델파이법을 적용한 암연구수준의 평가

강영호,윤석준,강길원,김창엽,유근영,신영수,Khang, Young-Ho,Yoon, Seok-Jun,Kang, Gil-Won,Kim, Chang-Yup,Yoo, Keun-Young,Shin, Young-Soo 대한예방의학회 1998 Journal of Preventive Medicine and Public Health Vol.31 No.4

Globally, cancer research has been considered one of the most important field of biomedical researches. Recently, in Korea, there are increasing concerns about cancer research and the development of national cancer control programme. For the efficient investment in cancer research at the national level, strategic approach is needed based on the nationwide information about current status of research. However even the basic data on cancer research have not been systematically collected, and are not available when necessary. The aim of this study is to assess current status of cancer research. For this purpose, this study applied two round Delphi method in which fifteen experts in cancer research fields participated. They rated each items on the initial list at the first round, and modified their responses at the second round. Panels responded that pathogenesis of cancer, research & development of cancer drug, and oncogene, etc. are the most urgent and important research Holds. They assessed national level of cancer research as being 49.6% of the world highest level. Coefficient of variation tended to be lowered with the iteration. Predictive stability was evaluated to be lower in items of urgency than in items of importance and research level. Although this study shares the same limitations in the selection of the experts with many other Delphi studies, it provides a primary data that would be required to plan the national strategy of the cancer research.

사회경제적 건강 불평등에 대한 생애적 접근법

강영호,Khang, Young-Ho 대한예방의학회 2005 예방의학회지 Vol.38 No.3

Evidence on the relation of socioeconomic position (SEP) with health and illness is mounting in South Korea. Several unlinked studies and individually linked studies (longitudinal study) showed a graded inverse relationship between SEP and mortality among South Korean males and females. Based on the mortality relative ratios by occupational class reported in the published papers of South Korea and western countries, the magnitude of the socioeconomic inequality in mortality in South Korea seems to be similar to or even greater than that in western industrialized countries. A potential contribution of health related selection, health behaviors and psychosocial factors to explain this socioeconomic inequality in mortality was discussed. It was suggested that early life exposure measures would demonstrate a greater ability to explain socioeconomic inequalities in all-cause mortality than the above pathway variables in South Korea. This is based on the cause-specific structure of mortality among the South Korean population who have a relatively greater proportion of stomach cancer, hemorrhagic stroke, liver cancer and liver disease, and tuberculosis, which share early life exposures as important elements of their etiology, than western countries. However, the relative contribution of early and later life socioeconomic conditions in producing socioeconomic inequality in health may differ according to the outcome, thus remains to be investigated.

건강 불평등 연구의 역사전 발전

강영호,Khang, Young-Ho 대한예방의학회 2007 예방의학회지 Vol.40 No.6

The socioeconomic inequalities in health have recently become an important public health concern in South Korea, and the issue has gained increasing attention from many South Korean researchers due to the increasing income inequality and Widening social polarization following its economic crisis in the late 1990s. However, despite the mounting literature on health inequalities published in recent years, the history of research on health inequality in South Korea is premature in comparison to the long histories in several Western countries. Understanding the historical background underlying the issue of health inequality research may aid in establishing and accumulating scientifically solid evidence in South Korea. It may also direct the South Korean research community to develop research agendas that are. more politically and academically appropriate for South Korean society. This paper describes the historical development of health inequality research in the West and introduces several important issues contributing to the advancement of health inequality research. Specifically, the major studies conducted before and after the UK Black Report are presented. In addition, the history and current status of health inequality research in South Korea are documented and evaluated. Finally, several research agendas for the quantitative and qualitative improvement of health inequality research in South Korea are proposed.

우리나라 사망등록자료에서 의사에 의한 사망진단 분율의 양상과 관련 요인

강영호,윤성철,이진용,이무송,이상일,조민우,Khang, Young-Ho,Yun, Sung-Cheol,Lee, Jin-Yong,Lee, Moo-Song,Lee, Sang-Il,Jo, Min-Woo 대한예방의학회 2004 예방의학회지 Vol.37 No.4

Objectives : Previous studies showed that death certification by physicians was an important predictor to improve the quality of death certificate data in South Korea. This study was conducted to examine the proportion of death certificates issued by physicians and associated factors in South Korea from 1990 to 2002. Methods : Data from 3,110,883 death certificates issued between 1990 and 2002, available to the public from the National Statistical Office of Korea, were used to calculate the proportion of death certificates issued by physicians and to examine associated factors with logistic regression analysis. Results : The overall proportion of death certificates issued by physicians increased from 44.6% in 1990 to 77.6% in 2002 (mean: 63.5%). However, the proportion was greatly influenced by the deceased's age. In 2002, more than 90% of the deceased aged 51 or less were certified by physicians. A higher proportion was found among deceased who had tertiary education (college or higher) living in more developed urban areas. Conclusion : The information regarding the cause of death for younger, well-educated deceased in urban areas of South Korea may show a higher level of accuracy. Epidemiologic research using information on causes of death may well benefit from the continually increasing proportion of death certificates issued by physicians in the future in South Korea.

우리 나라 국민의 보완요법 이용률, 이용양상과 비용지출

강영호,이무송,구희조,강위창,홍창기,이상일,Khang, Young-Ho,Lee, Moo-Song,Koo, Hee-Jo,Kang, Wee-Chang,Hong, Chang-Gi,Lee, Sang-Il 대한예방의학회 1999 예방의학회지 Vol.32 No.4

Objectives : To determine the prevalence, pattern. and out-of-pocket expenditure of complementary and alternative medicine (CAM) utilization in Korean adult population. Methods : We conducted a representative telephone survey of 2,042 persons aged 18 or older. Data about any health problem, details of their use of medical doctors(MDs) offices/hospitals/pharmacies services and CAM during the preceding 12 months were collected with structured questionnaire. Results : The utilization rate of CAM among Korean adults was 29% in one year. A total of 231 kinds of CAM was identified from this survey. Annual out-of-pocket expenditure associated with CAM use in 1998 amounted to ${\xi}{\S}1.88$ billion and was comparable to 40.8% of out-of-pocket expenditure paid for MDs offices/hospitals/pharmacies services. Among those(N=424) who paid for both MDs offices/hospitals/pharmacies services an d CAM, 35.8% paid more for CAM. CAM gave more satisfaction than western medicine to those who had experience of both types of therapy. About half of CAM users were willing to recommend CAM to others. Disclosure rate to physician among CAM users was not high(40.6%). Conclusion : CAM became a popular source of health care in Korea, Korean spent a substantial amount of out-of-pocket money on CAM without any public control. Because CAM use is likely to be increased rapidly through lay referral system, health policy makers and health professionals should pay more attention to CAM for making appropriate utilization of CAM.

사회경제적 사망률 불평등: 한국노동패널 조사의 추적 결과

강영호 ( Young Ho Khang ),이상일 ( Sang Il Lee ),이무송 ( Moo Song Lee ),조민우 ( Min Woo Jo ) 한국보건행정학회 2004 보건행정학회지 Vol.14 No.4

This study is to examine relationships of several socioeconomic position indicators with mortality risk in a nationwide longitudinal study of South Korea. The Korea Labor & Income Panel Study, conducted on a probability sample of urban South Korean households by Korea Labor Institute, contains date of death information for the decedents which were used to estimate relative risks of mortality and their 95% confidence intervals (CI) with Cox regression analysis. A total of 125 men and women among 8,415 subjects died between 1998 and 2002. Socioeconomic differentials in mortality were observed after adjustment for sex and age. Those with less than 12-year education had 1.90 times (95% CI=1.25-2.91) greater mortality risk than those with 12-year education or more. Greater mortality risks were also found among those with low occupational class and manual occupation. The magnitude of differentials in mortality risks between occupational class were similar in two different approaches to measuring women`s occupational class: (1) approach 1 where women, married or not, retain their own occupational class, and (2) approach 2 where married women are assigned their husbands` occupational class. Relative risks of dying among those with low household income were 1.62 (95% CI=1.08-2.42) compared with the counterparts. Those who reported economic hardship at the time of survey in 1998 had greater risk of mortality (RR=1.83, 95% CI=1.21-2.78) than those who did not. In conclusion, increased social discourse and policy discussions about these health inequalities are needed in Korean society. Future studies should explore the causes and mechanisms of socioeconomic mortality inequalities.

만성질환 위험요인 감소를 위한 전략과 방향

강영호(Young-Ho Khang) 한국보건교육건강증진학회 2016 보건교육건강증진학회지 Vol.33 No.4

우리나라 표준직업분류에 따른 흡연율 차이: 2003년도 사회통계조사 자료의 분석

조홍준,강영호,윤성철,Cho, Hong-Jun,Khang, Young-Ho,Yun, Sung-Cheol 대한예방의학회 2006 예방의학회지 Vol.39 No.4

Objectives: The purpose of this study was to investigate the differences in smoking rates according to the major occupational categories in South Korea. Methods: The study subjects were a weighted sample of 24,495 men and 26,121 women aged 25-64 from the 2003 Social Statistics Survey, which was conducted by the Korea National Statistical Office. Occupation was classified according to the Korean Standard Occupation Classification. We computed the age-standardized smoking rates according to gender and occupations after adjusting for the education level, marital status, and self-rated health. Results: For men, the smoking rate in elementary occupations was two times higher than that of clerks (OR=1.98, 95% CI=1.74-2.26). In general, a more prestigious job(professionals) correlated with lower smoking rates, and less prestigious jobs correlated with higher smoking rates, except for legislators, senior officials and managers. For women, smoking among service workers was 4.1 times higher than among clerical workers (OR=4.11, 95% CI=2.87-5.88). For women, their occupations, except elementary workers, and the unemployed, the retired and the armed forces, failed to show significant differences in smoking compared with the clerical workers. After adjusting for education, occupational differences in the smoking rate for men were attenuated in most occupations, except for legislators, professionals, and technicians. Further adjustment for marital status and self-rated health had a minimal effect on the occupational differences in the smoking rate for men. For women workers with service or elementary occupations, the ORs of smoking were attenuated with adjustment of the educational levels. However, the ORs of smoking were increased in workers with service, sales or elementary occupations, as well as for legislators, and the unemployed, the retired and the armed forces, after additionally adjusting for marital status. Conclusions: More prestigious jobs generally correlated with lower smoking rates in both sexes. The anti-tobacco policy should consider smoking rate differentials by occupations.

면접조사자료와 사망등록자료 간 교육수준 및 직업계층의 신뢰도

김혜련,강영호,Kim, Hye-Ryun,Khang, Young-Ho 대한예방의학회 2005 Journal of Preventive Medicine and Public Health Vol.38 No.4

Objectives : This study was done to evaluate the reliability of education and occupational class between using the health survey and the death certificate data. Methods : The 1998 National Health and Nutrition Examination Survey (NHANES) was conducted on a cross-sectional probability sample of South Korean households, and it contained unique 13-digit personal identification numbers that were linked to the data on mortality from the Korean National Statistical Office. The data from 263 deaths were used to estimate the agreement rates and the Kappa indices of the education and occupational class between using the NHANES data and the death certificate data. Results : The simple and weighted Kappa indices for education were 0.60 (95% CI=0.53-0.68) and 0.73 (95% CI=0.67-0.79) respectively, if the educational level was grouped into five categories: no-formal-education, elementary-school, middle-school, high-school and college or over. The overall agreement rate was 71.9% for these educational groups. The magnitude of reliability, as measured by the overall agreement rates and Kappa indices, tended to increase with a decrease in the educational class. The number of non-educated people with using the death certificate data was smaller than that with using the NHANES data. For the occupational class (manual workers, non-manual workers and others), the Kappa index was 0.40 (95% CI=0.30-0.51), which was relatively lower than that for the educational class. Compared with the NHANES, the number of non-manual workers for the deceased who were aged 30-64 tended to be increased (8 to 12) when using the death certificate data, whereas the number of manual workers tended to be decreased (59 to 41). Conclusions : The socioeconomic inequalities in the mortality rates that were based on the previous unlinked studies in South Korea were not due to a numerator/denominator bias. The mortality rates for the manual workers and the no-education groups might have been underestimated.

우리 나라의 사회경제적 사망률 불평등: 1998년도 국민건강영양조사 자료의 사망추적 결과

김혜련,강영호,Kim, Hye-Ryun,Khang, Young-Ho 대한예방의학회 2006 예방의학회지 Vol.39 No.2

Objectives : This study was conducted to examine the relationships of the several socioeconomic position indicators with the mortality risk in a representative longitudinal study of South Korea. Methods : The 1998 National Health and Nutrition Examination Survey was conducted on a cross-sectional probability sample of South Korean households, and it contained unique 13-digit personal identification numbers that were linked to the data on mortality from the National Statistical Office of Korea. Of 5,607 males and females, 264 died between 1999 and 2003. Cox's regression was used to estimate the relative risks (RR) and their 95% confidence intervals (CI) of mortality. Results: Socioeconomic differences in mortality were observed after adjustments were made for gender and age. Compared with those people having college or higher education, those people without any formal education had a greater mortality risk (RR=2.21, 95% CI=1.12-4.40). The mortality risk among manual workers was significantly greater than that for the non-manual workers (RR=2.73, 95% CI=1.47-5.06). A non-standard employment status was also associated with an increase in mortality: temporary or daily workers had a greater mortality risk than did the full-time workers (RR=3.01, 95% CI=1.50-6.03). The mortality risk for the low occupational class was 3.06 times greater than that of the high and middle occupational classes (95% CI=1.75-5.36). In addition, graded mortality differences according to equivalized monthly household income were found. A reduction of monthly household income by 500 thousand Korean Won (about 400 US dollars) was related with a 20% excess risk of mortality. Self-reported poor living standards were also associated with an increased risk of mortality. Those without health insurance had a 3.63 times greater risk of mortality than the insured (95% CI=1.61-8.19). Conclusions: This study showed the socioeconomic differentials in mortality in a national longitudinal study of South Korea. The existence of socioeconomic mortality inequalities requires increased social discussion on social policies in Korean society. Furthermore, the mechanisms for the socioeconomic inequalities of mortality need to be explored in future studies.