Juhwan Oh

Association between deprivation status at community level and outcomes from out-of-hospital cardiac arrest: a nationwide observational study.

STUDY OBJECTIVES We sought to examine the association between area deprivation and outcomes of out-of-hospital cardiac arrest in Korea. METHODS Data were obtained from the emergency medical service (EMS) system. A nationwide OHCA cohort database from January 2006 to December 2007 was constructed via hospital chart review and ambulance run sheet data. We enrolled all EMS-assessed OHCA victims and excluded cases without available hospital outcome data or residential address. The Carstairs index was used to categorize districts according to level of deprivation into five quintiles, from (Q1, the least deprived) to (Q5, the most deprived). Main outcomes were survival to hospital discharge, survival to admission, and return of spontaneous circulation (ROSC). RESULTS 34,227 patients were included. Initial rhythm, witnessed status, attempted bystander cardiopulmonary resuscitation (CPR), CPR by EMS, CPR in the emergency department (ED), and elapsed time interval significantly varied according to area deprivation level (p < 0.001). OHCA outcomes were consistently worse in the most deprived areas. The adjusted OR (95% CI) for survival to hospital discharge was 0.58 (0.45-0.77) in the most deprived areas compared to the least deprived areas. CONCLUSION Community deprivation was strongly associated with survival among out-of-hospital cardiac arrest patients in Korea.

Gender and Socioeconomic Status in Relation to Weight Perception and Weight Control Behavior in Korean Adults

Aim: In Korea, obesity is more prevalent among men and lower socioeconomic groups. To explain this obesity disparity, we compared weight perception and weight control behavior across gender and socioeconomic status (SES). Methods: We analyzed data from 16,260 participants aged 20 years or older in a nationally representative cross-sectional survey. SES indicators included education and income levels. Weight under-perception was defined when participants considered themselves lighter than their measured BMI status. Either no active or inappropriate weight control (i.e., trying to gain weight in obese individuals) was considered to be unhealthy patterns. Multivariate prevalence ratios were calculated using log-binomial regressions. Results: Men had a higher prevalence of weight under-perception (24.5 vs. 11.9%) and unhealthy patterns of weight control behavior (57 vs. 40%) than women. Low education level was associated with weight under-perception (ptrend = 0.022 in men, ptrend < 0.001 in women). Both education and income levels were significantly associated with patterns of weight control behavior (for education: ptrend < 0.001 in men and women; for income: ptrend = 0.047 in men, ptrend < 0.001 in women). Conclusion: Weight perception and weight control behavior significantly varied by gender and SES. Public actions should be directed toward improving perception and behavior of high-risk populations.

Socioeconomic Inequalities in Adolescent Depression in South Korea: A Multilevel Analysis

Background In recent years, South Korea has witnessed a sustained rise in the prevalence of adolescent depression. In the present study, we sought to investigate family and school environmental influences on adolescent depression. Methods and Findings Middle and high school students (N = 75,066) were randomly selected respondents to a web-based survey and answered questions on their academic and socioeconomic backgrounds, parental support, parental education level, physical activities, lifestyle habits and their experience of depression in the past one year. Two-level multilevel analysis was used to investigate the relationship between depression and individual (level 1) and school (level 2) factors. Girls reported having experienced depression in greater numbers than boys (43.96% vs. 32.03%). A significant association was found between adolescent depression experience and gender, grade, self-rated academic achievement, family affluence scale, parental support, parental education level, lifestyle habits, physical activity and sleep dissatisfaction. The students living with rich parents were more likely to be depressive, and maternal higher education was significantly associated with higher probability of boys’ depression experience. Low academic achievement was highly associated with the experience of depression. In school level contexts, girls were found to be less likely to be depressive in girls-only schools. Conclusion The adolescent depression experience is not only an individual phenomenon but is highly associated with other factors such as parents, peers, academic achievement, and even gender mix in the school. Thus, prevention measures on youth depression need to focus on emphasizing less pressure from parents on academic performance, and establishing healthy inter-gender relationships within co-education schools.

Social inequalities in life expectancy and mortality during the transition period of economic crisis (1993-2010) in Korea

BackgroundsThis study examines social inequalities in life expectancy and mortality during the transition period of the Korean economic crisis (1993–2010) among Korean adults aged 40 and over.MethodsData from the census and the national death file from the Statistics Korea are employed to calculate life expectancy and age-specific-death-rates (ASDR) by age, gender, and educational attainment for five years: 1993, 1995, 2000, 2005, and 2010. Absolute and relative differences in life expectancy and Age-Specific Death Rates by educational attainment were utilized as proxy measures of social inequality.ResultsClear educational gradient of life expectancy was observed at age 40 by both sexes and across five time periods (1993, 1995, 2000, 2005, and 2010). The gradient became notably worse in females between 1993 and 2010 compared to the trend in males. The educational gradient was also found for ASDR in all five years, but it was more pronounced in working age groups (40s and 50s) than in elderly groups. The relative disadvantage of ASDR among working age Korean adults, both males and females, became substantially worse over time.ConclusionsSocial inequalities in life expectancy and ASDR of the working age group across socioeconomic status over time were closely related to the widening of the social difference created by the macroeconomic crisis and the expansion of neo-liberalism in Korea.

Inequalities in childhood cancer mortality according to parental socioeconomic position: A birth cohort study in South Korea

We sought to explore a possible association between higher parental socioeconomic position and lower child cancer mortality. We examined total cancer mortality as well as site-specific cancer mortality. We constructed a retrospective birth cohort by linking South Korean birth records to death records from 1995 to 2004. Parental socioeconomic position and birth characteristics were identified from the birth records. Parental education and occupation were examined as socioeconomic variables while sex, parental age, gestational age, birth weight, multiple birth, birth order, and the death of previous children were included as birth characteristics. Cancer deaths were identified from the death records. In total, 5711,337 births were analyzed, including 30,844,015 total person-years. The total number of deaths was 21,217, including 1102 children who died of cancer. Hazard ratios of cancer mortality according to parental socioeconomic position were calculated using a Cox proportional hazard analysis with adjustment for the birth characteristics. All socioeconomic measures except maternal occupation showed a significant inverse association with cancer mortality after adjusting for the birth characteristics. For paternal education, high school and middle school graduation or lower was associated with an increased hazard ratio of cancer mortality compared to university education or higher: 1.14 (1.00-1.29) and 1.29 (1.02-1.62), respectively. For maternal education, middle school graduation or lower was associated with a hazard ratio of 1.54 (1.21-1.95). For paternal occupation, manual work and economic inactivity were associated with increased hazard ratios as compared to non-manual work: 1.17 (1.02-1.34) and 1.34 (1.04-1.73), respectively. Inequalities were also found for leukemia and central nervous system tumors. The extent of the inequalities decreased after age 5, and only the 1-4-year-old group showed significant associations with parental socioeconomic position. We conclude that there is an inverse relationship between childhood cancer mortality and parental socioeconomic position in Korea.

Household and School-Level Influences on Smoking Behavior among Korean Adolescents: A Multilevel Analysis

Background Trends in adolescent smoking rates in South Korea have not shown substantial progress due to a lack of effective anti-smoking interventions and policies in school settings. Methods and Findings We examined individual- and school-level determinants of adolescent smoking behavior (ever smoking, current smoking, and daily smoking) using the nationally representative fifth Korean Youth Risk Behavior Web-based Survey conducted in 2009. We found that students in coeducation schools or vocational high schools had greater risks of smoking for each type of smoking behavior than those in single-sex schools or general high schools, respectively even after controlling for individual-level factors. Higher family affluence and higher weekly allowances were associated with greater risks of ever smoking, current smoking and daily smoking even after controlling for parental education and other confounders. Conclusions Whilst caution is required in interpreting results given the cross-sectional nature of the study, our findings suggest that in addition to raising the price of cigarettes, youth anti-smoking interventions in South Korea may benefit from focusing on coeducation schools and vocational high schools.

Gender differences in emergency stroke care and hospital outcome in acute ischemic stroke: a multicenter observational study.

BACKGROUND We aimed to investigate the effect of gender difference on the accessibility to emergency care, hospital mortality and disability in acute stroke care. METHODS This study was performed on a single-tiered basic emergency medical service with a comprehensive national health insurance. Demographic variables, risk factors, elapsed time intervals, performing diagnosis and treatment options, hospital mortality, and modified Rankin Scale of acute ischemic stroke during 2008 were collected. We modeled the multivariate regression analysis for gender differences on the accessibility, hospital mortality, and disability. The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated adjusting for potential risk factors. RESULTS The total number of patients was 6635. The time from symptom onset to emergency department (ED) arrival and to computed tomography or magnetic resonance imaging scan and from ED arrival to computed tomography or magnetic resonance imaging scan was significantly longer in women. No significant difference was found in either the time to intravenous thrombolysis or in the number of patients who received intravenous thrombolysis, anti-platelet therapy, anti-coagulation, or operation. The hospital mortality rate was higher in women (3.9%) than in men (2.9%) (P = .03). The increased disability was significantly higher in women (67.8%) than in men (65.1%) (P = .02). The hospital mortality and increased disability showed a non-significant difference between the 2 genders in the adjusted model (OR, 1.10; 95% CI, 0.74-1.64) and (OR, 1.11; 95% CI, 0.96-1.28), respectively. CONCLUSION The adjusted model for risk factors showed no significant difference on hospital mortality and disability between the 2 genders for stroke patients.

The extent and distribution of inequalities in childhood mortality by cause of death according to parental socioeconomic positions: A birth cohort study in South Korea

It has been shown that childhood mortality is affected by parental socioeconomic positions; in this article, we investigate the extent and distribution of inequalities across major causes of childhood death. We built a retrospective birth cohort using individually linked national birth and death records in South Korea. 1,329,540 children were followed up to exact age eight from 1995 to 1996 and total observed person-years were 10,594,168.18. Causes of death were identified from death records while parental education, occupation and birth characteristics were identified from birth records. Survival analysis was performed according to parental socioeconomic positions. Cox proportional hazard analysis was done according to parental education and occupation with adjustment of birth characteristics such as sex, parental age, gestational age, birth weight, multiple birth, the number of total births, and previous death of children. Cumulative incidence of mortality by age was obtained through a competing-risk method in each cause according to maternal education. From these results, distribution of inequalities across major causes of death was calculated. In total, 7018 deaths occurred during the eight years and mortality rate was 66.24 per 100,000 person-years. External cause was the most common cause of death followed by congenital malformations, nervous system diseases, perinatal diseases, cancer, respiratory, cardiovascular, infectious and gastrointestinal diseases. For all-cause mortality, hazard ratios (HR) were 1.98 (95% CI: 1.83-2.13) for paternal education, 1.90 (1.75-2.07) for maternal education, 1.40 (1.33-1.47) for paternal occupation and 2.33(1.98-2.73) for maternal occupation (between middle school graduation or lower and university or more for education, between manual and non-manual for occupation). Mortality differentials were found in every cause of death. External cause, respiratory, cardiovascular and infectious diseases showed larger HR than all-cause mortality: 2.20 (1.90-2.56), 2.87 (2.02-4.08), 2.50 (1.67-3.75) and 2.12 (1.43-3.15) respectively according to maternal education. On the contrary, congenital malformations and cancer had smaller HR than all-cause mortality: 1.49 (1.22-1.82) and 1.43 (1.00-2.05) respectively according to maternal education. In all-cause mortality and most of the causes, cumulative incidence of mortality increased rapidly until one or two years after birth and then slowed down. But in external cause and cancer, cumulative incidence of mortality accumulated at a constant pace. Thus, inequalities in these causes of death consistently widened. External cause was the leading cause of overall inequalities and its proportion was 36-42% followed by congenital malformations, respiratory diseases etc. We conclude that there were inequalities of childhood mortality in every major cause of death. External cause was the leading cause of both all-cause mortality and overall inequalities. Public health interventions to reduce inequalities are necessary and external cause should be primarily considered.

A comparison of serum haptoglobin levels between acute exacerbation and clinical remission in asthma

Background Bronchial asthma is characterized by airway inflammation, which underlies the phenomenon of bronchial hyperresponsiveness. The concentration of serum haploglobin (Hp), one of the acute phase reactant proteins, has been reported to correlate with bronchial hyperresponsiveness. The extent to which bronchoconstriction or airway inflammation contributes to airflow obstruction of exacerbation is presumed to determine the responsiveness to the initial bronchodilator therapy.

Short-term and long-term associations between household wealth and physical growth: a cross-comparative analysis of children from four low- and middle-income countries

Background Stunting, a form of anthropometric failure, disproportionately affects children in developing countries with a higher burden on children living in poverty. How early life deprivation affects physical growth over various life stages is less well-known. Objective We investigate the short- and long-run associations between household wealth in early life with physical growth in childhood in four low- and middle-income countries to understand the persistent implications of early life conditions of poverty and resource constraints on physical growth. Design Longitudinal study of eight cohorts of children in four countries – Ethiopia, India, Peru, and Vietnam (n=10,016) – ages 6 months to 15 years, using data from the Young Lives project, 2002–2009. Physical growth outcomes are standardized height-for-age z-scores (HAZ) and stunting. The key exposure is household wealth measured at baseline using a wealth index, an asset-based indicator. Covariates include childs age and sex, caregivers educational status, household size, and place of residence. Results Baseline wealth index is significantly associated with higher physical growth rates as suggested by higher HAZ and lower odds of stunting. We found these associations in all four countries, for younger and older cohorts and for children who experienced changes in living standards. For the older cohort, despite the timing of the first survey at age 7–8 years, which is beyond the critical period of 1,000 days, there are lasting influences of early poverty, even for those who experienced changes in wealth. Conclusions Household wealth in early life matters for physical growth with conditions of poverty and deprivation influencing growth faltering even beyond the 1,000 days window. The influences of early childhood poverty, so prevalent among children in low- and middle-income countries, must be addressed by policies and programs targeting early life but also focusing on older children experiencing growth faltering.Background Stunting, a form of anthropometric failure, disproportionately affects children in developing countries with a higher burden on children living in poverty. How early life deprivation affects physical growth over various life stages is less well-known. Objective We investigate the short- and long-run associations between household wealth in early life with physical growth in childhood in four low- and middle-income countries to understand the persistent implications of early life conditions of poverty and resource constraints on physical growth. Design Longitudinal study of eight cohorts of children in four countries - Ethiopia, India, Peru, and Vietnam (n=10,016) - ages 6 months to 15 years, using data from the Young Lives project, 2002-2009. Physical growth outcomes are standardized height-for-age z-scores (HAZ) and stunting. The key exposure is household wealth measured at baseline using a wealth index, an asset-based indicator. Covariates include childs age and sex, caregivers educational status, household size, and place of residence. Results Baseline wealth index is significantly associated with higher physical growth rates as suggested by higher HAZ and lower odds of stunting. We found these associations in all four countries, for younger and older cohorts and for children who experienced changes in living standards. For the older cohort, despite the timing of the first survey at age 7-8 years, which is beyond the critical period of 1,000 days, there are lasting influences of early poverty, even for those who experienced changes in wealth. Conclusions Household wealth in early life matters for physical growth with conditions of poverty and deprivation influencing growth faltering even beyond the 1,000 days window. The influences of early childhood poverty, so prevalent among children in low- and middle-income countries, must be addressed by policies and programs targeting early life but also focusing on older children experiencing growth faltering.