin injection, patients have long duration of suffering from DM are to get more fundus examination. According to multivariate logistic regression analysis, sex and education level, income level, and duration of suffering from DM, comorbidity with hypertension, patients have got the insulin injection are significant factors on fundus examination for prevent microvascular diabetes mellitus complications. Conclusions and Discussion: We have concluded that physicians and policy makers should consider to fundus examination especially of man and DM patients who have more shorter disease period and low educated patients and low incomed patients and patients who have taken insulin therapy.

• 한국산학기술학회논문지
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• 제15권10호
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• pp.6223-6233
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• 2014

본 연구는 심뇌혈관질환자들을 대상으로 소득수준과 교육수준이 건강행태에 미치는 영향을 분석하여 질병관리와 예방에 도움을 주는 방안을 제시하는데 있다. 2010-2011 국민건강영양조사 원시자료를 이용하여 30세 이상의 심뇌혈관질환자 3,687명을 대상으로 건강행태, 일반적(사회인구학적) 특성, 신체계측 및 혈액검사를 소득수준별, 교육수준별로 상관관계를 분석하였다. 본 연구의 결과, 소득수준과 교육수준이 낮을수록 심뇌혈관질환의 유병율이 높고, 현재흡연에서의 OR(95% CI) 값은 고소득자 0.71(0.52-0.96), 고교육자 0.41(0.29-0.58)로 소득과 교육수준이 낮을수록 건강수준의 감소와 관계되는 현재흡연과의 상관성이 높았다. 한편 1개월음주와 고위험음주에서 고소득자의 OR(95% CI) 값은 각각 1.55(1.22-1.95), 1.42(1.11-1.82)로 음주율이 고소득자에서 높았으나 교육수준에서는 유의한 차이가 없었다. 걷기운동의 실천율은 소득과 교육수준 모두 유의한 차이가 없었다. 따라서 소득수준이 높은 환자군에서는 절주홍보를 강조하고, 소득과 교육수준이 낮은 환자군에서는 금연의 중요성을 강조하는 것 이외에도 서비스공급을 위한 제도적인 뒷받침이 필요할 것으로 보인다.

• 한국콘텐츠학회논문지
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• 제18권10호
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• pp.145-157
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• 2018

본 연구에서는 국민건강보험공단 코호트를 이용하여 한국의 사망원인 1, 2, 3 위에 해당하는 질병이자 4대 중증질환에 포함되는 암, 뇌졸중, 심근경색 환자의 소득수준이 사망에 미치는 영향을 확인하고자 한다. 또한 발병 1년 이후 이차적으로 암, 심뇌혈관 질환에 발생할 위험을 확인하고자 한다. 2007년 해당 질환으로 신규 발병한 환자를 대상자로 하여 2015년까지 관찰하였고, 분석은 Cox 확률비례위험모형과 경쟁위험모형을 이용하였다. 소득수준은 2007년 발병 당시 정보를 사용하였으며, 소득분위 수 1~3/4~7/8~10으로 나눠 각각 low/mid/high로 범주화하였고 '의료급여'군은 low군으로 분석에 포함했다. 연구 결과에서 소득분위 수준에 따라 암, 뇌졸중, 심근경색이 발병한 환자의 사망 위험이나 추가 발병 위험에 차이가 있음이 나타났다. 저소득층의 초기 사망을 낮추기 위한 사회적 안전망이 필요하다는 것과 더불어 현 정책과 같이 중증질환에 대한 보편적인 보장성 강화도 지속해서 필요하다고 보인다.

• Asian Pacific Journal of Cancer Prevention
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• 제14권4호
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• pp.2567-2570
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• 2013

Background: This study analyzed Surveillance, Epidemiology and End Results (SEER) data to assess if socio-economic factors (SEFs) impact on endometrial cancer survival. Materials and Methods: Endometrial cancer patients treated from 2004-2007 were included in this study. SEER cause specific survival (CSS) data were used as end points. The areas under the receiver operating characteristic (ROC) curve were computed for predictors. Time to event data were analyzed with Kaplan-Meier method. Univariate and multivariate analyses were used to identify independent risk factors. Results: This study included 64,710 patients. The mean follow up time (S.D.) was 28.2 (20.8) months. SEER staging (ROC area of 0.81) was the best pretreatment predictor of CSS. Histology, grade, race/ethnicity and county level family income were also significant pretreatment predictors. African American race and low income neighborhoods decreased the CSS by 20% and 3% respectively at 5 years. Conclusions: This study has found significant endometrial survival disparities due to SEFs. Future studies should focus on eliminating socio-economic barriers to good outcomes.

• Journal of Preventive Medicine and Public Health
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• 제42권5호
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• pp.315-322
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• 2009

Objectives : Knowledge about the management status of diabetic melitus (DM) is essential to improve diabetic management. Moreover, low income is associated with poor adherence to treatment and increased mortality. This study was performed to evaluate the management status of DM in low-income patients in a rural area. Methods : We enrolled 370 patients with type 2 DM living in Gokseong county, JeollaNamdo. A well-trained examiner measured the height, weight, waist circumference, blood pressure, total cholesterol, triglyceride, high density lipoprotein cholesterol, fasting blood sugar and glycosylated hemoglobin (HbA1c) levels. Carotid ultrasonography was used to measure carotid artery carotid artery intima media thickness (IMT) and plaque. anklebrachial index (ABI) was used to evaluate peripheral artery disease. A fundoscopic examination was performed to evaluate diabetic retinopathy. A history of diabetes complications and health-related questionnaires were also completed. Results : The age of diabetic subjects was 68.7$\pm$8.7 years and the duration of diabetes was 8.9$\pm$8.2 years. Most (63.5%) had hypertension, and 45.7% had triglycerides below 150 mg/dl, 38.1% had low density lipoprotein cholesterol (LDL) cholesterol below 100 mg/dl, 48.7% had urine albumin to creatinine ratio (UACR) below 30 mg/g. Less than half (45.9%) achieved the goal of HbA1c less than 7% suggested by the American Diabetes Association (ADA). 10.6% had peripheral vascular disease, 11.9% had retinopathy, and 60.8% had chronic kidney disease. Conclusions : DM management in low income patients is very poor and requires further work to improve.

• Asian Pacific Journal of Cancer Prevention
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• 제13권2호
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• pp.407-409
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• 2012

The ACTION (Asean CosTs In ONcology) Study will be one of the largest observational studies of the burden of cancer ever conducted in Asia. The study will involve 10,000 newly diagnosed patients with cancer and will be carried out across eight low- and middle income countries within the ASEAN region (Indonesia, Thailand, Malaysia, Cambodia, Myanmar, Viet Nam, Laos and the Philippines). Patients will be interviewed three times over 12 months to assess their health, use of health care services, out of pocket costs related to their illness, social and quality of life issues. The project is a collaboration between the George Institute for Global Health, the ASEAN Foundation and Roche. The aim of the study is to assess the health and socioeconomic impact of cancer on patients in ASEAN communities, and the factors that may impact on these outcomes.

• 보건행정학회지
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• 제20권4호
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• pp.58-73
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• 2010

Background : Cancer is a disease that not only places a significant burden on patients clinically but also requires significant expense for diagnosis and treatment. Although the cancer coverage of health insurance has recently been expended, the need for financial assistance among cancer patients and their families is still expected to be significant. In this study, cancer patients' need for financial assistance in Korea was examined and its influence factors were analyzed. Methods : Target study subjects were those who are over 18 years of age and were diagnosed with cancer more than four months prior at the National Cancer Center and 9 Regional Cancer Centers in Korea during the period from July to August of 2008. Quarter sampling was conducted according to the ratio of the type of each cancer. A face to face interview survey was conducted. A total of 2,661 cancer patients finished the survey. Medical charts were reviewed in order to obtain the cancer type and SEER stage of cancer patients. An ordered logistic regression model was used to examine the level of need for financial assistance according to the demographical, clinical, and socio-economic variables of cancer patients. Result : The percentage of cancer patients who needed financial assistance was 69.0%, and 36.9% needed significant financial assistance. The need for financial assistance was perceived to be greater in males, younger age group, low income group, low education group, medical aid recipients, those who were diagnosed recently, those with a low level of quality of life measured through EQ5D, and those with decreased income after cancer diagnosis. Conclusion : In spite of the current policy to increase health insurance coverage, the majority of cancer patients and their families in Korea still need financial assistance due to cancer. In particular, there were more vulnerable groups, such as the low income, or low education group. In the future, policies that focus on the disadvantaged, which strengthen social security, should be considered for achievement of a substantially better quality of life for cancer patients and their families.

• 대한지역사회영양학회지
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• 제6권3호
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• pp.542-552
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• 2001

The purpose of this study was to investigate dietary habits and food compliance in stroke patients. One-hundred sixty eight elderly stroke patients and 97 young patients with first -ever stroke admitted to Asan Medical Center between 1994 and 1998 were studied. Using a structured interview, we assessed food intake. food consumption frequency and compliance to low salt, low meat hight fish and high fruit and vegetable diets. These results were analyzed with X$^2$, t-tests, and analysis of variance (ANOVA) using the SAS package program. Salted food intake and cholesterol-containing food frequency were increased whereas frequency of fruits and vegetables intake was decreased in young stroke patients compared to the elderly. Meat intake and cholesterol-containing food frequency were increased in the males compared to the females in elderly stroke patients. and fish intake and cholesterol-containing food frequency were higher in the males than the females in the young. In patients with high economic status, frequency of fruits and vegetables was elevated. Also compliance the low meat and high fruit and vegetable diet in young patients was lower than that in the elderly. When the life-style risk factors influencing the food intake of frequency of fruits and vegetables was affected by education in young stroke patients. In elderly stroke patients, meat intake frequency of cholesterol-containing foods and fruits and vegetables were influenced by sex and /or income. Our results suggest that dietary intake of salt meat ,cholesterol-containing foods. fruits and vegetables in stroke patients may vary with age, sex the presence of risk factors or economic status therefore guidelines and nutrition education should by formulated to prevent stroke recurrence based on dietary habits and risk factors of individual patients.