Deprivation and Mortality at the Town Level in Busan, Korea: An Ecological Study
2
조회
0
다운로드
21
인용
0
참고문헌
키워드
초록
Objectives: Busan is reported to have the highest mortality rate among 16 provinces in Korea, as well as considerable health inequality across its districts. This study sought to examine overall and cause-specific mortality and deprivation at the town level in Busan, thereby identifying towns and causes of deaths to be targeted for improving overall health and alleviating health inequality. Methods: Standardized mortality ratios (SMRs) for all-cause and four specific leading causes of death were calculated at the town level in Busan for the years 2005 through 2008. To construct a deprivation index, principal components and factor analysis were adopted, using 10% sample data from the 2005 census. Geographic information system (GIS)mapping techniques were applied to compare spatial distributions between the deprivation index and SMRs. We fitted the Gaussian conditional autoregressive model (CAR) to estimate the relative risks of mortality by deprivation level,controlling for both the heterogeneity effect and spatial autocorrelation. Results: The SMRs of towns in Busan averaged 100.3, ranging from 70.7 to 139.8. In old inner cities and towns reclaimed for replaced households, the deprivation index and SMRs were relatively high. CAR modeling showed that gaps in SMRs for heart disease, cerebrovascular disease, and physical injury were particularly high. Conclusions: Our findings indicate that more deprived towns are likely to have higher mortality, in particular from cardiovascular disease and physical injury. To improve overall health status and address health inequality, such deprived towns should be targeted.
Abstract
Objectives: Busan is reported to have the highest mortality rate among 16 provinces in Korea, as well as considerable health inequality across its districts. This study sought to examine overall and cause-specific mortality and deprivation at the town level in Busan, thereby identifying towns and causes of deaths to be targeted for improving overall health and alleviating health inequality. Methods: Standardized mortality ratios (SMRs) for all-cause and four specific leading causes of death were calculated at the town level in Busan for the years 2005 through 2008. To construct a deprivation index, principal components and factor analysis were adopted, using 10% sample data from the 2005 census. Geographic information system (GIS)mapping techniques were applied to compare spatial distributions between the deprivation index and SMRs. We fitted the Gaussian conditional autoregressive model (CAR) to estimate the relative risks of mortality by deprivation level,controlling for both the heterogeneity effect and spatial autocorrelation. Results: The SMRs of towns in Busan averaged 100.3, ranging from 70.7 to 139.8. In old inner cities and towns reclaimed for replaced households, the deprivation index and SMRs were relatively high. CAR modeling showed that gaps in SMRs for heart disease, cerebrovascular disease, and physical injury were particularly high. Conclusions: Our findings indicate that more deprived towns are likely to have higher mortality, in particular from cardiovascular disease and physical injury. To improve overall health status and address health inequality, such deprived towns should be targeted.
참고문헌 (39)
- The 5th regional health care planning (2011-2014), "Busan Metropolitan City", Busan Metropolitan City, ~ (2011)
- Closing the gap in a generation: health equity through action on the social determinants of health: final report of the Commission on Social Determinants of Health, "WHO Commission on Social Determinants of Health; World Health Organization", World Health Organization, ~ (2008)
- 2008 life tables for Korea, "Korea National Statistical Office", Korea National Statistical Office, ~ (2009)
- Townsend P, "Health and deprivation: inequality and the North" (1988), Croom Helm
- Carstairs V, "Deprivation: explaining differences in mortality between Scotland and England and Wales", BMJ, 299(6704), pp.886~889 (1989)
- Jarman B, "Underprivileged areas: validation and distribution of scores", Br Med J (Clin Res Ed), 289(6458), pp.1587~1592 (1984)
- 정백근, "우리나라에서의 지역의 물질적 결핍수준과 15-64세 인구 표준화사망비의 관계", 예방의학회지, 39(1), pp.46~52 (2006), 대한예방의학회
- Kim MH, "Multilevel analysis on the association between socioeconomic factors and the metabolic syndrome", 석사, pp.2002
- 손미아, "직업,교육수준 그리고 물질적 결핍이 사망률에 미치는 영향", 예방의학회지, 35(1), pp.10~82 (2002), 대한예방의학회
- 신호성, "표준화사망비와 지역결핍지수의 상관관계: 지역사회 통합결핍지수 개발", 예방의학회지, 42(6), pp.392~402 (2009), 대한예방의학회
- 2008 cause of death statistics by provinces, "Korea National Statistical Office", Korea National Statistical Office, ~ (2009)
- Carstairs V, "Deprivation indices: their interpretation and use in relation to health", J Epidemiol Community Health, 49(2), pp.S3~S8 (1995)
- Gordis L, "Epidemiology. 4th ed", pp.2009, Elsevier
- Vandenbroucke JP, "A shortcut method for calculating the 95 per cent confidence interval of the standardized mortality ratio", Am J Epidemiol, 115(2), pp.303~304 (1982)
- Townsend P, "Deprivation", J Soc Policy, 16(2), pp.125~146 (1987)
- Pampalon R, "A deprivation index for health and welfare planning in Quebec", Chronic Dis Can, 21(3), pp.104~113 (2000)
- Environment policy study for protecting low social class in city I-1, "Chu JM", Korea Environment Institute, ~ (2007)
- The English indices of deprivation 2004: summary (revised), "Great Britain", Office of the Deputy Prime Minister, ~ (2004)
- 윤태호, "사회계급 분포와 사망률과의 연관성", 보건행정학회지, 13(4), pp.99~114 (2003), 한국보건행정학회
- Benach J, "Material deprivation and leading causes of death by gender: evidence from a nationwide small area study", J Epidemiol Community Health, 55(4), pp.239~245 (2001)
- Moran PA, "Notes on continuous stochastic phenomena", Biometrika, 37(1), pp.17~23 (1950)
- Besag J, "Bayesian image restoration, with two applications in spatial statistics", Ann Inst Stat Math, 43(1), pp.1~20 (1991)
- Brooks SP, "General methods for monitoring convergence of iterative simulations", J Comput Graph Stat, 7(4), pp.434~455 (1998)
- Nakaya T, "An information statistical approach to the modifiable areal unit problem in incidence rate maps", Environ Plan A, 32(1), pp.91~110 (2000)
- Talbot RJ, "Underprivileged areas and health care planning: implications of use of Jarman indicators of urban deprivation", BMJ, 302(6773), pp.383~386 (1991)
- Slachtová H, "Czech socio-economic deprivation index and its correlation with mortality data", Int J Public Health, 54(4), pp.267~273 (2009)
- Elliott P, "Spatial epidemiology: current approaches and future challenges", Environ Health Perspect, 112(9), pp.998~1006 (2004)
- Lawson A, "Bayesian disease mapping: hierarchical modeling in spatial epidemiology" (2009), CRC Press
- Beaglehole R, "Medical management and the decline in mortality from coronary heart disease", Br Med J (Clin Res Ed), 292(6512), pp.33~35 (1986)
- Bots ML, "Decline of coronary heart disease mortality in The Netherlands from 1978 to 1985: contribution of medical care and changes over time in presence of major cardiovascular risk factors", J Cardiovasc Risk, 3(3), pp.271~276 (1996)
- Hunink MG, "The recent decline in mortality from coronary heart disease, 1980-1990. The effect of secular trends in risk factors and treatment", JAMA, 277(7), pp.535~542 (1997)
- Thunhurst C, "The analysis of small area statistics and planning for health", Statistician, 34(1), pp.93~106 (1985)
- Health promotion strategies and programmes development for health inequalities alleviation, "Shin YJ", Ministry for Health, Welfare and Family Affairs, ~ (2009)
- Deguen S, "A small-area ecologic study of myocardial infarction, neighborhood deprivation, and sex: a Bayesian modeling approach", Epidemiology, 21(4), pp.459~466 (2010)
- Domínguez-Berjón MF, "Mortality and socioeconomic deprivation in census tracts of an urban setting in southern Europe", J Urban Health, 82(2), pp.225~236 (2005)
- Caranci N, "The Italian deprivation index at census block level: definition, description and association with general mortality", Epidemiol Prev, 34(4), pp.167~176 (2010)
- Dyck I, "Geographies of women’s health" (2001), Routledge
- Molinari C, "The relationship of community quality to the health of women and men", Soc Sci Med, 47(8), pp.1113~1120 (1998)
- Rey G, "Ecological association between a deprivation index and mortality in France over the period 1997 - 2001: variations with spatial scale, degree of urbanicity, age, gender and cause of death", BMC Public Health, 9, pp.33~ (2009)