Deaths from pesticide poisoning in South Korea: trends over 10 years

Objectives  Pesticide poisoning is a major cause of death in the world. The objective of this study was to examine the trends of pesticide poisoning deaths and their epidemiologic characteristics in South Korea. Methods  We evaluated the age-standardized mortality rates from pesticide-related deaths (intentional self-poisoning, accidental poisoning, assault, undetermined intent poisoning) in South Korea from 1996 through 2005, using registered death data obtained from the Korea National Statistical Office. The regional rurality index was calculated and correlation analyses were used to estimate the association with pesticide poisoning mortality. Results  The number of pesticide poisoning deaths from 1996 through 2005 was 25,360, which accounted for 58.3% of the total poisoning fatalities. The age-standardized mortality rates by pesticide poisoning significantly increased from 4.42 to 6.42 per 100,000 population, whereas the total death rate was decreased in the same period. Intentional self-poisoning was the majority cause of death from pesticides (84.8% of total pesticide poisoning deaths). The majority of the pesticide poisoning deaths were men, over 50 years old, with education less than middle school, and residing in rural areas. The rate of pesticide poisoning deaths was the highest in the farming period and was significantly correlated with the rurality index of each region. Conclusions  Pesticide poisoning deaths substantially increased during the 10-year study period, and showed demographic, seasonal and regional variations. More intensive intervention efforts to reduce pesticide mortality should become a public health priority in South Korea.     

Does community capacity influence self-rated health? Multilevel contextual effects in Seoul,Korea

This study examined the relationship between community-level contextual effects and self-rated health (SRH) based on the perspective of community capacity rather than social capital. Community capacity for mobilization is broad cooperation for networking among indigenous social agents and grassroots organizations that may serve as potential resources. The idea of community capacity is rooted in the philosophy that a community not only faces problems but also possesses the necessary resources to solve its problems. We used nationally representative data from South Korea, 2010, drawing on 14,228 residents in 404 communities. Community capacity was measured at two levels: an individual-level indicator of community satisfaction, and community-level indicators of participation rate in community organizations, number of community-based organizations (CBOs), and number of volunteer work camps (VWCs). The outcome variable was SRH, which was categorized into two groups: the low-SRH and high-SRH groups. Confounders included gender, age, and income at the individual level, and aggregate length of residency, financial independence ratio, and aggregate income at the community level. We estimated the effects of community capacity on SRH using hierarchical generalized linear models. The likelihood of belonging to the group having low-SRH is significantly high among those respondents living in places with lower community capacity at the community level, that report lower community satisfaction, and that have lower income at the individual level. After controlling for socio-economic confounders, the odds ratios were attenuated but remained significant in the final model, which included the gender-specific model. This study revealed that SRH is related to the level of community capacity for mobilization. It is probably because CBOs and VWCs not only provide necessary information and complementary services but also play an active role in identifying and resolving health problems therein. Thus, community capacity building warrants serious consideration for a community-based health promotion.     

Is precarious employment damaging to self-rated health? Results of propensity score matching methods,using longitudinal data in South Korea

We aimed to evaluate the health effects of precarious employment based on a counterfactual framework, using the Korea Labor and Income Panel Survey data. At the 4th wave (2001), information was obtained on 1991 male and 1378 female waged workers. Precarious work was defined on the basis of workers employed on a temporary or daily basis, part-time, or in a contingent (fixed short-term) job. The outcome was self-rated health with five response categories. Confounding factors included age, marital status, education, industry and occupation of current employment, household income, residential area, and prior health status. Propensity scores for each individual to be a precarious worker were calculated from logistic models including those covariates, and based on them, precarious workers were matched to non-precarious workers. Then, we examined the effects of precarious employment on health and explored the potential intermediary variables, using ordered logistic Generalized Estimating Equations models. All analyses were performed separately by gender. Precarious workers were found to be in a lower socioeconomic position and to have worse health status. Univariate matched analyses showed that precarious employment was associated with worse health in both men and women. By further controlling for socio-demographic covariates, the odds ratios were attenuated but remained significant. Job satisfaction, especially as related to job insecurity, and monthly wage further attenuated the effects. This suggests that to improve health status of precarious workers in Korea, policy strategies need to tackle the channeling of the socially disadvantaged into precarious jobs. Also, regulations to eliminate discrimination against precarious workers in working conditions or material reward should be introduced and enforced. There is no doubt that job insecurity, which is pervasive among workers in Korea, should be minimized by suspending market-oriented labor policies which rely on quantitative flexibility.     

Comparing self-rated health and self-assessed change in health in a longitudinal survey: Which is more valid?

Self-rated health (SRH) is commonly used in longitudinal analyses as a repeated outcome measure. This assumes that computed changes in SRH over time truly represent within-individual changes in underlying health. The longitudinal validity of SRH, however, is threatened by ceiling effects (where people reporting the highest level of SRH cannot report subsequent improved health), insensitivity to small changes within SRH categories, reference group effects (where individuals assess their health changes relative to their peers) and stability in SRH even when change in underlying health is occurring. We assessed the longitudinal validity of SRH by comparing computed changes in SRH with a measure of self-assessed change in health (SACH). We used two waves of data (2003-2005) from the New Zealand longitudinal Survey of Family, Income and Employment (SoFIE). Computed change in SRH and SACH were compared directly and also in regression models using an objective measure of health outcome change (hospitalisations within the past year). Computed change in SRH and SACH were not well correlated, consistent with ceiling and/or categorisation effects in SRH. In regression models, SACH was more strongly predictive of hospitalisation than computed change in SRH (worse SACH was associated with an increased odds of hospitalisation of 3.7 compared to 1.8 for decreased computed change in SRH). SACH may be affected by recall bias, but if SRH is used as a repeated outcome measure in longitudinal analyses, results may also be biased, if change in SRH does not occur in response to significant health events.     

Ethnic differences in self-rated and functional health: does immigrant status matter?

The current study examines self-rated health status and functional health differences between first-generation immigrant and Canadian-born (CB) persons who share the same ethnocultural origin, and the extent to which such differences reflect social structural and health-related behavioural contexts. Multivariate analyses of data from the 2000/2001 Canadian Community Health Survey indicate that first-generation immigrants of Black and French ethnicity tend to have better health than their CB counterparts, while the opposite is true for those of South Asian and Chinese origins, providing evidence that for these groups, immigrant status matters. West Asians and Arabs and other Asian groups are advantaged in health regardless of country of birth. Health differences between ethnic foreign-born and CB persons generally converge after controlling for sociodemographic, socioeconomic status (SES), and lifestyle factors. Analysis of the data does however reveal extensive ethnocultural disparities in self-rated and functional health within both the immigrant and CB populations. Implications for health care policy and programme development are discussed.     

Lifestyle-related attitudes: do they explain self-rated health and life-satisfaction?

Background

Strategies to improve public health may benefit from targeting specific lifestyles associated with poor health behaviors and outcomes. The aim of this study was to characterize and examine the relationship between health and lifestyle-related attitudes (HLAs) and self-rated health and life-satisfaction.

Methods

Secondary analyses were conducted on data from a 2012 community wellness survey in Kirklees, UK. Using a validated HLA tool, respondents (n?=?9130) were categorized into five segments: health conscious realists (33%), balanced compensators (14%), live-for-todays (18%), hedonistic immortals (10%), and unconfident fatalists (25%). Multivariate regression was used to examine whether HLAs could explain self-rated health using the EQ-5D visual analog scale (EQ-VAS) and life-satisfaction. Health conscious realists served as the reference group.

Results

Self-rated health differed by HLA, with adjusted mean EQ-VAS scores being significantly higher (better) among balanced compensators (1.15, 95% CI 0.27, 2.03) and lower scores among unconfident fatalists (??9.02, 95% CI ??9.85, ??8.21) and live-for-todays (??1.96, 95% CI ??2.80, ??1.14). Balanced compensators were less likely to report low life-satisfaction (OR 0.75, 95% CI 0.62, 0.90), while unconfident fatalists were most likely to have low life-satisfaction (OR 3.51, 95% CI 2.92, 4.23).

Significance

Segmentation by HLA explained differences in self-rated health and life-satisfaction,with unconfident fatalists being a distinct segment with significantly worse healthperceptions and life-satisfaction. Health promotion efforts may benefit from considering the HLAsegment that predominates a patient group, especially unconfident fatalists.

     

Climatological variability of air temperature and precipitation observed in South Korea for the last 50 years

This study analyzed decadal variability in the near-surface air temperature and precipitation and key climatological elements in South Korea from 1960 to 2010. The decadal trend toward increases in annual temperature was conspicuous in large cities at a rate of 0.29 ± 0.08 °C decade^?1 compared with 0.11 ± 0.08 °C decade^?1 in other stations. The increasing rate in January temperatures has resulted in a rise in annual temperature. The 1990s marked an all-time high in decadal January temperatures, which caused a shift of ?3 °C in the northern boundary of the subtropical climate zone, compared with the 1960s–1980s. The shift of ?3 °C isotherm to the north occurred in the inland and on the western parts of South Korea in the 1990s. The increasing trend of air temperature in Korea is associated with the general increase in greenhouse gases in East Asia. The decadal precipitation trend has caused a large increase in summer precipitation at a rate of 40.6 ± 4.3 mm decade^?1, resulting in an increase of annual precipitation of 27.7 ± 5.5 mm decade^?1. The spatial variability of the overlapping 30-year precipitation grew due to increases in precipitation on the southern and eastern parts of South Korea from 1981 to 2010. The northward shift of the subtropical zone has resulted in a rise of heavy rainfall days (≥30 mm day^?1) from 1981 to 2010.     

Social support and self-rated health revisited: is there a gender difference in later life?

This study examines the physical, behavioral, emotional and social determinants of self-rated health among Chinese older persons, and investigates if the effect of social support varies by gender. A representative sample of 1589 elderly community dwellers in Hong Kong were interviewed using a structured questionnaire. Gender difference in the effect of social support was tested by an interaction term, 'gender x social support', in a hierarchical regression analysis. The frequency of falling ill, the number of chronic illnesses, sleep quality, mobility and positive emotions were most important determinants of self-rated health. The effect of social support was completely redundant when these factors were taken into account. The interaction term 'gender x social support' was significant and indicated a stronger effect for women, but the effect size was negligible (adding only 0.3% to the explained variance). This suggests that the effect of social support by and large is gender free. These findings suggest a high degree of similarity in the determinants of self-rated health between Western and Chinese older populations.     

Income inequality and elderly self-rated health in São Paulo,Brazil

PurposeTo test the association between income inequality and elderly self-rated health and to propose a pathway to explain the relationship.MethodsWe analyzed a sample of 2143 older individuals (60 years of age and over) from 49 distritos of the Municipality of São Paulo, Brazil. Bayesian multilevel logistic models were performed with poor self-rated health as the outcome variable.ResultsIncome inequality (measured by the Gini coefficient) was found to be associated with poor self-rated health after controlling for age, sex, income and education (odds ratio, 1.19; 95% credible interval, 1.01–1.38). When the practice of physical exercise and homicide rate were added to the model, the Gini coefficient lost its statistical significance (P > .05). We fitted a structural equation model in which income inequality affects elderly health by a pathway mediated by violence and practice of physical exercise.ConclusionsThe health of older individuals may be highly susceptible to the socioeconomic environment of residence, specifically to the local distribution of income. We propose that this association may be mediated by fear of violence and lack of physical activity.     

Do Latino immigrants link self-rated health with BMI and health behaviors?

OBJECTIVES: To assess the association between self-rated health, obesity, and self-reported health behaviors of Latino immigrants METHODS: Two hundred two Latino immigrants (mean age=31.63, SD=8.30, 54% female) participated in a 15-minute interview and height and weight measurements. RESULTS: Participants reporting good to excellent health reported engaging in physical activity during the past month (P<.05), eating more fruits and vegetables (P<.001 and P<.01 respectively), and watching less television (P<.01) than did those who reported fair to poor health. Self-rated health was not associated with BMI. CONCLUSIONS: Greater attention to Latinos' self-perception of health in relation to weight is needed to develop interventions to improve health status.     

Health care reform in South Korea: success or failure?

South Korea is one of the world's most rapidly industrializing countries. Along with industrialization has come universal health insurance. Within the span of 12 years, South Korea went from private voluntary health insurance to government-mandated universal coverage. Since 1997, with the intervention of the International Monetary Fund, Korean national health insurance (NHI) has experienced deficits and disruption. However, there are lessons to be drawn for the United States from the Korean NHI experience.     

Trajectories of self-rated health in the last 15 years of life by cause of death

Poor self-rated health is associated with increased risk of mortality, but no previous study has examined how long-term trajectories of self-rated health differ among people at risk of subsequent death compared to those who survive. Data were drawn from French occupational cohort (the GAZEL study, 1989–2010). This nested case–control study included 915 deceased men and women and 2578 controls matched for sex, baseline age, occupational grade and marital status. Self-rated health was measured annually and dichotomized into good versus poor health. Trajectories of poor self-rated health up to 15 years were compared among people who subsequently died to those who survived. Participants contributed to an average 10.3 repeated assessments of self-rated health. Repeated-measures log-binomial regression analysis with generalized estimating equations showed an increased prevalence of poor self-rated health in cases 13–15 years prior to death from ischemic and other cardiovascular disease [multivariable-adjusted risk ratio 2.06, 95 % confidence interval (CI) 1.55–2.75], non-smoking-related cancers (1.57, 95 % CI 1.30–1.89), and suicide (1.78, 95 % CI 1.00–3.16). Prior to death from ischemic and other cardiovascular disease, increased rates of poor self-rated health were evident even among persons who were free of cardiovascular diseases (2.05, 95 % CI 1.50–2.78). In conclusion, perceptions of health diverged between the surviving controls and the deceased already 15 years prior to death. For cardiovascular mortality, decline in self-rated health started before diagnosis of the disease leading to death. The findings suggest that declining self-rated health might capture pathological changes before and beyond the disease diagnosis.     

Whiners and deniers – What does self-rated health measure?

Self-rated health is a widely used measure of health typically obtained from a question, “How do you rate your health?” Despite the measure’s popularity, debates continue as to what exactly self-rated health captures. This study augments the rich literature on the construct of self-rated health using a unique measurement approach. We conceptualize self-rated health as consisting of two components: latent health and reporting behaviour. We operationalize a preference-standardized health-related quality of life as a measure of latent health, and its systematic deviation from self-rated health as a measure of reporting behaviour. Using the 2005 Canadian Community Health Survey, we assess comparatively how the deviations between self-rated health and latent health, measured by the Health Utilities Index Mark 3, vary systematically by demographic, socioeconomic, and cultural factors. We present reporting behaviour by these factors in terms of pessimism and optimism relative to the assessment of the average Canadian. Our analysis shows reporting behaviour statistically and clinically significantly varies by age and socioeconomic status: those aged 80+ years and those with less income and education exhibit optimism about their health. In addition, our analysis indicates a tendency for persons with healthier lifestyles to be slightly pessimistic about their health. Our results imply that it may be misleading to take self-rated health at face value as a measure of health status for applications where preferences should be standardized. For this popular measure to continue to play an important role in population health research and policy development, its users must acknowledge and understand the determinants of self-rated health, including reporting behaviour.     

The association between network social capital and self-rated health: Pouring old wine in new bottles?

This study examines whether there is an association between network social capital and self-rated health after controlling for social support. Moreover, we distinguish between network social capital that emerges from strong ties and weak ties. We used a cross-sectional representative sample of 815 adults from the Belgian population. Social capital is measured with the position generator and perceived social support with the MOS Social Support-scale. Results suggest that network social capital is associated with self-rated health after adjustment for social support. Because different social classes have access to different sets of resources, resources of friends and family from the intermediate and higher service classes are beneficial for self-rated health, whereas resources of friends and family from the working class appear to be rather detrimental for self-rated health. From a health-promoting perspective, these findings indicate that policy makers should deal with the root causes of socioeconomic disadvantages in society.     

Exercise participation and self-rated health: Do common genes explain the association?

The purpose of this study is to investigate whether there is an association between exercise participation and self-rated health and whether this association can be explained by common genes and/or common environmental influences. In a sample of 5,140 Dutch adult twins and their non-twin siblings from 2,831 families, exercise participation (sedentaries, light or moderate, vigorous exercisers) and self-rated health were assessed by survey. To investigate the etiology of the association, bivariate genetic models using structural equation modeling were applied to the data. The correlation between exercise participation and self-rated health is significant but modest (r = 0.20). Exercise participation and self-rated health are both heritable (around 50% of the variance of both phenotypes is explained by genetic factors). The genetic factors influencing exercise participation and self-rated health partially overlap (r = 0.36) and this overlap fully explains their phenotypic correlation. We conclude that the association between exercise and self-rated health can be explained by genes predisposing to both exercise participation and self-rated health. These genes may directly influence both phenotypes (pleiotropy). Alternatively, genes that affect exercise or self-rated health may indirectly influence the other phenotype through a causal relationship. We propose that identification of the genes that cause differences in␣exercise behavior will help resolve the issue of causality.     

Trends in income-related health inequalities in self-assessed health in Korea, 1998–2011

This study assesses income-related health inequalities in self-assessed health (SAH) and its trend from 1998 to 2011 in Korea that covers important time periods of financial crisis and post-crisis. Data came from the Korean National Health and Nutrition Examination Survey from 1998 to 2011. A population-representative sample aged 46 years and older was analysed. SAH was used as an indicator of health status, with household equivalence income as a proxy for socio-economic position. Age-adjusted prevalence rates of SAH were analysed to estimate both absolute and relative measures of health inequalities and the trend over time by the relative index of inequality (RII) and the slope index of inequality (SII). Results indicated that the highest level of health inequalities was found among men aged 46–59 years, especially in 2001 and 2005. For men, there was no clear, consistent pattern of increase or decrease in the trend over time. On the other hand, increasing trends in the RII and SII were found for women, except for women aged 46–59 years who reported a decreasing trend in the SII. Trends in health inequalities over time were influenced by economic crisis, demonstrating the need for macro-level economic policies as well as health policies addressing health gaps.     

Health risks and informal employment in South Africa: does formality protect health?

Background:

The association between work and health has not been well explored in the context of economically developing countries, largely due to inadequate data.

Objectives:

The objective of this study was to identify the association between informal wage work and health in South Africa using a newly available data set that includes detailed information on both employment and health.

Methods:

To explore the relationship between formality, work, and health in South Africa, data from the first (2008) wave of the National Income Dynamic Study (NIDS) were analyzed. We constructed a “formality index” which represents work arrangements on a continuum of formality to informality allowing for a more nuanced analysis of the association between wage work and health.

Results:

We found that formality of employment was significantly associated with health in South Africa, but that the protective effect of formality in employment on health was largely derived from the higher levels of income earned through more formal types of employment. Nevertheless, we did find that the association between informality and poor health was significantly greater for women in wage employment than for males.