OBJECTIVES: The aims of this paper were to develop the composite deprivation index (CDI) for the sub-district (Eup-Myen-Dong) levels based on the theory of social exclusion and to explore the relationship between the CDI and the standardized mortality ratio (SMR). METHODS: The paper calculated the age adjusted SMR and we included five dimensions of social exclusion for CDI; unemployment, poverty, housing, labor and social network. The proxy variables of the five dimensions were the proportion of unemployed males, the percent of recipients receiving National Basic Livelihood Security Act benefits, the proportion of households under the minimum housing standard, the proportion of people with a low social class and the proportion of single-parent household. All the variables were standardized using geometric transformation and then we summed up them for a single index. The paper utilized the 2004-2006 National Death Registry data, the 2003-2006 national residents' registration data, the 2005 Population Census data and the 2005-2006 means-tested benefit recipients' data. RESULTS: The figures were 115.6, 105.8 and 105.1 for the CDI of metropolitan areas (big cities), middle size cities and rural areas, respectively. The distributional variation of the CDI was the highest in metropolitan areas (8.9 - 353.7) and the lowest was in the rural areas (26.8 - 209.7). The extent and relative differences of deprivation increased with urbanization. Compared to the Townsend and Carstairs index, the CDI better represented the characteristics of rural deprivation. The correlation with the SMR was statistically significant and the direction of the CDI effects on the SMR was in accordance with that of the previous studies. CONCLUSIONS: The study findings indicated mortality inequalities due to the difference in the CDI. Despite the attempt to improve deprivation measures, further research is warranted for the consensus development of a deprivation index.
Humans ; Logistic Models ; Male ; *Mortality ; *Prejudice ; *Psychosocial Deprivation ; Republic of Korea ; Social Class ; Social Justice ; Socioeconomic Factors ; Statistics as Topic

OBJECTIVES: This study sought to analyze the effects of ADL and IADL on dental care utilization behaviors for the elderly 65 years of age and older. METHODS: Using data from the Korea Health Panel 2010-2011, we examined 2683 elderly people who did not use dental care and 12,550 cases of dental care utilization of 963 elderly people who used dental care among people aged 65 and older who responded to the items of ADL and IADL limitations. We employed two-part model (TPM) including logistic regression analysis in a first part of the model and negative binomial regression analysis in a second part of the model to estimate dental care utilization patterns associated with ADL and IADL of elderly adults. RESULTS: A frequency analysis revealed that dental care utilization was more frequent in the elderly with IADL limitations than in the elderly with ADL limitations. The first part of TPM predicted that dental care utilization was more likely to be present in males and younger age group along with increasing number of chronic diseases and independence in ADL and IADL. The results of the second part of TPM estimated the quantity of dental care utilization increased among high income groups. CONCLUSIONS: Limitations in ADL and IADL were found to affect the decision to seek dental care utilization, but physical limitations to have no statistical effect on the quantity of dental care utilization, once dental care utilization was taken for treatment. These findings suggested that dental care utilization would be determined by supplier induced demand and patient's own power to obtain treatment. Since decision to take dental care utilization, despite the barriers of limitations in activities, is an important factor which can satisfy medical needs, various policies to reflect oral health and physical fitness are required.
Activities of Daily Living* ; Adult ; Aged* ; Chronic Disease ; Dental Care* ; Humans ; Korea ; Logistic Models ; Male ; Oral Health ; Physical Fitness

OBJECTIVES: With increasing emphasis being placed on early interventions for health promotion, early dental visits to prevent early childhood caries have been receiving more attention. Infant oral health examinations have been implemented as a component of early health examination in South Korea, but there is a lack of research on its effectiveness. This study aimed to estimate the effectiveness of infant and toddler oral health examinations by performing economic analyses of infant health examinations and dental treatment costs after examinations. METHODS: The analyses were conducted using the National Health Insurance Service claims data. Subjects included in this study were children who had undergone their “3(rd) infant oral health examination (54-65 months)” between 2010 and 2014. To estimate dental treatment costs over the five years, four retrospective cohorts were evaluated, which included a total of 256,965 subjects. The direct medical costs following infant oral health examinations were calculated over five years (including only costs from health insurance claims), and the effects of infant oral health examinations were compared. RESULTS: Although the rate of infant oral health examinations showed a persistently increasing trend, differences were observed according to the type of health insurance. Children who underwent infant oral health examinations showed a higher number of visits to the dentist, but lower dental treatment costs compared with children who did not undergo examinations. CONCLUSIONS: This study confirmed, from an economic perspective, the effects of policy interventions that emphasize the necessity of early intervention and a life-course health management strategy, based on the concept that oral health is not determined at specific time points, but rather is determined by the accumulation of exposure to various factors over the course of life.
Child ; Cohort Studies ; Dentists ; Diagnosis, Oral* ; Early Intervention (Education) ; Health Care Costs ; Health Promotion ; Humans ; Infant Health ; Infant* ; Insurance, Health ; Korea ; National Health Programs ; Oral Health ; Retrospective Studies

OBJECTIVES: Despite various government initiatives, including the expansion of national health insurance coverage, health inequality has been a key health policy issue in South Korea during the past decade. This study describes and compares the extent of the total health inequality and the income-related health inequality over time among Korean adults. METHODS: This study employs the 1998, 2001 and 2005 Korean National Health and Nutrition Examination Surveys (KNHANESs). The self-assessed health (SAH) ordinal responses, measured on a five-point scale, rescaled to cardinal values to measure the health inequalities with using interval regression. The boundaries of each threshold for the interval regression analysis were obtained from the empirical distribution of the EuroQol-5 Dimension (EQ-5D) valuation weights estimated from the 2005 KNHANES. The final model predicting the individuals' health status included age, gender, educational attainment, occupation, income, and the regional prosperity index. The concentration index was used to measure and analyze the health inequality. RESULTS: The KNHANES data showed an unequal distribution of the total health inequality in favor of the higher income groups, and this is getting worse over time (0.0327 in 1998, 0.0393 in 2001 and 0.0924 in 2005). The income-related health inequality in 2005 was 0.0278, indicating that 30.1% of the total health inequality can be attributed to income. CONCLUSIONS: The findings indicate there are health inequalities across the sociodemographic and income groups despite the recent government's efforts. Further research is warranted to investigate what potential policy actions are necessary to decrease the health inequality in Korea.
Adult ; Aged ; Female ; *Health Status Disparities ; Humans ; Income ; Korea ; Male ; Middle Aged ; *Quality of Life ; Questionnaires

OBJECTIVES: Given that oral health is one of the major factors affecting the quality of life, it is necessary to measure the oral-health-related-quality-of-life dimension in order to value health. The aim of this study was to compare the dimensions of oral-health-related quality-of-life measured by a generic health measure [EuroQol-5D (EQ-5D)] and an oral health specific measure [Oral Health Impact Profile 14 (OHIP-14)]. METHODS: A questionnaire including EQ-5D, OHIP-14, self-rated general/oral health, and visual analog scale (VAS) was developed, and both patients and dentists participated in measuring the patient's oral health-related quality of life based on oral diseases. Data was collected from the Dental University Hospital from 2016 to 2017. For descriptive analysis, t-test, chi-square, ANOVA, Tukey HSD post-test, and Pearson correlation analysis were performed. To confirm the factors associated with EQ-5D, multiple regression analysis was conducted. RESULTS: A total of 305 subjects were selected for the final analysis excluding the partially missing questionnaires. EQ-5D and OHIP-14 showed a statistically significant correlation and a sensitive distribution of the values depending on the oral diseases. The values of EQ-5D and OHIP-14 ranged from highest to lowest in the following order of oral diseases: endodontic, TMJ, gingivitis, and tooth sensitivity. A 10-point increase in OHIP-14 was associated with a 0.34-point increase in EQ-5D. CONCLUSIONS: The result of this study proved to be consequential since both OHIP-14 and EQ-5D were good measures for oral health-related quality of life, and the oral disease status could also be measured in terms of health valuation weights. This increased the possibility of comparison with general health, and provided the loss of socioeconomic costs of individuals, families, and societies due to oral diseases.
Dentists ; Gingivitis ; Humans ; Oral Health ; Quality of Life ; Temporomandibular Joint ; Tooth ; Visual Analog Scale ; Weights and Measures

OBJECTIVES: Oral-specific measures are often preferred for examining oral disease outcomes; however, generic measures can add additional important information. This study measured oral health-related quality of life, reflecting the multidimensional characteristics of oral health, and we compared sub-dimensions of the Oral Health Impact Profile 14 (OHIP-14) with the EuroQual-5D (EQ-5D). METHODS: Data from 305 patients were collected from patients who visited the dental university hospital in 2016-2017 and included EQ-5D, OHIP-14, and self-rated general/oral health questionnaires. A factor analysis was performed to identify sub-dimensions of the EQ-5D and OHIP-14, and a cluster analysis was conducted to examine the degree of overlap among the sub-dimensions of two measures. RESULTS: In the factor analysis, a range of OHIP-14 items (physical pain, physical disability, and handicap) loaded on factor 3, along with EQ-5D items. In the analysis of groups with relatively low oral qualities of life, moving from the bottom towards the top of the dendrogram, the next major branch split was the dimension of EQ-5D pain/discomfort, anxiety/depression items, which clustered between the OHIP-14 interrupted meal and difficult relaxing subscales. CONCLUSIONS: The results of this study suggest that using the EQ-5D for oral health status expends the complementary role of oral health-related quality of life measures.
Humans ; Meals ; Oral Health ; Quality of Life

OBJECTIVES: The present study aimed to estimate the survival rate of teeth after non-surgical root canal treatment and to investigate the effect of income on the tooth survival rate. METHODS: The study included 1,414.668 endodontically treated teeth from 1,193.666 persons enrolled in the National Health Insurance Service in 2002. A survival analysis of the teeth was performed using the Kaplan-Meier method. The survival rates were calculated using a follow-up period of 11 years after the root canal treatment. RESULTS: In the present study, the 11-year cumulative survival rate of teeth after non-surgical endodontic treatments was 86.90%. The survival rates of teeth tended to decrease for the posterior teeth; the maxillary teeth showed a lower survival rate than that of the mandibular teeth. The teeth with the highest survival rates were the mandibular left lateral incisor, maxillary right incisor, mandibular right lateral incisor, and maxillary left central incisor, in that order. The lowest survival rates were shown by the mandibular second molar, maxillary second molar, maxillary first molar, and mandibular first molar, in that order. The survival rate of the first molar (#16, #26, #36, #46) was higher in the low-income group than in the high-income group (P<0.001). CONCLUSIONS: This study represents the outcome pattern of root canal treatment among South Korean individuals. These study findings can be used as comparative data for clinical decision making about endodontic treatment.
Clinical Decision-Making ; Dental Pulp Cavity ; Follow-Up Studies ; Humans ; Incisor ; Methods ; Molar ; National Health Programs ; Survival Rate ; Tooth Extraction ; Tooth*

OBJECTIVES: This study examined the misuse and abuse of antibiotics in relation to the demographic and socioeconomic characteristics of patients given prescriptions by dental providers. METHODS: We examined data collected in 2011 by the Korea Health Panel from 3,836 dental visits. The data included multiple visits per individual for 3,738 household members of 2,588 households using outpatient dental services. The data were analyzed by dental service provider type, using four types of beta-regression. Model analysis and comparison were performed using Akaike's information criterion (AIC) and Bayesian information criterion (BIC) to select the best model. RESULTS: Prescription rates according to type of dental service provider are as follows: 18% by dental hospitals and 19%-20% by dental clinics. The patient factors contributing to the prescription rate are gender, age, education, and income level. Higher antibiotics exposure was found in patients who were male, older, with less education, and lower incomes. Patient exposure to antibiotics did not significantly differ between dental hospitals and dental clinics. CONCLUSIONS: When prescribing antibiotics in dental practices, patient safety can be improved by reducing misuse and abuse of antibiotics through consideration of individual patient characteristics.
Anti-Bacterial Agents ; Dental Clinics ; Dental Health Services* ; Drug Prescriptions* ; Education ; Family Characteristics ; Humans ; Korea ; Male ; Outpatients ; Patient Safety ; Prescriptions

OBJECTIVES: This study discussed dental care utilization efficiency and equity from the perspective of private health insurance policy using the 2011 Korea Health Panel dataset. METHODS: A total of 10,577 subjects, aged 20 years or older, were selected from a larger sample (N=18,256). The study conducted a two-part model analysis to determine the impact of private health insurance on utilization and amount of dental care. RESULTS: Average monthly payment of private health insurance is 76,727 KRW. Analysis of average monthly fees and income distribution by quartile showed that higher income groups pay proportionally more for private health insurance. The highest income group was 3.82 times more likely to have private health insurance than the lowest income group. Those with private health insurance coverage had a higher probability of using dental care but were not more likely to use a greater number of dental services. CONCLUSIONS: Based on these empirical findings, a guarantee of health care system and policy equity and efficiency should be established for changes in private health insurance.
Dataset ; Delivery of Health Care ; Dental Care* ; Fees and Charges ; Income ; Insurance, Health* ; Korea

OBJECTIVES: Health inequity across social classes is closely associated with unequal healthcare utilization, and there have been sustained efforts to improve healthcare accessibility. Public healthcare insurance is one attempt to eliminate such health inequities. The purpose of this study was to examine a horizontal equity index for dental service utilization, which included diverse factors affecting health inequity, such as personal health and social context variables. METHODS: The 2008 to 2011 outpatient datasets of the Korean Healthcare Panel were analyzed. Zero-inflated negative binomial regression (ZINB) was conducted to estimate need-adjusted healthcare use with the following independent variables: health outcome (EQ-5D), chronic disease, and the Composite Deprivation Index. The concentration index and horizontal inequality index were calculated for the actual use of dental services and resource use-based dental visits. RESULTS: The ZINB regression analysis showed that age and personal health level on the EQ-5D were significant predictors, and the Composite Deprivation Index was influential. The concentration index for dental service utilization indicated that there was inequity favoring high-income brackets, but there was inequity favoring low-income groups when health level was taken into account. Overall, the horizontal equity index for dental service utilization estimated based on the two values was positive, meaning that there was inequity favoring high-income groups. CONCLUSIONS: The use of dental services has been steadily on the rise, and dental service accessibility and public healthcare coverage seem to have expanded. However, when the horizontal equity index for dental service utilization was estimated based on health level, there was inequity, with high-income groups making more use of dental services. Thus, equal access to dental services is not guaranteed, despite the adjustment for need. Methods of increasing dental service use in different income brackets must be carefully considered to remove disparities in the use of dental services.
Chronic Disease ; Dataset ; Delivery of Health Care ; Health Status ; Humans ; Insurance ; Outpatients ; Social Class ; Socioeconomic Factors