Objectives: Over the past several years, the incidence of hepatitis A infection has been increasing rapidly in the young-adult population in Korea. We examined the effects of area-level socioeconomic status and environmental hygiene on the incidence of hepatitis A. Methods: This study is based on th...
Objectives: Over the past several years, the incidence of hepatitis A infection has been increasing rapidly in the young-adult population in Korea. We examined the effects of area-level socioeconomic status and environmental hygiene on the incidence of hepatitis A. Methods: This study is based on the registered national population of Korea and the national health insurance data from 2004 to 2008. A total of 73 459 individuals were confirmed to have had hepatitis A. The standardized incidences of hepatitis A in 232 districts adjusted for sex and age of people were calculated for each year, and the rate ratios of the incidence rates were estimated according to area-level socioeconomic status and environmental hygiene using multiple Poisson regression models. Results: The incidence rates of hepatitis A infection were 15.6 (per 100 000) in 2004, 19.0 (per 100 000) in 2005, 27.2 (per 100 000) in 2006, 25.1 (per 100 000) in 2007, and 61.7 (per 100 000) in 2008. The analysis of the area-level effects showed that residential areas of the less deprived than other regions, areas with higher levels of education, and heavily populated areas were significantly associated with increased risk. Conclusions: There is a very strong possibility that both area-level socioeconomic status and environmental hygiene play a role in increasing the risk of hepatitis A infection in Korea. Therefore, to reduce hepatitis A infection, we need a nationwide strategy that considers these area-level characteristics.
Objectives: Over the past several years, the incidence of hepatitis A infection has been increasing rapidly in the young-adult population in Korea. We examined the effects of area-level socioeconomic status and environmental hygiene on the incidence of hepatitis A. Methods: This study is based on the registered national population of Korea and the national health insurance data from 2004 to 2008. A total of 73 459 individuals were confirmed to have had hepatitis A. The standardized incidences of hepatitis A in 232 districts adjusted for sex and age of people were calculated for each year, and the rate ratios of the incidence rates were estimated according to area-level socioeconomic status and environmental hygiene using multiple Poisson regression models. Results: The incidence rates of hepatitis A infection were 15.6 (per 100 000) in 2004, 19.0 (per 100 000) in 2005, 27.2 (per 100 000) in 2006, 25.1 (per 100 000) in 2007, and 61.7 (per 100 000) in 2008. The analysis of the area-level effects showed that residential areas of the less deprived than other regions, areas with higher levels of education, and heavily populated areas were significantly associated with increased risk. Conclusions: There is a very strong possibility that both area-level socioeconomic status and environmental hygiene play a role in increasing the risk of hepatitis A infection in Korea. Therefore, to reduce hepatitis A infection, we need a nationwide strategy that considers these area-level characteristics.
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문제 정의
Third, this study analyzed not only the regional incidence rate itself, but also the relationship between the region’s socioeconomic level and the incidence rate. In addition, this study is significant in the way that it explores the reasons for the regional differences in hepatitis A incidence. This study hows that there can be changes in the hepatitis A incidence rate related to the socioeconomic status and environmental hygiene of Korean regions.
In addition, this study is significant in the way that it explores the reasons for the regional differences in hepatitis A incidence. This study hows that there can be changes in the hepatitis A incidence rate related to the socioeconomic status and environmental hygiene of Korean regions. It is a very important public eubiotic problem that, in epidemics of hepatitis A in a country with intermediate danger such as Korea, the incidence rate is higher in regions with a low antibody cultivation rate.
This study shows that differences in socioeconomic status can be a risk factor for hepatitis A infection. In case the hepatitis A infection epidemic trend continues, public health measures, such as strategic vaccination, ensuring a safe supply of drinking water, and being responsible for the clean handling of food ingredients, can be utilized.
가설 설정
1 Increasing deprivation indices represent the districts that are more deprived.
2 Increasing deprivation indices represent the districts that are more deprived.
제안 방법
By using National Health Insurance data, which is a representative source of data on Koreans, and by targeting subjects infected with hepatitis A, the authors of this calculated the incidence of hepatitis A in each city, district, and borough (si, gun, and gu), and studied the relevance of socioeconomic status and environmental hygiene to hepatitis A outbreaks.
Despite its limitations, this study is significant for several reasons. First, this study has undertaken a process of targeting all citizens registered in the residence registration statistics, and this likely produced representative data that can reflect various aspects of hepatitis A incidence in Korea. Second, previous studies have targeted certain regions of Korea [12-14,24], but this study targeted the entire country.
In order to calculate the incidence rate of hepatitis A at the city, district, and borough levels using population data, the Resident Registration Population Statistics data was used. In order to suggest a standardized incidence rate, an administration district was unified for five years, and a total of 232 sites were categorized based on the administration district.
In order to determine the difference in the appearance of hepatitis A according to region, this study described that the incidence rate of the entire nation’s 16 metropolitan cities and provinces, and the incidence rate according to the distribution of independent variables using analysis of variance.
Third, this study analyzed not only the regional incidence rate itself, but also the relationship between the region’s socioeconomic level and the incidence rate.
This study divided the Republic of Korea into 232 city, district, and borough sites, obtained the incidence rate of each region, and studied the correlation between the region’s socioeconomic and environmental hygiene indexes and the incidence rate.
대상 데이터
9 (hepatitis A without hepatic coma). By using these disease classification codes, a total of 168 522 cases of check-up bill data were confirmed; after overlapping cases were consolidated, 95 063 incidences and 72 941 people (518 people excluded because their residence address data was missing) were included in the study as targets who had contracted hepatitis A.
데이터처리
4 p-value by ANOVA test.
For want of space, only the map of 2008 with the highest incidence rate is presented here. All statistical analysis was performed using SAS version 9.2 (SAS Inc., Cary, NC, USA), and the map was drawn using the geographic information program MapWizard for Excel 2007 (Tastech Inc., Seoul, Korea).
성능/효과
In this study, the age group with the highest incidence rate varied according to the region: when the region was less developed, the incidence rate was at the highest level for those in their 20s, while in urbanized regions, the incidence rate was at the highest level for those in their 30s. The reason for this can be explained as follows: First, many of those in the 20s age cohort may actually reside in different regions than the ones stated on their social security cards.
The results of the analysis in this study show that the lower the regional deprivation index, and the higher the educational level of the population, the greater the incidence rate of hepatitis A. This means that the higher the socioeconomic level of a region, the more susceptible the adults in their 20s and 30s will be to hepatitis A infection, as they have vigorous social lives, with frequent contact with people from a wide geographic distribution. Although we made an effort to adjust the age groups through direct standardization, the reason why the incidence rate shows differences according to the age structure is because each region has a different herd immunity level.
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