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"Socioeconomic Factors"

Original Article

One-year mortality disparities between infants of unmarried and married families in South Korea: a large scale retrospective cohort study
Seonyoung Jeong, Yeani Choi, Hajin Kim, Sang Min Park
Received September 2, 2024  Accepted December 5, 2024  Published online April 16, 2025  
DOI: https://doi.org/10.4082/kjfm.24.0226    [Epub ahead of print]
Background
This study examined disparities in 1-year mortality rates between infants born to married and unmarried single-parent families, emphasizing the need for targeted health policies.
Methods
Data from 3,298,263 cases, obtained from the South Korea National Statistical Office (2010–2017), were analyzed. T-tests and chi-square tests were used to assess the demographic characteristics of the study group. The number of deaths per 1,000 live births was calculated, and logistic and multivariable logistic regressions were employed to compare infant mortality rates between family types. Additional stratified analyses, based on gestational age and birth weight, further elucidated the relationship between parental marital status and infant mortality.
Results
Infants from unmarried families exhibited a 3.34-fold higher crude odds ratio (OR) for 1-year mortality (95% confidence interval [CI], 2.56–4.36; P<0.001) than that from married families. After adjusting for confounders, the adjusted OR was 1.40 (95% CI, 1.03–1.92). Stratification by gestational age and birth weight revealed crude ORs of 4.62 (95% CI, 3.34– 6.39) in non-preterm infants (≥37 weeks) and 4.76 (95% CI, 3.46–6.56) in non-low-birth-weight infants (≥2.5 kg), highlighting a more pronounced disparity in infants born at or above normal weight and full term. No significant difference (P>0.05) was found in the crude OR for 1-year mortality rates among low-birth-weight (<2.5 kg) or preterm (<37 weeks) infants between the two-family types.
Conclusion
This study highlights the significant disparity in infant mortality rates based on parental marital status, underscoring the need for enhanced social support and tailored policies for unmarried single-parent families.
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  • 17 Download

Review Article

The socioeconomic and environmental determinants of metabolic dysfunction-associated steatotic liver disease: understanding inequalities in prevalence and outcomes
Dominika Lorek, Krzysztof Łupina, Wiktoria Bisaga, Dominik Malicki, Weronika Stępień, Laura Kumor, Jakub Janczura
Korean J Fam Med 2025;46(2):61-69.   Published online March 19, 2025
DOI: https://doi.org/10.4082/kjfm.25.0027
Metabolism-associated steatotic liver disease (MASLD) is the most prevalent chronic liver condition worldwide and affects nearly 30% of the global population. While traditionally associated with metabolic risk factors, such as obesity and insulin resistance, increasing attention is being directed toward socioeconomic and environmental determinants that contribute to disparities in MASLD prevalence and outcomes. Low-income populations often experience higher rates of MASLD owing to limited access to healthcare, poor diet quality, and reduced opportunities for physical activity. Conversely, high-income countries are witnessing a paradoxical rise in MASLD cases, driven by sedentary lifestyles and excessive consumption of ultra-processed foods. This review examined the effects of socioeconomic status, education, healthcare access, and environmental exposure on the epidemiology of MASLD. The findings revealed that individuals from lower socioeconomic backgrounds and migrant populations experience a disproportionately higher burden of MASLD due to systemic healthcare barriers, dietary transitions, and occupational exposure. Children and adolescents face increasing susceptibility owing to rising obesity rates, and geographic disparities highlight Europe as the most affected region, followed by Asia and North America. Given the growing public health impact of MASLD, addressing both socioeconomic and environmental determinants is essential. Future efforts should prioritize policy-driven interventions, including equitable healthcare access, lifestyle modifications, and research into novel therapeutic approaches to mitigate the disease burden and improve patient outcomes.
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  • 59 Download
Original Articles
Background
We evaluated the effects of socioeconomic factors and psychosocial factors, both individually and combined, on all-cause mortality risk (mortality risk).
Methods
We conducted an 8-year (2006–2014) longitudinal analysis of 10,247 individuals who took part in the Korean Longitudinal Study of Aging, a nationwide survey of people aged 45–79 years. Socioeconomic vulnerability (SEV) was assessed with factors such as education, household income, commercial health insurance, and residential area. Mental health (MH) was assessed with factors such as depression, social engagement, and life satisfaction. The covariates were age, gender, marital status, cohabiting, number of chronic diseases, and health behaviors such as regular exercise, smoking, and alcohol intake. We used a Cox proportional hazard analysis to investigate the effects of SEV and MH on mortality risk and also to analyze the superimposed effects of SEV-MH on mortality risk.
Results
After the controlling for the covariates, high SEV and negative MH were found to be strong predictors of all-cause mortality. The highest quartile of SEV (vs. lowest) had a 1.70 times greater mortality risk (hazard ratio [HR], 1.70; 95% confidence interval [CI], 1.24–2.33) and the highest quartile of MH (vs. lowest) had a 2.13 times greater mortality risk (HR, 2.13; 95% CI, 1.72–2.64). Being in the highest quartile for both SEV and MH (vs. lowest) increased mortality risk more than 3 times (HR, 3.11; 95% CI, 2.20–4.40).
Conclusion
High SEV and negative MH were independently associated with increased mortality risk, and their superimposed effects were associated with an increased risk of mortality.

Citations

Citations to this article as recorded by  
  • Sustained Low Income, Income Changes, and Risk of All-Cause Mortality in Individuals With Type 2 Diabetes: A Nationwide Population-Based Cohort Study
    Hong Seok Lee, Jimin Clara Park, Inkwan Chung, Junxiu Liu, Seong-Su Lee, Kyungdo Han
    Diabetes Care.2023; 46(1): 92.     CrossRef
  • The role of social factors in the successful ageing – Systematic review
    J. Takács, C. Nyakas
    Developments in Health Sciences.2022; 4(1): 11.     CrossRef
  • Combined Effects of Depression and Chronic Disease on the Risk of Mortality: The Korean Longitudinal Study of Aging (2006-2016)
    Hyunji Kim, Sung Hi Kim, Yoon Jeong Cho
    Journal of Korean Medical Science.2021;[Epub]     CrossRef
  • KLoSA—Korean Longitudinal Study of Aging
    Jungun Lee
    Korean Journal of Family Medicine.2020; 41(1): 1.     CrossRef
  • 6,018 View
  • 64 Download
  • 3 Web of Science
  • 4 Crossref
Decomposing Socioeconomic Inequality Determinants in Suicide Deaths in Iran: A Concentration Index Approach
Yousef Veisani, Ali Delpisheh, Kourosh Sayehmiri, Ghobad Moradi, Jafar Hassanzadeh
Korean J Fam Med 2017;38(3):135-140.   Published online May 23, 2017
DOI: https://doi.org/10.4082/kjfm.2017.38.3.135
Background

It is recognized that socioeconomic status (SES) has a significant impact on health and wellbeing; however, the effect of SES on suicide is contested. This study explored the effect of SES in suicide deaths and decomposed inequality into its determinants to calculate relative contributions.

Methods

Through a cross-sectional study, 546 suicide deaths and 6,818 suicide attempts from January 1, 2010 to December 31, 2014 in Ilam Province, Western Iran were explored. Inequality was measured by the absolute concentration index (ACI) and decomposed contributions were identified. All analyses were performed using STATA ver. 11.2 (Stata Corp., College Station, TX, USA).

Results

The overall ACI for suicide deaths was -0.352 (95% confidence interval, -0.389 to -0.301). According to the results, 9.8% of socioeconomic inequality in suicide deaths was due to addiction in attempters. ACI ranged from -0.34 to -0.03 in 2010–2014, showing that inequality in suicide deaths declined over time.

Conclusion

Findings showed suicide deaths were distributed among the study population unequally, and our results confirmed a gap between advantaged and disadvantaged attempters in terms of death. Socioeconomic inequalities in suicide deaths tended to diminish over time, as suicide attempts progressed in Ilam Province.

Citations

Citations to this article as recorded by  
  • Socioeconomic disparities in suicide: Causation or confounding?
    Vincent Lorant, Dharmi Kapadia, Julian Perelman, Astrid M. Kamperman
    PLOS ONE.2021; 16(1): e0243895.     CrossRef
  • Income-related inequities of adult obesity and central obesity in China: evidence from the China Health and Nutrition Survey 1997–2011
    Ling Zhou, Dan Cao, Yafei Si, Xuexue Zhu, Liang Du, Yu Zhang, Zhongliang Zhou
    BMJ Open.2020; 10(10): e034288.     CrossRef
  • Trends of Suicide Attempts and Completed Suicide in Ilam Province of Iran; A Demographic Analysis Study
    Yousef Veisani, Ali Delpisheh, Fathola Mohamadian, Reza Valizadeh
    Bulletin of Emergency and Trauma.2018; 6(3): 245.     CrossRef
  • Suicidal ideation among Chinese methadone-maintained patients: prevalence and correlates
    Yan-Min Xu, Bao-Liang Zhong, Wen-Cai Chen, Jun-Hong Zhu, Jin Lu
    Oncotarget.2017; 8(49): 86181.     CrossRef
  • 5,049 View
  • 48 Download
  • 4 Web of Science
  • 4 Crossref
Socioeconomic Indicators Associated with Initiation and Cessation of Smoking among Women in Seoul
Yu-Na Kim, Young-Gyu Cho, Cheol-Hwan Kim, Jae-Heon Kang, Hyun-Ah Park, Kyoung-Woo Kim, Yang-Im Hur, Su-Hyun Lee, Yun-Min Na, No-Yai Park
Korean J Fam Med 2012;33(1):1-8.   Published online January 31, 2012
DOI: https://doi.org/10.4082/kjfm.2012.33.1.1
Background

While smoking prevalence in Korean men has been decreasing, it is increasing in Korean women. Little is known about women's smoking inequalities in Korea. This study was conducted to investigate the association of socioeconomic indicators with the initiation and cessation of smoking among Korean women.

Methods

This was a cross-sectional study on 9,089 women aged 25-64 years from the 2008 Seoul Community Health Survey. The data on smoking and socioeconomic status were obtained through face-to-face interviews. Smoking initiation rate was defined as the proportion of the individuals who had started smoking at least one cigarette among all subjects. Smoking cessation rate was calculated by dividing the number of individuals who had quit smoking by the number of ever smokers. Education level, total family income and occupation were investigated as socioeconomic indicators.

Results

Education level was significantly associated with both initiation and cessation of smoking. Lower educated women had a higher likelihood of smoking initiation (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.17 to 2.51) but lower likelihood of smoking cessation (OR, 0.38; 95% CI, 0.22 to 0.66) than higher educated women. Smoking initiation rate was higher in manual workers (OR, 1.65; 95% CI, 1.20 to 2.27) than in non-manual workers. However, there were no significant differences of both initiation and cessation of smoking according to total household income.

Conclusion

This study shows that there are smoking inequalities among Korean women. It is thought that education level and occupation are important determinants of women's smoking status.

Citations

Citations to this article as recorded by  
  • The smoking spectrum: review of the existing evidence and future directions
    Garbis A. Meshefedjian
    Journal of Public Health.2020; 28(1): 105.     CrossRef
  • Cigarette Smoking in South Korea: A Narrative Review
    Rebekah Gunter, Edwin Szeto, Se-Hoon Jeong, Sooyeon Suh, Andrew J. Waters
    Korean Journal of Family Medicine.2020; 41(1): 3.     CrossRef
  • Women’s Smoking: Relationships Among Emotional Labor, Occupational Stress, and Health Promotion
    Sunjoo Boo, Hyunjin Oh
    Workplace Health & Safety.2019; 67(7): 361.     CrossRef
  • Factors associated with smoking cessation
    Samires Avelino de Souza França, Ana Ligian Feitosa das Neves, Tatiane Andressa Santos de Souza, Nandara Celana Negreiros Martins, Saul Rassy Carneiro, Edilene do Socorro Nascimento Falcão Sarges, Maria de Fátima Amine Houat de Souza
    Revista de Saúde Pública.2015;[Epub]     CrossRef
  • A History of Ashes: An 80 Year Comparative Portrait of Smoking Initiation in American Indians and Non-Hispanic Whites—the Strong Heart Study
    Raymond Orr, Darren Calhoun, Carolyn Noonan, Ron Whitener, Jeff Henderson, Jack Goldberg, Patrica Henderson
    International Journal of Environmental Research and Public Health.2013; 10(5): 1747.     CrossRef
  • Predictors of long-term smoking cessation: results from the global adult tobacco survey in Poland (2009–2010)
    Dorota Kaleta, Przemysław Korytkowski, Teresa Makowiec-Dąbrowska, Bukola Usidame, Leokadia Bąk-Romaniszyn, Adam Fronczak
    BMC Public Health.2012;[Epub]     CrossRef
  • 4,406 View
  • 26 Download
  • 6 Crossref
Socioeconomic Factors Associated with Initiating and Quitting Cigarette Smoking Among Korean Men.
So Ra Kim, Ok Kil Kim, Kyung Eun Yun, Young Ho Khang, Hong Jun Cho
Korean J Fam Med 2009;30(6):415-425.   Published online June 20, 2009
DOI: https://doi.org/10.4082/kjfm.2009.30.6.415
Background
The prevalence of current cigarette smoking is the net result of different processes over the entire life course, namely initiation, continuation and cessation of smoking. This study examined the association of socioeconomic indicators with initiating and quitting smoking among South Korean men. Methods: We analyzed a total of 2,798 men aged 25-64 who participated in the Korean National Health and Nutrition Examination Survey in 2005. Odds ratios (ORs) with 95% confi dence intervals (CIs) for smoking initiation and cessation according to socioeconomic position indicators were calculated with logistic regression. Socioeconomic position was measured by education, occupation, income and marital status. Results: Greater rates of ever initiation of smoking were observed among lower educated men (OR = 1.51; 95% CI = 1.09-2.09) after controlling for other socioeconomic factors. Independent associations were found among men who performed manual labor (OR = 1.55; 95% CI = 1.12-2.14). After simultaneous adjustment for socioeconomic factors, lower likelihood of quitting smoking was detected among men who were in the middle third and the lower third income group (OR = 0.72; 95% CI = 0.55-0.92, OR = 0.60; 95% CI = 0.46-0.79, respectively), who performed manual labor (OR = 0.66; 95% CI = 0.50-0.86) or who were not married (OR for never-married = 0.65; 95% CI = 0.42-0.99 and OR for divorced or widowed = 0.56; 95% CI = 0.36-0.87, respectively). Conclusion: For Korean men, educational attainment was a strong predictor of ever initiating smoking, however, smoking cessation was independently related to income and marital status. To be effective, tobacco control interventions should consider these different social determinants in initiating and quitting smoking.

Citations

Citations to this article as recorded by  
  • Current Use of Heated Tobacco Products and Its Association with Socioeconomic Factors in Korean Adults: A Study Using Community Health Survey 2019
    Sung Yeol Son, Seo Young Kang, Hong-Jun Cho
    Journal of the Korean Society for Research on Nicotine and Tobacco.2022; 13(4): 140.     CrossRef
  • Association of Eating Alone with Depressive Symptoms and Suicidal Ideation among Korean Adults
    Joonyoung Park, Gyeongsil Lee
    Korean Journal of Family Medicine.2021; 42(3): 219.     CrossRef
  • Decrease in Smoking and Related Factor after the Price Raise of Tobacco in Hypertension Patients: Using 2015 Korea National Health and Nutrition Examination Survey
    Mi Hyun Joo, Mi Ah Han, Jong Park, Seong Woo Choi, So Yeon Ryu, Jun Ho Shin
    Journal of Health Informatics and Statistics.2019; 44(1): 83.     CrossRef
  • Socioeconomic factors associated with tobacco smoking among adult males in Sri Lanka
    Hiranya Nilakshi Fernando, Imaesha Thilini Pradeepika Wimaladasa, Anjali Nimaya Sathkoralage, Ashani Nisansala Ariyadasa, Chathurika Udeni, Lahiru Sandaruwan Galgamuwa, Prasanna Herath, Nishantha Kumarasinghe
    BMC Public Health.2019;[Epub]     CrossRef
  • Associations of the eating alone behavior with nutrient intake, obesity and metabolic syndrome in middle-aged adults based on the 2013 ~ 2017 Korean National Health and Nutrition Examination Survey
    Hyun Kyung Kim, Jayong Chung
    Journal of Nutrition and Health.2019; 52(5): 435.     CrossRef
  • The Effects of Socio-Economic Status on Smoking Cessation Plans in Smokers
    Mi-Jin Gong, Yong-Woo Shim
    The Korean Journal of Health Service Management.2018; 12(2): 135.     CrossRef
  • Changes of Cigarette Smoking Initiation Age among South Korean Adults: 2007-2012
    Hee Won Kim, Si Nae Kang, Ji Sun Lim, Jung Ah Lee, Hong-Jun Cho
    Journal of the Korean Society for Research on Nicotine and Tobacco.2017; 8(1): 20.     CrossRef
  • The Abstinence Rate of the Inpatient Smoking Cessation Program
    Jae-Hang Cho, Seock-Hwan Lee, Jung-Woo Sohn, Hye-Young Yang
    Journal of the Korean Society for Research on Nicotine and Tobacco.2017; 8(2): 88.     CrossRef
  • Characteristics of Intermittent Smokers in Korean Adults: Comparison with Daily Smokers
    Si Nae Kang, Hee Won Kim, Jisun Lim, Jung Ah Lee, Hong-Jun Cho
    Journal of the Korean Society for Research on Nicotine and Tobacco.2017; 8(2): 58.     CrossRef
  • The Convergence relation of tobacco smoking to tooth loss in older adults
    Mee-Jin Jun
    Journal of the Korea Convergence Society.2016; 7(5): 127.     CrossRef
  • Comparison of the Health Behaviors according to Income and Education Level among Cardio-Cerebrovascular Patients; based on KNHANES data of 2010-2011
    Ji-Yeon Choi, Seong-Woo Choi
    Journal of the Korea Academia-Industrial cooperation Society.2014; 15(10): 6223.     CrossRef
  • Effects of Brief Smoking Cessation Education with Expiratory Carbon Monoxide Measurement on Level of Motivation to Quit Smoking
    Won-Young Choi, Cheol-Hwan Kim, Ok-Gyu Lee
    Korean Journal of Family Medicine.2013; 34(3): 190.     CrossRef
  • Relationship between Work Hours and Smoking Behaviors in Korean Male Wage Workers
    Sung-Mi Jang, Eun-hee Ha, Hyesook Park, Eunjeong Kim, Kyunghee Jung-Choi
    Annals of Occupational and Environmental Medicine.2013; 25(1): 35.     CrossRef
  • The Relationship between Smoking, Alcohol Drinking, and Parenting Behavior Perceived by Adolescents
    Yun Ho Roh, Eun Joo Kim
    Korean Journal of Health Education and Promotion.2013; 30(2): 71.     CrossRef
  • Socioeconomic Indicators Associated with Initiation and Cessation of Smoking among Women in Seoul
    Yu-Na Kim, Young-Gyu Cho, Cheol-Hwan Kim, Jae-Heon Kang, Hyun-Ah Park, Kyoung-Woo Kim, Yang-Im Hur, Su-Hyun Lee, Yun-Min Na, No-Yai Park
    Korean Journal of Family Medicine.2012; 33(1): 1.     CrossRef
  • Is income or employment a stronger predictor of smoking than education in economically less developed countries? A cross-sectional study in Hungary
    Mall Leinsalu, Csilla Kaposvári, Anton E Kunst
    BMC Public Health.2011;[Epub]     CrossRef
  • 2,880 View
  • 49 Download
  • 16 Crossref
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