한국과 미국의 주관적 건강상태와 관련요인들의 비교 = A Comparison between Korea and the US in Self-Rated Health and Its Related Factors

다국어 초록 (Multilingual Abstract)

Korea is higher than US in the proportion of negative ratings in self-rated health (SRH), while the life expectancy of Korea is longer than that of US. We do not fully understand why these discrepancies in subjective health and objective health exist. This study aimed to compare the factors related to SRH between Korea and the US. We used 2016 data of the Korea National Health and the Nutrition Examination Survey and National Health and Nutrition Examination Survey. Self-rated health was recoded into three categories: very good or good, fair, bad or very bad. Several variables of socioeconomic characteristics and health condition that were related to SRH and their interaction variables with country variable were included in the ordered regression. Marginal effects were estimated by country for those factors whose interaction effect were statistically significant. Results showed that Koreans tended to report worse SRH than Americans. And then we also found that sex, education, smoking status, activity limitation, and several chronic conditions were differently associated with SRH by country. The fact that Koreans rate their health more negatively than Americans do when there is activity limitation or a chronic disease may be related to worse subjective 132 보건과 사회과학 제 집 50 (2019) health status of Koreans than Americans. We also found that the meaning of ‘botong’ in Korean and ‘fair’ in English may be different. Further studies are needed to understand the meanings of SRH and response styles of the two countries.

국문 초록 (Abstract)

한국은 미국보다 주관적 건강상태에서 부정적으로 평가하는 비율이 높은 반면 기대여명은 높다 , . 한국이 객관적인 건강수준에 비해 주관적 건강수준이 낮은 이유가 무엇인지에 대해서는 이해가 부족 하다 본 연구의 목적은 정량적 분석을 통하여 한국과 미국 사이에 존재하는 주관적 건강상태의 수준 . 을 결정하는 요인들의 차이를 비교하는 것이었다. 연구 자료는 년 국민건강영양조사와 미국의 2016 NHANES(National Health and Nutrition 였다 두 자료는 통합하여 분석에 사용하였다 주관적 건강상태는 매우 좋음 Examination Survey) . . 혹은 좋음 보통 그리고 나쁨 혹은 매우 나쁨 의 세 범 (very good, good), (fair), (bad or very bad) 주로 정의하였다 주관적 건강상태와 관련된 사회경제적 특성과 건강상태 변수들 그리고 각 독립변 . , 수와 국가 변수의 교호변수들을 모형에 추가하여 순서 로지스틱 회귀분석을 실시하였다 또한 유의한 . 교호작용이 확인된 독립변수에 대해서는 각 국가별로 한계효과를 추정하여 비교하였다. 분석결과 미국이 한국보다 주관적 건강상태가 더 좋은 것을 확인하였다 그리고 성 교육수준 흡 . , , 연상태 활동제한 일부 만성질환 여부의 주관적 건강상태와의 관련성에서 한국과 미국 사이에 차이 , , 가 있었다 활동제한과 만성질환이 존재할 때 한국이 미국보다 주관적 건강상태를 더 비관적으로 평 . 가하는 것은 한국이 미국보다 주관적 건강수준이 나쁜 것과 관련이 있을 수 있다 또한 응답보기 중 . 보통과 의 의미를 다르게 이해하고 있을 가능성을 발견하였다 두 나라의 주관적 건강상태의 의 ‘ ’ ‘fair’ . 미와 응답 스타일의 차이를 이해할 수 있는 추가 연구들이 필요하다.

참고문헌 (Reference)

1 최홍석, "주요우울장애의 선별 도구로서 한국판" 대한가정의학회 28 (28): 114-119, 2007

2 강은정, "교육수준과 주관적 불건강-매개 요인의 탐색" 한국보건경제정책학회 14 (14): 51-74, 2008

3 Grol-Prokopczyk, H., "Using anchoring vignettes to assess group differences in general self-rated health" 52 (52): 246-261, 2011

4 Jürges, H., "True health vs. response styles : Exploring cross-cultural differences in self-rating health" 16 : 163-178, 2007

5 Lee, Y., "The predictive value of self assessed general, physical, and mental health on functional decline and mortality in older adults" 54 : 123-129, 2000

6 Albrecht, G. L., "The disability paradox : high quality of life against all odds" 48 : 977-988, 1999

7 Kerkhofs, M., "Subjective health measures and state dependent reporting errors" 4 : 221-235, 1995

8 StataCorp, "Stata Statistical Software: Release 15"

9 Braveman, P. A., "Socioeconomic disparities in health in the United States: what the patterns tell us" 100 (100): S186-S196, 2010

10 Chamberlain, A. M., "SelfR‐ at ed Health Predicts Healthcare Utilization in Heart Failure" 3 : e000931-, 2014

11 Idler, E. L., "Self-rated health and mortality : a review of twentyseven community studies" 38 (38): 21-37, 1997

12 Bardage, C., "Self-rated health among older adults : a cross-national comparison" 2 : 149-158, 2005

13 Garbarski, D., "Research in and prospects for the measurement of health using self-rated health" 80 (80): 977-997, 2016

14 OECD, "OECD Health at a Glance 2017" OECD Publishing 2017

15 OECD, "OECD Health Statistics 2018: online database"

16 National Center for Health Statistics, "NHANES 2015-2016 Overview"

17 van Oort, F. V. A., "Material, psychosocial, and behavioral factors in the explanation of educational inequalities in mortality in the Netherlands" 59 : 214-220, 2005

18 Verropoulou, G., "Key elements composing self-rated health in older adults : a comparative study of 11 European countries" 6 : 213-226, 2009

19 Hays, R. D., "Item response theory and health outcomes measurement in 21st century" 38 (38): II28-II42, 2000

20 Andrade, F. C. D., "Increasing educational inequalities in self-rated health in Brazil, 1998-2013" 13 (13): 1-13, 2018

21 Garbarski, D., "How participants report their health status : cognitive interviews of self-rated health across race/ethnicity, gender, age, and educational attainment" 17 : 771-, 2017

22 Simon, J. G., "How is your health in general? A qualitative study on self-assessed health" 15 : 200-208, 2005

23 OECD, "Health at a Glance 2015 : OECD Indicators" OECD Publishing 2015

24 De Bruin, A., "Health Interview Surveys. Towards International Harmonization of Methods and Instruments" WHO 1996

25 Lee, S. Y., "Gender gap in self-rated health in South Korea compared with United States" 16 : 11-20, 2016

26 Kontis, V., "Future life expectancy in 35 industrialised countries : projections with a Bayesian model ensemble" 389 (389): 1323-1335, 2017

27 Fellinghauer, B., "Explaining the disability paradox : a cross-sectional analysis of the Swiss general population" 12 : 655-, 2012

28 Kweon S., "Data Resource Profile: The Korea National Health and Nutrition Examination Survey (KNHANES)" 43 : 69-77, 2014

29 Lindeboom, M., "Cut-point shift and index shift in self-reported health" 23 : 1083-1099, 2004

30 Murry, C., "Cross-population comparability of evidence for health policy" World Health Organization 2002

31 Sadana, R., "Comparative Analysis of More than 50 Household Surveys on Health Status" WHO/EIP 2000

32 Burgard, S. A., "Challenges of health measurement in studies of health disparities" 106 : 143-150, 2014

33 Groot, W., "Adaptation and scale of reference bias in self-assessments of quality of life" 19 (19): 403-420, 2000