노년기 예방검진에서 사회경제적 불평등

천희란,김일호,Chun, Hee-Ran,Kim, Il-Ho 대한예방의학회 2007 예방의학회지 Vol.40 No.5

Objectives: Due to the assumptions of homogeneity as well as challenges in the socioeconomic position of the elderly, they have been relatively neglected in studies of health inequalities. Therefore, this study was conducted to investigate the social inequalities in preventive services among elderly men and women. Methods: Data were obtained from a nationally representative sample of 342 men and 525 women aged 65 and over collected during the 2001 National Health and Nutrition Examination Survey. Age adjusted proportions and logistic regression were used to identify the social patterning of preventive services among elderly Koreans using various social position indicators. Results: The findings of this study generally supported the presence of social gradients in preventive services among the Korean elderly. The likelihood of using the service becomes progressively higher with social position. Educational level, income, and self-rated living status were significantly associated with increased medical checkups and cancer checks. In addition, logistic regression detected educational inequalities only among older women receiving BP checks. After being stratified based on health status and chronic disease status, social disparities still existed when educational level and self-rated living status were considered. Among unhealthy individuals, place of residence was observed as a barrier to medical checkups. Conclusions: This study demonstrated strong and consistent associations between socioeconomic position and preventive services among the elderly in Korea. The results indicate that public health strategies should be developed to reduce the barriers to preventive services encountered by the elderly.

여성노인의 건강불평등 현황과 측정 : 통합방법론(Mixed Methodology)의 적용

천희란,강민아 한국노인복지학회 2011 노인복지연구 Vol.0 No.51

Measuring appropriate socioeconomic positions(SEP) to capture health inequality among older women has always been a challenging issue. This study sought to explore mixed methods to better understand health disparity and its causes among Korean women. We followed a sequential explanatory design, in which two data collection methods - qualitative (12 Korean elderly women residing in Seoul with in-depth interviews) and quantitative (564 women with a nationally representative survey), were employed to understand and identify appropriate ways to measure SEPs of older Korean women and its implications on the health disparity. Qualitative interview data were checked, coded and interpreted through an iterative process of discussion and in-depth analyses. Survey data were analyzed for descriptive statistics and of the effect of each SEP and health. In the multi-methods analysis stage, we used a concurrent triangulation design strategy and illustrated the major findings, according to ‘corroboration of findings’, ‘elaboration for deeper meanings’, and ‘initiation of new issues’ steps. In both quan/qual data, most elder women were found to be reporting their health to be poor, often with diabetes, arthritis, and hypertension. Stress related mental problems were also found to be a major precursor to poorer physical health in these women. According to the findings, low education, financial problems, physically demanding work experience, and lack of social support (ie: relationship with children, existence of friends) resulted in poorer self rated health, chronic diseases, limited activity, and depression. Findings from quantitative approach were further supplemented and elaborated with in-depth interpretations of data from face-to-face interviews. We found the cultural meanings of SEP for elder women and cultural specific reasons for their roles in determining health, particularly in regards to the education of and occupations of Korean women. Older women in Korea were often found to have been deprived of educational opportunities regardless of familial affluence. The educational levels of their male siblings, rather than their own, may better reflect the familial economic condition in the childhood of these Korean older women. Also, we found that the quantitative scores of health status and SEP did not linearly match with verbal descriptions. Often the middle category in verbatim could encompass a very wide range of scores. Self-reported health status and SEPs among Korean older women may have different meanings from those for the younger population and should be interpreted with caution. In addition to redefining and expanding the traditional definition of the subjects’ health status, own education, occupation, and income, other SEP indicators of older women for health policy should be taken into account, whilst employing multiple methods. The mixed methods, using both quantitative and qualitative approaches, could go some way towards explaining the health disparity in Korean older women. 이 연구는 여성노인의 건강불평등 측정을 위한 사회경제적 위치 지표와 관련하여 동일한 주제에 두가지 이상의 방법을 적용하는 통합 연구 방법의 적용가능성을 살펴보았다. 연구 자료 수집은 순차적 방식(sequential approach)에 따라 12명 여성노인을 심층 면접하는 질적연구를 우선 수행한 후, 전국에서 60세 이상 여성 564명을 대상으로 설문조사를 실시하였다. 분석은 동시적 삼각측량방법(concurrent triangulation design) 기준에 따라 양적/질적 자료를 통합적으로 적용하여 다양한 자료와 증거를 통한 기존 이론 확인(확증, corroboration), 이면에 숨겨져 있던 상세한 내용 발견(정교화, elaboration), 새로운 주제발견(창시, initiation) 등 3가지 단계로 나누어 분석하였다. 설문조사 결과에 의하면 여자노인의 낮은 교육수준, 경제적 어려움, 육체적으로 힘든 노동경험, 낮은 수준의 사회적 지지 등은 자가평가 건강수준을 낮추고 만성질환, 활동장애, 우울수준을 높이는 방향으로 관련성을 보였다. 심층면접 자료는 이러한 양적조사 결과를 확인해주었고, 더하여 우리나라 현재 여성노인이 겪었던 시대적 배경으로 인한 교육기회박탈이나 다양한 노동경험 등, 여성노인들의 교육과 직업에 대한 심층적이고 다양한 해석을 찾아주었다. 또한 남자형제의 교육수준이 여자노인 자신의 교육수준보다 유년기 가정형편을 더욱 잘 반영할 수 있다는 시사점이나 여성노인들이 소득이나 건강수준을 평가할 때 넓은 범주의 ‘보통’이라는 응답 이면의 재해석적 시각의 중요성을 제시하였다. 이 연구는 노년기 여성의 건강불평등을 설명하는 도구로서 통합연구방법을 유용성을 제시한다. 노년기 연구 분야에서 보다 다양한 접근의 통합에 대한 학문적 논의와 관심이 필요하다.

여성 노인의 건강인식에 관한 질적 연구

천희란,강민아,정최경희,조성일,조성일 이화여자대학교 한국여성연구소 2010 여성학논집 Vol.27 No.2

이 연구는 실증주의적이고 계량적 연구방법에 치우쳐 온 건강과학분야에서 노년기 건강에 관한 일반적 연구방법의 한계를 보완하고자 시도되었다. 반-구조화된 질문과 심층면접을 통해 생애단계별로 수집된 구술 자료를 분석하여, 여성 노인들이 자신의 건강을 어떻게 평가하고 있으며 현재의 건강을 결정하는데 중요하다고 인식하는 사건이나 요인은 무엇인지 살펴보고자 하였다. 대상은 기준표본방법(criterion sampling)에 의거해 서울거주 67-79세 여성 노인 12명을 모집하였고, 기초생활수급자 및 비수급자를 비례적으로 포함하였다. 분석은 colaizzi의 현상학적 분석 방법을 사용하였다. 연구에 참여한 여성 노인들은 ‘젊어서 고생’, ‘자식 사망’이나 ‘사업 실패’와 같은 충격적 사건이나 ‘화병’, ‘유산, 출산, 산후조리와 같은 여성특이적 경험’, ‘어릴적 영양상태’와 같이 “생애사유인(誘因)적”으로 건강과 질병의 원인을 찾는 경향이 있었다. 더불어 질병이나 노화를 필연적 인생과정으로 인식하거나, 타고난 체질로 받아들이는 “인생순응(順應)적” 범주도 나타났다. 여성 노인들에게 현재의 건강과 질병은 의학적 진단명이나 임상적 수치로만 표현할 수 없는, 일생동안 축적된 슬픔과 한의 간접적 표현이기도 하고, 사회적 관계의 건전성과 관련된 포괄적 삶의 질 지표이기도 하다. 노인의 입장에서 건강의 의미를 찾고 문제를 검토하는 다양한 연구가 필요하다. This phenomenological study describes how older women evaluate their health and what they perceive attributes to their current health status. Despite recent growing recognition of the need for qualitative methods, there has been little literature on the health of older Korean women from their own subjective perspective. In an effort to fill this gap, we conducted semi-structured, face-to-face in-depth interviews with 12 women aged 67 to 79, residing in Seoul. Each woman was interviewed for 50 to 120 minutes regarding her life course and health perception. We found that, in the case of older females, health and illness might be an expression of accumulated sadness/anger and that their perceptions of health were influenced by life trajectory events according to ‘her lived experience’. Moreover, an individual’s health status in old age seemed to reflect the overall quality of life, particularly in regards to the soundness of social relations. This analysis, following Colaizzi's method, revealed such ‘life experiences’ categories as ‘overwork in younger ages,’ ‘death of a child,’ ‘business failure,’ ‘abortion or post-partum care’ and ‘wha-byung (culturally bounded mental illness due to suppressed anger).’ At the same time, the women interviewed seemed to accept diseases and frailty as ‘part of being old,’ or a ‘natural process.’ For a deeper understanding of health and the meaning of health in later life, further studies should take into consideration, and explore in more details, not only what is answered, but the unique perspective, from which it is said.

Trends in Gender-based Health Inequality in a Transitional Society: A Historical Analysis of South Korea

천희란,조성일,강영호,강민아,김일호 대한예방의학회 2012 Journal of Preventive Medicine and Public Health Vol.45 No.2

Objectives: This study examined the trends in gender disparity in the self-rated health of people aged 25 to 64 in South Korea, a rapidly changing society, with specific attention to socio-structural inequality. Methods: Representative sample data were obtained from six successive, nationwide Social Statistics Surveys of the Korean National Statistical Office performed during 1992 to 2010. Results: The results showed a convergent trend in poor self-rated health between genders since 1992, with a sharper decline in gender disparity observed in younger adults (aged 25 to 44) than in older adults (aged 45 to 64). The diminishing gender gap seemed to be attributable to an increase in women’s educational attainment levels and to their higher status in the labor market. Conclusions: The study indicated the importance of equitable social opportunities for both genders for understanding the historical trends in the gender gap in the self-reported health data from South Korea.

지표로 보는 한국여성의 재생산건강

천희란 한국보건사회연구원 2016 보건복지포럼 Vol.235 No.-

재생산기간은 여성의 생애주기에서 민감한 시기이며 임신, 분만, 출산과 관련된 재생산활동은 여성 건강에 크게 영향을 미치고 있다. 이 글은 임신과 출산, 피임, 인공임신중절, 재생산주기 등 영역으로 나누어 추이와 함께 우리나라 여성의 재생산건강 현황과 관련요인을 살펴보았다. 가임기 기혼여성의 연령이 높을수록 임신 소모 및 인공임신중절 경험이 증가하는 경향이다. 피임실천은 1960년대 이후 현격히 증가하였지만 약 20%의 비실천자나 실천자들의 정확한 피임 사용법 등 질적인 문제도 있다. 초경에서 폐경까지 재생산주기는 빨라진 초경으로 늘어났으며 초경연령은 연령코호트별 큰 차이를 보이고 있다. 또한 초경연령, 임신 소모, 인공임신중절 경험에서 여성의 교육수준, 가구소득, 직업, 지역 특성별 사회경제적 격차가 관찰되었다. 재생산건강 정책에서 여성 내부의 차이를 고려한 접근이 필요하다.

노인차별과 정신건강: 감정반응의 매개효과

천희란,김일호 한국자료분석학회 2017 Journal of the Korean Data Analysis Society Vol.19 No.5

이 연구는 노인차별과 정신건강의 관련성을 감정적 인지적 과정의 매개적 역할에 주목하여 살펴보고자 한다. 자료는 단면연구이며 면대면 방문조사인 “노인차별경험과 건강조사” 60세-89세 812명 자료를 분석하였다. 노인차별 경험 설문에 응답한 후 연구 대상 고령자들은 16개 항목의 감정반응 설문에 참여하였다. 탐색적 요인분석 결과, 16개 항목은 ‘화남/슬픔’, ‘보복감’, ‘실망감’, ‘무력감’, ‘창피함’ 등 5가지 유형으로 나뉘었다. 1단계 회귀 분석결과 노인차별은 우울증상과 유의한 연관성이 있었다(b=.323, p<.001). 하지만 감정반응을 투입한 회귀분석 모형에서 노인차별의 영향은 매개변수인 감정변수가 통제될 때 독립변수인 노인차별의 영향이 사라지게 되어, 노인차별과 우울의 관계에서 감정반응의 완전매개 효과가 확인되었다. 다중 회귀 분석 결과 다섯 가지 감정반응 유형은 모두 우울과 유의한 관련성이 있는 반면, 노인차별과 우울의 관계에서 ‘화남/슬픔’, ‘실망감’, ‘창피함’ 등 감정 반응만 매개효과가 유의하였다. 본 연구 결과는 한국 고령자들이 경험하는 노인차별과 우울의 관련성은 정신건강문제를 초래하는 감정적 인지적 평가 경로를 통해 일부 설명될 수 있음을 증명하고 노년기 차별영향의 사회·정서적 평가에 관한 추가 연구의 필요성을 제언한다. This study is to examine how ageism is related to mental health, focusing the mediating roles of emotional and cognitive processes in the link between ageism and depression. Data were drawn from ageism and health survey among Korean elderly aged 60 to 89 (N=812), which was a cross-sectional survey collected through face-to-face interviews. After responding to the questions of ageism, the elderly were queried to 16-item emotional reactions to ageism. Using exploratory factor analysis, the measure yields five types of emotional reaction scales: anger/sadness, aggression, discouragement, powerlessness, and shame. Internal consistency coefficients (Cronbach’s α) ranged from 0.665 to 0.873. The results show that ageism was significantly associated with depressive symptoms (b=.393, p<.001). Cognitive appraisal, especially in discouragement and shame appraisals, significantly mediated the ageism-depression link, whereas all five types of emotional reactions were significantly associated with depression. This finding implies that the association between ageism and depression experienced by Korean elderly is partly explained by the pathways of emotional and cognitive appraisals that lead to mental health problems.

고령화 연구를 위한 바이오마커 예비조사 소개

천희란,부가청,조성일 한국노동연구원 2008 노동리뷰 Vol.2008 No.12

부모의 사회경제적 위치에 따른 자녀의 출생 성비 추이: 1981년부터 2004년까지

천희란,김일호,강영호,Chun, Hee-Ran,Kim, Il-Ho,Khang, Young-Ho 대한예방의학회 2009 예방의학회지 Vol.42 No.2

Objectives : South Korea has experienced unprecedented ups and downs in the sex ratio at birth(SRB), which has been a unique phenomenon in the last two decades. However, little is known about socioeconomic factors that influence the SRB. Employing the diffusion theory by Rogers, this study was undertaken to examine the trends in social variations in the SRB from 1981 to 2004 in Korea. Methods : The data was taken from Vital Birth Statistics for the period from 1981-2004. We computed the annual male proportion of live births according to the parental education(university, middle/high school, primary) and occupation(non-manual, manual, others). Logistic regression analysis was employed to estimate the odds ratios of male birth according to social position for the equidistant three time periods(1981-1984, 1991-1994, and 2001-2004). Results : An increased SRB was detected among parents with higher social position before the mid 1980s. Since then, however, a greater SRB was found for the less educated and manual jobholders. The inverse social gradient for the SRB was most prominent in early 1990s, but the gap has narrowed since the late 1990s. The mother's socioeconomic position could be a sensitive indicator of the social variations in the sex ratio at birth. Conclusions : Changes in the relationship of parental social position with the SRB were detected during the 1980-2004 in Korea. This Korean experience may well be explained by diffusion theory, suggesting there have been socioeconomic differences in the adoption and spread of sex-detection technology.

노인차별(ageism)의 사회경제적 관련요인과 건강영향

천희란(Chun, Heeran),김일호(Kim, Il-Ho) 한국노년학회 2013 한국노년학 Vol.33 No.3

현대사회에 들어서며 전통적으로 공경의 대상이었던 노인은 나이로 인한 부당한 대우 및 차별을 경험하게 되었다. 이 연구는 노인의 사회경제적 지위를 고려하여 노인차별경험의 관련요인을 파악하고, 차별경험으로 인한 건강 영향을 다각적으로 살펴보고자 하였다. 편의표집으로 추출된 60세-89세 345명을 대상으로 Palmore의 'The Ageism Survey' 도구를 사용하여, 노인차별경험을 측정하였다. 연구결과, 고령자의 약 45.8%가 한번 이상의 노인차별을 경험한 것으로 나타났다. 노인차별경험은 남자, 무배우자, 수입이 낮은 노인이 유의미하게 높았다. 또한 노인차별경험은 노년기 우울감과 유의미하게 높은 연관성을 보였으나, 주관적 건강수준과 고혈압과의 연관성은 보이지 않았다. 사회적 지지가 있는 경우, 노인차별경험이 크게 증가할수록 우울증상을 유의미하게 증가시키는 결과를 보였다. 이 연구결과는 한국사회의 노인차별에 대한 정책적 관심을 촉구하고, 사회적 관계를 고려한 노인차별과 건강영향 연구의 필요성을 제기하고 있다. This study aims to examine how Korean elders experience ageism, with a focus on the social determinants, and how those experiences relate to their subjective, physical and mental health. Data was gathered from a convenient sample of 345 people aged 60-89 via face-to-face interviews. Ageism was measured using a 20 item questionnaire from 'The Ageism Survey' by Palmore. Health outcomes included self-rated health, hypertension, and depressive symptom. Half of the respondents reported having experienced ageism 'more than once' in 20 listed situations. The prevalence of ageism and sub-group characteristics appeared to show a different picture compared to the results in the Palmore's US study in which higher levels of ageism were reported by men (vs. women), people without spouses (vs. with spouses), and people with lower income (vs. higher). Furthermore, the ageism experience increased the risk of having depressive symptoms, with the association still significantly consistent even after adjusting for socio-demographic characteristics by OR 1.18 (95%CI 1.09-1.28). The health effect of ageism was not observed in hypertension or self-rated health. Interestingly, for those who experienced higher levels of ageism, having social support appeared to increase the risk of depressive symptoms. Ageism and the harmful impact on health need to be better understood in social context.

고령자의 건강리터러시에서 사회적 격차

천희란 ( Heeran Chun ) 대한보건협회 2020 대한보건연구 Vol.46 No.1

연구목적: 이 연구는 사회경제적 불평등에 주목하며, 고령자의 건강리터러시와 관련된 사회적 요인을 파악하고자 한다. 연구방법: 본 연구는 단면연구이며 자료는 다단계확률추출 표집으로 서울시 각 구별 60-79세 고령자 725명을 면담한 설문 조사 결과이다. 건강리터러시 측정도구는 Chew등 연구의 16문항을 수정하여 국내 고령자를 대상으로 타당도가 입증된 8문항을 사용하였다. 대상 인구집단의 건강리터러시 수준의 높고 낮음 구분은 중위수 32점 기준으로 나누었다. 사회경제적 요인으로 교육수준은 초졸 이하, 중졸, 고졸이상 등 세 그룹으로, 기타 사회인구학적 독립변수로 연령(60대, 70대), 성별, 배우자 유무, 사회적지지, 소득이 있는 일 유무, 주관적 경제수준 및 용돈 수준 등을 고려하였다. 로지스틱 회귀분석을 사용하여 낮은 건강리터러시 수준 관련요인을 분석하고, 사회경제적 불평등을 비교하였다. 결과: 연구 결과, 참여자의 연령은 68.5세(±5.6) 이고 여자가 55%였다. 단변량 분석 결과, 고려한 모든 사회경제적 변수와 건강리터러시의 관련성이 관찰되었다. 연령보정 오즈비로 계산한 건강리터러시의 격차는 교육불평등 지표에서 두드러졌다(aOR 2.15 95%CI 1.45-3.19, and aOR 3.85 95%CI 2.38-6.23; RII 10.37 95%CI 5.57-19.32). 다변량 분석 결과, 고령자, 여성, 낮은 교육수준 그룹 등이 낮은 건강리터러시의 유의한 관련 요인으로 나타났다. 결론: 본 연구결과는 우리나라 고령자의 건강리터러시 정책에서 사회경제적 불평등에 대한 관심과 특히 교육 불평등을 고려한 접근의 필요성을 제시한다. Objective: This study aims to assess the associated factors in health literacy, focusing on the socioeconomic inequalities among older adults. Methods: Data were drawn from a cross-sectional design, which includes 725 non-institutionalized older Koreans aged 60-79 residing in Seoul, from a multistage probability sample. The health literacy measure of 8 questions was modified and validated from Chew’s 16 Questionnaire. The lower health literacy group was divided by the median score of health literacy 32(range 11-40). Education was classified by three groups; elementary school or lower, middle school, high school or over. Other independent variables included age, gender, marital status, social support, working status, subjective economic status, and pocket money. Logistic regression models were used to examine the relative inequality in low health literacy. Results: The mean age of the sample was 68.5(±5.6) of which 55% were women. Bivariate analysis demonstrated significant associations between all considered socioeconomic positions and health literacy. Educational disparity in health literacy was prominent, with the odds of getting lower health literacy increasing by the lower level of education (aOR 2.15 95%CI 1.45-3.19, and aOR 3.85 95%CI 2.38-6.23; RII 10.37 95%CI 5.57-19.32). Multivariate results showed that older age, women, and lower education were associated with lower health literacy. Conclusion: The finding calls for more attention to educational disparity in health literacy among older adults in Seoul.