Neighborhood Deprivation and Unmet Health Care Needs: A Multilevel Analysis of Older Individuals in South Korea

Effect of Regional Deprivation and Dental Care Resources on the Unmet Dental Care Needs due to Cost of Older Individuals in South Korea

OBJECTIVES

To provide policy-relevant evidence to reduce oral health disparities and improve dental care accessibility by considering characteristics of urban and rural areas.

BACKGROUND

Individual and regional factors influence dental care access. Regional poverty and limited dental resources among older adults may contribute to unmet dental care needs due to cost.

MATERIALS AND METHODS

A multilevel logistic regression analysis was conducted to examine the association between regional factors (regional deprivation, number of dentists per 10,000 and number of dental offices per 100,000) and unmet dental care needs due to cost. The analysis was adjusted for individual factors, such as sex, education, marital status, household income, subjective health status, chewing difficulty and limited daily activities, as determined by the 2021 Korean Community Health Survey (KCHS; n = 47,802).

RESULTS

The prevalence of unmet dental care needs due to cost was 4.94% in urban and 4.80% in rural older adults. Individuals who lived in higher regional deprivation (poorer regions) were less likely to experience unmet dental care needs due to cost (OR = 0.66, 95% CI = 0.47-0.94) only in rural areas. Individuals residing in areas with a higher number of dentists per 10,000 were more likely to experience unmet dental care needs due to cost in urban (OR = 2.19, 95% CI = 1.01-4.73) and rural (OR = 1.97; 95% CI = 1.16-3.34). Household income and oral health status were the strongest predictors of unmet dental care needs due to cost.

CONCLUSIONS

The influence of regional poverty, dentist distribution and individual factors should be considered in developing policies to reduce the unmet dental care needs of older Koreans.

Socioeconomic inequality in health-related quality of life among Korean adults with chronic disease: an analysis of the Korean Community Health Survey

OBJECTIVES

Health-related quality of life is crucial for people dealing with chronic illness. This study investigated the quality of life in individuals with 5 common chronic conditions in Korea. We also analyzed socioeconomic factors such as education, income, occupation, and urbanization to identify determinants of inequality.

METHODS

Using 2016 Korea Community Health Survey data, we examined individuals aged 30 or older with chronic diseases (diabetes, hypertension, cardiovascular disease, hyperlipidemia, arthritis) using the EuroQol 5-Dimension 3 Level tool. We analyzed the associations between socioeconomic factors (education, income, occupation, urbanization) and quality of life using descriptive statistics and regression analysis. Inequality indices (relative inequality index, absolute inequality index) were used to measure inequality in quality of life.

RESULTS

Individuals with higher income levels showed a 1.95-fold higher likelihood of a better quality of life than those with the lowest income. The lowest income group had higher odds of mobility (adjusted odds ratio [aOR], 2.2), self-care (aOR, 2.1), activity limitations (aOR, 2.4), pain/discomfort (aOR, 1.8), and anxiety/depression (aOR, 2.3). Educational disparities included a 3-fold increase in mobility and daily activity problems for those with elementary or lower education. Well-educated participants had a 1.94 times higher quality of life, with smaller differences in anxiety/depression and self-management. The income gap accounted for 14.1% of variance in quality-of-life disparities.

CONCLUSIONS

Addressing socioeconomic disparities in the quality of life for individuals with chronic diseases necessitates tailored interventions and targeted health policies. This research informs policymakers in developing focused initiatives to alleviate health inequities. It emphasizes the importance of mental health support and ensuring affordable, accessible healthcare services.

What are the factors affecting older adults' experience of unmet healthcare needs amid the COVID-19 pandemic in Korea?

BACKGROUND

Unmet healthcare need is a critical indicator, showing a plausible picture of how the healthcare system works in the unprecedented pandemic situation. It is important to understand what factors affect healthcare services of older adults in the midst of the outbreak, as this could help identify service- and performance-related challenges and barriers to the healthcare system. This study aimed to identify factors associated with unmet healthcare needs among the older Korean population amid the COVID-19 pandemic.

METHODS

Cross-sectional data were used from the Experience Survey on Healthcare Use of Older Adults during the COVID-19 (COVID-19 Survey) in Korea (n = 1,917). Our main outcome, unmet healthcare need, was measured based on self-reported experience of overall, regular, and irregular outpatient care services-related unmet healthcare needs. Independent variables were selected based on previous studies on determinants of unmet healthcare need during the COVID-19 pandemic and Andersen's expanded behavioural model, which theorizes that healthcare-seeking behaviours are driven by psychosocial, enabling, and need factors.

RESULTS

Using multiple logistic regression models, we identified a good understanding of the nation's health system was associated with lower likelihood of all types of unmet healthcare needs among older Korean adults (OR: 0.39, 95%CI: 0.25-0.61; OR: 0.36, 95%CI: 0.20-0.63; OR: 0.41, 95%CI: 0.23-0.75). Decreased social activities (i.e., shopping and visiting family members) and worsened psychological health issues (i.e., increased anxiety & nervousness and greater difficulty sleeping) were also factors affecting overall and irregular outpatient services-related unmet needs.

CONCLUSIONS

To ensure timely access to necessary healthcare services for older adults in the era of the COVID-19 outbreak, improving older adult's understanding on how the healthcare system works is necessary. Moreover, changes in psychological condition and daily activities due to COVID-19 should be considered as possible barriers to healthcare services among older adults during the global pandemic.

PhaVIP: Phage VIrion Protein classification based on chaos game representation and Vision Transformer

MOTIVATION

As viruses that mainly infect bacteria, phages are key players across a wide range of ecosystems. Analyzing phage proteins is indispensable for understanding phages' functions and roles in microbiomes. High-throughput sequencing enables us to obtain phages in different microbiomes with low cost. However, compared to the fast accumulation of newly identified phages, phage protein classification remains difficult. In particular, a fundamental need is to annotate virion proteins, the structural proteins, such as major tail, baseplate, etc. Although there are experimental methods for virion protein identification, they are too expensive or time-consuming, leaving a large number of proteins unclassified. Thus, there is a great demand to develop a computational method for fast and accurate phage virion protein (PVP) classification.

RESULTS

In this work, we adapted the state-of-the-art image classification model, Vision Transformer, to conduct virion protein classification. By encoding protein sequences into unique images using chaos game representation, we can leverage Vision Transformer to learn both local and global features from sequence "images". Our method, PhaVIP, has two main functions: classifying PVP and non-PVP sequences and annotating the types of PVP, such as capsid and tail. We tested PhaVIP on several datasets with increasing difficulty and benchmarked it against alternative tools. The experimental results show that PhaVIP has superior performance. After validating the performance of PhaVIP, we investigated two applications that can use the output of PhaVIP: phage taxonomy classification and phage host prediction. The results showed the benefit of using classified proteins over all proteins.

AVAILABILITY AND IMPLEMENTATION

The web server of PhaVIP is available via: https://phage.ee.cityu.edu.hk/phavip. The source code of PhaVIP is available via: https://github.com/KennthShang/PhaVIP.

Urban-Rural Differences in the Prevalence of Depressive Symptoms in Korean Adults

This study aimed to investigate the prevalence of depression among Koreans living in urban and rural areas, stratified by socioeconomic status. The study included 216,765 participants from the 2017 Korean Community Health Survey. Depressive symptoms were assessed using the PHQ-9, with a score of 10 or higher indicating depressive symptoms. Residences with the words Eup and Myeon in their addresses were categorized as rural areas, and residences with Dong in their addresses as urban areas. Socioeconomic status was evaluated by household income and education level. A Poisson regression analysis with sampling weights was conducted and adjusted for demographic, lifestyle, socioeconomic status, and comorbidity. The adjusted prevalence rate of depressive symptoms was 3.33% (95% CI, 3.21-3.45) in urban areas and 2.59% (95% CI, 2.43-2.74) in rural areas. The prevalence of depressive symptoms in urban areas was 1.29 times (95% CI, 1.20-1.38) higher than in rural areas. The prevalence rate ratio for depressive symptoms in urban areas compared to rural areas sorted by monthly incomes was 1.39 (95% CI, 1.28-1.51) for less than 2 million won, 1.22 (95% CI, 1.06-1.41) for 2 to 3.99 million won, and 1.09 (95% CI, 0.90-1.32) for more than 4 million won, and the urban-rural difference was more evident in lower household income subjects (p for interaction=0.033). However, urban-rural differences did not differ according to sex, age, or education level. In conclusion, we found urban-rural differences in depressive symptoms in a representative sample of Koreans, and revealed that these differences may vary according to income level. These results suggest that mental health policy must consider the health disparities according to residence and income.

The Older Persons' Index of Multiple Deprivation: Measuring the deprivation circumstances of older populations in Aotearoa New Zealand

Existing indices of multiple deprivation exclude indicators specifically relevant to the population aged ≥65 years. In this study we create a whole-of-population cohort of people aged ≥65 years living in private dwellings and who completed the 2013 New Zealand Census of Populations and Dwellings to create an Older Persons' Index of Multiple Deprivation (OPIMD). We combined 22 indicators representing 6 domains of deprivation (Income, Housing, Health, Assets, Connectedness and Geographic access) to establish this individual-level measure of deprivation. We used smoking data from the census to validate the OPIMD and describe the geography of the OPIMD by District Health Board, contrasting these patterns with a conventional area deprivation index. The OPIMD has the potential to inform policies concerning resource allocation for the older population. An accompanying website with an interactive atlas and an online OPIMD calculator is available for wider use of the data. Further research is required to explore associations between the OPIMD and other major health and social outcomes affecting this population.

The Contribution of Material, Behavioral, Psychological, and Social-Relational Factors to Income-Related Disparities in Cardiovascular Risk Among Older Adults

Supplemental digital content is available in the text.

Understanding the factors underlying health disparities is vital to developing strategies to improve health equity in old age. Such efforts should be encouraged in Korea.

Association between community deprivation and practising health behaviours among South Korean adults: a survey-based cross-sectional study

OBJECTIVES

This study aimed to determine the association between community deprivation and poor health behaviours among South Korean adults.

DESIGN

This was a survey-based cross-sectional study.

SETTING AND PARTICIPANTS

Data of 224 552 participants from 244 communities were collected from the Korea Community Health Survey, conducted in 2015.

PRIMARY AND SECONDARY OUTCOME MEASURES

We defined health behaviours by combining three variables: not smoking, not high-risk drinking and walking frequently. Community deprivation was classified into social and economic deprivation.

RESULTS

Multilevel logistic analysis was conducted to determine the association of poor health behaviours through a hierarchical model (individual and community) for the 224 552 participants. Among them, 69.9% did not practice healthy behaviours. We found that a higher level of deprivation index was significantly associated with higher odds of not-practising healthy behaviours (Q3, OR: 1.15, 95% CI: 1.00 to 1.31; Q4 (highest), OR: 1.22, 95% CI: 1.06 to 1.39). Economic deprivation had a positive association with not-practising health behaviours while social deprivation had a negative association.

CONCLUSION

These findings imply that community deprivation levels may influence individual health behaviours. Accordingly, there is a need for enforcing the role of primary healthcare centres in encouraging a healthy lifestyle among the residents in their communities, developing national health policy guidelines for health equity and providing financial help to people experiencing community deprivation.