Journal of Preventive Medicine and Public Health January 010, Vol. 4, No. 1, 5061 doi: 10.961/jpmph.010.4.1.50 Socioeconomic Inequity in SelfRated Health Status and Contribution of Health Behavioral Factors in Korea Minkyung Kim 1, Woojin Chung 1,, Seungji Lim 1,, Soojin Yoon 1, Jakyoung Lee 1, Eunkyung Kim 1, Lanju Ko 1 1 Graduate School of Public Health, Yonsei University, Institute of Health Services Research, Yonsei University Objectives: The study is investigated socioeconomic variations in selfrated health status and contribution of health behavioral factors in Korea. Methods: A nationally representative sample (,800 men and,0 women aged 064 years) from the 005 Korea National Health and Nutrition Surveys was analyzed using logistic regression. Results: Selfrated health was lower among lower socioeconomic groups compared with higher socioeconomic groups, with gender being irrelevant. This association was attenuated when health behavioral and sociodemographic factors were adjusted. When each health behavioral factor was considered separately, mediators such as smoking in men, and stress or exercise in women explained a large part of the decreased socioeconomic health inequalities. Conclusions: In Korea, subjective health inequalities arise from different socioeconomic status, but this difference is decreased by health behavioral factors. Therefore, socioeconomic inequity in selfrated health status can be corrected more effectively by promotional health behaviors. Key words: Social class, Health status, Socioeconomic factors, Health behavior, Korea J Prev Med Public Health 010;4(1):5061
Table 1. Classification of social stratum groups Occupation Legislator, senior officials and manager Professionals Technicians and associate professionals Clerks Service and sales works Skilled agricultural and fishery workers Craft and related trades workers Plant, machine operators and assemblers Elementary occupations Household Selfemployer Employer Job status Formal Formal Temporar EM* EM* y workers (Full time) (Part time) Day workers Family volunteer Others EM: *The present study was conducted on the working population. Not economically active population as a student, army and unemployed ruled out.
Table. Characteristics of study subjects among men and women Variables Age (yr) 0 9 0 9 40 49 50 59 60 64 Social stratum group Education level Income (1,000 KRW) High risk drinking for chronic harm Low risk Medium risk High risk Smoking Nonsmoker Exsmoker Smoker Stress A few times/never Occasionally Often Very often Exercise Regular No Residential area Large city Small city Rural area Marital status Never married Married Others* Total,800 *Others includes divorced, widowed and separated Men Women n % n % 0,81 0,786 0,84 0,565 0,5 0,16 0,677 0,454 0,74 0,144 0,567 1,105 1,44 0, 0,08 0,669 0,76 0,941 0,464 1,150 0,70 1,80 0,48 0,814 1,558 0,11 1,44 0,88 0,17 1,86 1,414 1,6 1,09 0,499 0,56,096 0,168 01.6 08.1 00.1 00. 008.0 007.7 04. 016. 06.5 005.1 00. 09.5 051. 008. 001.0 0.9 05.9 0.6 016.6 041.1 01. 045.7 015. 09.1 055.6 011.1 051. 09.9 007.8 049.5 050.5 045.1 07.11 017.8 019.1 074.9 006.0 576 875 911 604 64 15 46 1 50 01 571 1,91 940 1,71 47 106 751 88 994 657,117 64 471,94 117 179 44 1,695 91 199 1,48 1,748 1,57 1,146 547 49,9 98,0 017.8 07.1 08. 018.7 008. 004.7 014. 006.8 015.5 001.0 017.7 040.0 09.1 05.0 014.6 00. 0. 05.6 00.8 00. 065.5 019.9 014.6 090.8 00.6 005.5 01.1 05.5 08.4 006. 045.9 054.1 047.6 05.5 016.9 015. 07.4 01.
Table. Relation of social stratum group, socioeconomic and health behavior variables to selfrated health status among men and women Age (yr) 0 9 0 9 40 49 50 59 60 64 Social stratum group Education level Income (1,000 KRW) High risk drinking for chronic harm Low risk Medium risk High risk Smoking Nonsmoker Exsmoker Smoker Stress A few times/never Occasionally Often Very often Exercise Regular No Residential area Large city Small city Rural area Marital status Never married Married Others* Total UnHealthy group Men n (%) n (%) n (%) 81 786 84 565 5 16 677 454 74 144 567 1,105 1,44 8 669 76 941 464 1,150 70 1,80 48 814 1,558 11 1,44 88 17 1,86 1,414 1,6 1,09 499 56,096 168 1.6 8.1 0.1 0. 8.0 7.7 4. 16. 6.5 5.1 0. 9.5 51. 8. 1.0.9 5.9.6 16.6 41.1 1. 45.7 15. 9.1 55.6 11.1 51. 9.9 7.8 49.5 50.5 45.1 7.1 17.8 19.1 74.9 6.0 148 97 44 8 161 96 08 47 81 96 58 475 8 169 0 06 48 489 4 65 166 685 18 44 879 147 689 509 141 656 80 68 51 91 6 1,151 109 10.0 6.7 9.7.7 10.8 6.5 0.7 16.6 5.6 6.5 4.1.0 55. 11.4 1. 0.6.4.9.1 4.7 11. 46.1 1. 8.5 59. 9.9 46.4 4. 9.5 44.1 55.9 45.9 4.5 19.6 15. 77.5 7. Healthy group pvalue 89 401 7 64 10 69 07 61 48 09 60 61 64 8 6 78 45 11 515 04 595 45 90 679 164 745 9 76 70 584 580 56 08 10 945 59 17.7 9.6 0.5 17. 4.9 9.1 8.1 15.8 7.5.7 15.9 47.9 46.6 4.9 0.6 7.6 8.8 4.4 9. 9. 15.5 45. 18.6 9.7 51.7 1.5 56.7 5.0 5.8 55.6 44.4 44.1 40.0 15.8.6 71.9 4.5 74.4 57.0 94.7 10.6 1. 5.6 50.9 6. 11.7 7.9 0.000 0.000 576 875 911 604 64 15 46 1 50 1 571 1,91 940 1,71 47 106 751 88 994 657,117 64 471,94 117 179 44 1,695 91 199 1,48 1,748 1,57 1,146 547 49,9 98 Total 17.8 7.1 8. 18.7 8. 4.7 14. 6.8 15.5 1.0 17.7 40.0 9.1 5.0 14.6.. 5.6 0.8 0. 65.5 19.9 14.6 90.8.6 5.5 1.1 5.5 8. 6. 45.9 54.1 47.6 5.5 16.9 15. 7.4 1. UnHealthy group 59 47 548 446 17 6 197 10 15 7 418 794 48 1,05 78 85 7 45 65 49 1,10 65 68 1,75 7 118 08 959 67 149 845 1,098 95 650 68 1,45 85 Women n (%) n (%) n (%) 1. 4. 8..0 11.. 10.1 6.7 16. 1.4 1.5 40.9.0 54.1 19.5 4.4 19... 5. 67.4 18.8 1.8 90..7 6.1 10.7 49.4. 7.7 4.5 56.5 47.6.5 18.9 1.0 7. 14.7 Healthy group pvalue 17 40 6 158 47 90 65 91 187 4 15 497 51 660 94 1 78 75 69 165 807 77 0 1,181 45 61 16 76 85 50 67 650 61 496 179 60 914 11 4.6 1. 8. 1..7 7.0 0.6 7.1 14.5 0. 11.9 8.6 9.8 51. 7. 1.6 9.4 9.1 8.7 1.8 6.7 1.5 15.8 91.8.5 4.7 16.8 57..1.9 49.5 50.5 47.6 8.5 1.9 0. 71.0 8.8 169.7 15.4 181.0 107. 7.6.8 76.9 11. 17. 56.5 0.00 0.490 Total,800 1,486 1,14,0 1,94 1,87 *Others includes divorced, widowed and separated
Table 4. Sexspecific odds ratio (OR) and 95% confidence intervals (CI) of selfrated health status according to socioeconomic factors aged 064 by logistic regression 95% CI Men Social stratum group Education Income (1,000 KRW) Women Social stratum group Education Income (1,000 KRW) Model 1* OR* 95% CI pvalue 1.17 0.861.600 0.861.600 1.45 1.05.00 1.05.00 1.50 1.10.050 1.10.050.11 1.5.00 1.5.00. 1.60.080 1.60.080 1.64 1.401.940 1.401.940.69 1.9.760 1.9.760. 5.40 5.40 1.16 0.951.410 0.951.410 1.4 1.161.70 1.161.70.4 1.89.090 1.89.090 1.18 0.811.70 0.811.70 1.5 0.99.0 0.99.0.05 1.41.990 1.41.990 5. 1.7115.97 1.7115.97.80 1.914.110 1.914.110 1.85 1.1.60 1.1.60 1.6 1.71.90 1.71.90.84.09.860.09.860.51 1.464.00 1.464.00 1. 1.011.480 1.011.480 1.71 1.40.080 1.40.080.4 1.94.050 1.94.050 0.160 0.060 0.0100 0.0510 0.1500 0.900 0.0570 0.0040 0.0440 Model Model OR 95% CI pvalue OR 95% CI pvalue 1.08 0.861.600 0.781.480 1. 1.05.00 0.881.70 1. 1.10.050 0.971.80 1.91 1.5.00 1.0.00 1.91 1.60.080 1.6.680 1.54 1.401.940 1.01.80.4 1.9.760 1.65.10 1.99 5.40 0.844.710 1.11 0.951.410 0.911.60 1.9 1.161.70 1.051.590.1 1.89.090 1.65.70 1.14 0.811.70 0.781.680 1.44 0.99.0 0.9.0 1.96 1.41.990 1.4.880 5.08 1.7115.97 1.6415.76.79 1.914.110 1.894.10 1.98 1.1.60 1.9.80 1.64 1.71.90 1.71.950.70.09.860 1.97.700.48 1.464.00 1.44.00 1.19 1.011.480 0.981.450 1.6 1.40.080 1.4.000. 1.94.050 1.76.800 *Model 1: odds ratio were adjusted for age Model : odds ratio were adjusted for age and health behavior variables Model : odds ratio were adjusted for age, health behavior, and sociodemographic variables 0.650 0.50 0.0780 0.0060 0.1170 0.10 0.0140 0.500 0.1040 0.0050 0.0750 1.09 0.861.600 0.791.500 1. 1.05.00 0.871.70 1.4 1.10.050 0.971.800 1.8 1.5.00 1.1.960 1.94 1.60.080 1.8.740 1.5 1.401.940 1.81.800.1 1.9.760 1.6.90 1.9 5.40 0.84.580 1.10 0.951.410 0.901.50 1.7 1.161.70 1.01.560.08 1.89.090 1.61.607 1.1 0.811.70 0.761.640 1.6 0.99.0 0.9.50 1.95 1.41.990 1..870 4.74 1.7115.97 1.5114.8.7 1.914.110 1.84.00.01 1.1.60 1.40.880 1.64 1.71.90 1.71.960.66.09.860 1.9.670.41 1.464.00 1.84.0 1.19 1.011.480 0.981.450 1.6 1.40.080 1.1.980. 1.94.050 1.75.80 0.590 0.80 0.0770 0.0160 0.150 0.50 0.00 0.570 0.100 0.0080 0.000 0.0800
Table 5. Logistic regression for effect of high risk drinking for acute harm, smoking, stress, and exercise on socioeconomic health inequality Men Social stratum group Education Income (1,000 KRW) Women Social stratum group Education Income (1,000 KRW) Age+high risk drinking for acute harm adjustment OR* 95% CI pvalue 1.17 0.861.600 0.861.600 1.46 1.05.00 1.05.00 1.51 1.11.050 1.11.050.09 1..70 1..70. 1.61.100 1.61.100 1.6 1.81.90 1.81.90.64 1.89.700 1.89.700.7 5.10 5.10 1.16 0.951.410 0.951.410 1.4 1.161.70 1.161.70.4 1.90.100 1.90.100 1.18 0.811.70 0.811.70 1.51 0.98.0 0.98.0.05 1.41.990 1.41.990 5.1 1.7015.90 1.7015.90.80 1.914.110 1.914.110 1.85 1.1.60 1.1.60 1.6 1.71.90 1.71.90.87.11.910.11.910.54 1.484.60 1.484.60 1. 1.011.490 1.011.490 1.7 1.41.090 1.41.090.45 1.95.070 1.95.070 0.180 0.040 0.0090 0.0590 0.1460 0.950 0.0600 0.0040 0.090 Age+smoking adjustment OR 95% CI pvalue 1.08 0.861.600 0.791.48 1.0 1.05.00 0.91.81 1.4 1.11.050 0.981.84 1.9 1..70 1..0 1.99 1.61.100 1.4.77 1.56 1.81.90 1.1.84.49 1.89.700 1.77.50.0 5.10 0.945.14 1.14 0.951.410 0.91.9 1.6 1.161.70 1.111.69.0 1.90.100 1.79.94 1.18 0.811.70 0.811.7 1.49 0.98.0 0.97.0.0 1.41.990 1.9.94 5.4 1.7015.90 1.716.0.76 1.914.110 1.884.05 1.84 1.1.60 1.0.61 1.60 1.71.90 1.51.90.81.11.910.07.8.49 1.484.60 1.454.7 1.1 1.011.490 1.47 1.70 1.41.090 1.9.07.40 1.95.070 1.91.0 0.60 0.10 0.0650 0.0040 0.0700 0.000 0.000 0.880 0.0690 0.0040 0.0500 Age+stress adjustment OR 95% CI pvalue 1.18 0.861.600 0.861.610 1.44 1.05.00 1.04.010 1.54 1.11.050 1.1.110.6 1..70 1.50.70.4 1.61.100 1.61.10 1.67 1.81.90 1.41.980.74 1.89.700 1.95.860.1 5.10 0.985.470 1.17 0.951.410 0.961.40 1.40 1.161.70 1.151.70.4 1.90.100 1.8.000 1.15 0.811.70 0.811.70 1.48 0.98.0 0.99.0.05 1.41.990 1.41.990 5.8 1.7015.90 1.7115.97.88 1.914.110 1.914.110.00 1.1.60 1.1.60 1.65 1.71.90 1.91.960.75.11.910.01.760.5 1.484.60 1.464.70 1.0 1.011.490 0.991.460 1.66 1.41.090 1.6.00.6 1.95.070 1.80.850 0.090 0.000 0.0070 0.0560 0.10 0.4880 0.0770 0.0040 0.0640 OR; Odds Ratio, CI; Confidence Interval *odds ratio were adjusted for age and high risk drinking for acute harm, odds ratio were adjusted for age and smoking odds ratio were adjusted for age and stress, odds ratio were adjusted for age and excercise Age+exercise adjustment OR 95% CI pvalue 1.14 0.861.600 0.81.55 1. 1.05.00 0.951.84 1.40 1.11.050 1.01.91 1.8 1..70 1.16.87.0 1.61.100 1.46.8 1.57 1.81.90 1.1.85.4 1.89.700 1.7.40.1 5.10 0.904.97 1.10 0.951.410 0.911.6 1. 1.161.70 1.081.6. 1.90.100 1.74.86 1.17 0.811.70 0.801.70 1.46 0.98.0 0.95.5 1.94 1.41.990 1..8 4.98 1.7015.90 1.615..70 1.914.110 1.8.95 1.84 1.1.60 1.0.60 1.59 1.71.90 1.41.89.68.11.910 1.96.66.6 1.484.60 1.74.06 1.19 1.011.490 0.991.45 1.66 1.41.090 1.6.0.4 1.95.070 1.86.94 0.490 0.100 0.040 0.0090 0.0840 0.080 0.0060 0.460 0.0840 0.0050 0.000 0.0710
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