Area-based inequalities and distribution of healthcare resources for managing diabetes in South Korea: a cross-sectional multilevel analysis

Ha, Rangkyoung; Jung-Choi, Kyunghee

doi:10.1136/bmjopen-2021-055360

Cited by 3 publications

(2 citation statements)

References 57 publications

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“…These differences in medical access are also indirectly identified via the rates of non-critical comorbidities such as hypertension, diabetes, and dyslipidemia. 21 22 In our results, the rates of these chronic diseases tended to be lower in the low-income group and rural residents. However, the high prevalence of these chronic conditions in the high-income and urban residence groups may, paradoxically, be associated with higher medical availability for these diseases.…”

Section: Discussionsupporting

confidence: 45%

Effects of Socioeconomic Status and Residence Areas on Long-Term Survival in Patients With Early-Onset Dementia: The Korean National Health Insurance Service Database Study

et al. 2022

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Background Early-onset dementia (EOD) is still insufficiently considered for healthcare policies. We investigated the effect of socio-environmental factors on the long-term survival of patients with EOD. Methods This retrospective cohort study utilized the Korean National Health Insurance Database from 2007 to 2018. We enrolled 3,825 patients aged 40 to 65 years old with all types of dementia newly diagnosed in 2009 as EOD cases. We defined socioeconomic status using the national health insurance premium (NHIP) levels. Residential areas were classified into capital, metropolitan, city, and county levels. All-cause mortality was the primary outcome. Kaplan-Meier curves and log-rank tests were employed. Further, Cox-proportional hazards models were established. Results The mean survival of the fourth NHIP level group was 96.31 ± 1.20 months, whereas that of the medical-aid group was 85.53 ± 1.30 months ( P < 0.001). The patients living in the capital had a mean survival of 95.73 ± 1.34 months, whereas those living in the county had 89.66 ± 1.75 months ( P = 0.035). In the Cox-proportional hazards model, the medical-aid (adjusted hazard ratio [aHR], 1.67; P < 0.001), first NHIP level (aHR, 1.26; P = 0.012), and second NHIP level (aHR, 1.26; P = 0.008) groups were significantly associated with a higher long-term mortality risk. The capital residents exhibited a significantly lower long-term mortality risk than did the county residents (aHR, 0.82; P = 0.041). Conclusion Socioeconomic status and residential area are associated with long-term survival in patients with EOD. This study provides a rational basis for establishing a healthcare policy for patients with EOD.

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Section: Discussionsupporting

confidence: 45%

Effects of Socioeconomic Status and Residence Areas on Long-Term Survival in Patients With Early-Onset Dementia: The Korean National Health Insurance Service Database Study

et al. 2022

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“…It is a disease that requires not only drug treatment but also self-management. Due to the aging of the population and the development of diagnostic and treatment technologies, the timing of diabetes diagnosis is accelerating, and the period to manage diabetes is lengthening, making it essential to develop more active self-management habits [35,36]. The subject of disease management is the patient.…”

Section: Discussionmentioning

confidence: 99%

Five-year Trajectory about Screening for Complication of Diabetes Kidney Disease and Cardiovascular Disease Mortality : Focusing on Regional Difference

Han,

Kim,

et al. 2024

Kidney Blood Press Res

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Backgrounds: The overall screening rate for complication of diabetes kidney disease is improving; however, regional variations are increasing. It is necessary to select regions vulnerable to change and understand their characteristics. Methods: Group-based trajectory analysis was performed to derive change patterns in the complication of diabetes kidney disease screening rate in 244 regions using Community Health Survey data between 2015 and 2019. ANOVA test was conducted to examine the differences in regional characteristics and CVD in each change pattern. Results: The change patterns in complication of diabetes kidney disease screening rate were classified into four groups: high and rapidly increasing (Group 1, 5.2%), steady high (Group 2, 8.2%), moderate and increasing (Group 3, 52.9%), and low and slightly increasing (Group 4, 23.8%). Group 4 had many rural areas and worse socioeconomic status, healthcare systems, health behaviors, and diabetes management, and these regions had higher CVD mortality rates. Conclusions: Regions where the screening for complication of diabetes kidney disease rate did not improve compared to other regions were vulnerable not only in socioeconomic status, healthcare system, and health behavior, but also in disease management. This suggests the need for local and environmental support, as well as aggressive health service interventions in relatively vulnerable areas.

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Spatial accessibility to emergency department and surgical treatment for patients with acute appendicitis in South Korea

Kim,

Sung,

Lee

et al. 2024

Preprint

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Background Acute appendicitis is a representative lower-risk condition requiring emergency general surgery (EGS), which has often been overlooked in terms of service and accessibility. Recent concerns regarding the delivery of surgical services in South Korea emphasize the need for close monitoring of spatial access to surgical care in patients with acute appendicitis at the regional level.Methods This study included emergency department (ED) visits with acute appendicitis and subsequent appendectomies from the National Emergency Department Information System (NEDIS) database (2015–2021). The 252 administrative districts in South Korea were classified by population density according to statistical terciles. Travel distances to the hospital were measured, and the proportion of patients admitted to regional hospitals was visualized on a geographic map. Factors related to complicated appendicitis were analyzed using logistic regression.Results Among 207,344 patients who visited the EDs, those from areas with low population density had higher proportions of patients aged ≥ 65 years (23.2%), Medical Aid recipients (4.8%), transfers from other hospitals (39.3%), and cases of complicated appendicitis (7.0%) compared to other regions. Additionally, patients in low-density regions exhibited the highest proportion of traveling 50 km or more (27.7%), compared to those in mid- (5.9%) and high-density (2.5%) regions. In the multivariate analysis, patients aged ≥ 65 years exhibited a stronger association with complicated appendicitis compared to other age groups. In some low-density regions, a significant proportion of the population traveled more than 50 km to seek surgical care despite the availability of community hospitals within the region.Conclusions The current results suggested that regions with low population density experienced low access to surgical care, revealing significant regional disparities linked to population density. Given the rapidly aging population in South Korea, urgent policy action is needed to guarantee the adequate delivery of EGS services in low-density regions.

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Area-based inequalities and distribution of healthcare resources for managing diabetes in South Korea: a cross-sectional multilevel analysis

Cited by 3 publications

References 57 publications

Effects of Socioeconomic Status and Residence Areas on Long-Term Survival in Patients With Early-Onset Dementia: The Korean National Health Insurance Service Database Study

Effects of Socioeconomic Status and Residence Areas on Long-Term Survival in Patients With Early-Onset Dementia: The Korean National Health Insurance Service Database Study

Five-year Trajectory about Screening for Complication of Diabetes Kidney Disease and Cardiovascular Disease Mortality : Focusing on Regional Difference

Spatial accessibility to emergency department and surgical treatment for patients with acute appendicitis in South Korea

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