Abstract
BackgroundPrevious studies have shown that contextual factors and individual socioeconomic status (SES) were associated with mortality in Western developed countries. In Korea, there are few empirical studies that have evaluated the association between SES and health outcomes.MethodsWe conducted cohort study to investigate the socioeconomic disparity in all-cause mortality for patients newly diagnosed with hypertension in the setting of universal health care coverage. We used stratified random sample of Korean National Health Insurance enrollees (2002–2013). We included patients newly diagnosed with hypertension (n = 28,306) from 2003–2006, who received oral medication to control their hypertension. We generated a frailty model using Cox’s proportional hazard regression to assess risk factors for mortality.ResultsA total of 7,825 (27.6%) of the 28,306 eligible subjects died during the study period. Compared to high income patients from advantaged neighborhoods, the adjusted hazard ratio (HR) for high income patients from disadvantaged neighborhoods was 1.10 (95% CI, 1.00–1.20; p-value = 0.05). The adjusted HR for middle income patients who lived in advantaged versus disadvantaged neighborhoods was 1.17 (95% CI, 1.08–1.26) and 1.27 (95% CI, 1.17–1.38), respectively. For low income patients, the adjusted HR for patients who lived in disadvantaged neighborhoods was higher than those who lived in advantaged neighborhoods (HR, 1.35; 95% CI, 1.22–1.49 vs HR, 1.28; 95% CI, 1.16–1.41).ConclusionsNeighborhood deprivation can exacerbate the influence of individual SES on all-cause mortality among patients with newly diagnosed hypertension.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-015-0288-2) contains supplementary material, which is available to authorized users.
Highlights
Previous studies have shown that contextual factors and individual socioeconomic status (SES) were associated with mortality in Western developed countries
An inverse relationship between mortality and neighborhood characteristics was found in Alameda County, 18 counties of Nova Scotia in Canada [17, 18]; in particular, low income individuals living in advantaged neighborhoods had higher mortality rates relative to low income individuals living in disadvantaged neighborhoods
Compared to a high income reference group, the adjusted hazard ratio (HR) for low income and middle income groups was 1.25 and 1.16, respectively
Summary
Previous studies have shown that contextual factors and individual socioeconomic status (SES) were associated with mortality in Western developed countries. Most studies that explain the inverse relationship between socioeconomic status (SES) and risk factors for hypertension have come from the developed countries. The results of these studies demonstrated a relationship between individual socioeconomic characteristics and health status, where higher SES correlated with better health [12,13,14,15]. Other studies have stated that neighborhood characteristics are the result of an aggregation of the relationships between the socioeconomic status and the health status of the individual [16]. Because Korea first implemented universal health care coverage in 1989 and has operated by a national tax system, there has been a greater redistribution of income in the population [19], resulting in smaller income inequalities than in the United States
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