Sex Differences in Cardiovascular Disease Risk by Socioeconomic Status (SES) of Workers Using National Health Information Database

Abstract

The socioeconomic status (SES) and health behaviors of workers are associated with the risks of developing obesity, diabetes, hypertension, hyperlipidemia, and other cardiovascular diseases. Herein, we investigated the factors influencing cardiovascular disease (CVD) risk based on the SES of male and female workers. This cross-sectional analysis used the National Health Information Database to assess the associations between gender, SES (income level, residential area), health behaviors, and CVD-related health status of workers, through multinomial logistic regression. Upon analysis of a large volume of data on workers during 2016, the smoking and drinking trends of male and female workers were found to differ, causing different odds ratio (OR) tendencies of the CVD risk. Also, while for male workers, higher ORs of obesity or abdominal obesity were associated with higher incomes or residence in metropolitan cities, for female workers, they were associated with lower incomes or residence in rural areas. Additionally, among the factors influencing CVD risk, lower income and residence in rural areas were associated with higher CVD risk for male and female workers. The study findings imply the importance of developing gender-customized intervention programs to prevent CVD, due to gender-specific associations between CVD-related health status and health behaviors according to SES. Health Information Database (NHIS-NHID), was employed to verify the association between the SES of male and female workers in Korea and their CVD-related health statuses. The findings of this study will contribute to the production of basic statistics with large volumes of data through an analysis of the factors influencing CVD risk in male and female workers. Materials and Methods Data SourcesThe NHIS of Korea provides health insurance cover to the entire population of the country [13] and allows an insured worker and his or her dependent to receive a free annual or biannual health examination [15]. Based on the NHIS, the national health information database has a large volume of data, including 1.3 trillion pieces of information on the qualifications, premiums, health examination results, and treatment records of the entire population [16]. The NHIS-NHID is the dataset prepared by extracting, summarizing, and processing the health insurance information collected, possessed, and managed by the NHIS for study purposes, while ensuring that personal information cannot be identified [16]. The NHIS-NHID consists of the qualification database, the health examination database, and the claim database [15]. The qualification database includes gender differentiated into male and female, age, premium, and residential area. The premium is defined as the amount paid thus far by the insured worker, and it is categorized into one of 20 quintiles. The residential area is categorized into codes representing the area of residence of the insured. The health examination database contains data from a regular health examination and the accompanying health questi...

Obesity Fact Sheet in Korea, 2019: Prevalence of Obesity and Abdominal Obesity from 2009 to 2018 and Social Factors

“…20,21 Numerous studies have examined the association between socioeconomic status and the cardiovascular disease-related health status and they showed income and education levels are associated with obesity and abdominal obesity. 21,22 Our findings support that individuals with lower income and education levels have higher rates of obesity and abdominal obesity, including especially in females. Similar to our findings, a study using data from the NHIS database identified a sex difference in the prevalence and odds ratio of obesity and abdominal obesity in workers: those with a lower income or rural residence were correlated with obesity and abdominal obesity among female workers.…”

“…Similar to our findings, a study using data from the NHIS database identified a sex difference in the prevalence and odds ratio of obesity and abdominal obesity in workers: those with a lower income or rural residence were correlated with obesity and abdominal obesity among female workers. 22 This study explained that this difference can be attributed to variations in health behaviors between males and females. In addition, the disparity in obesity prevalence according to socioeconomic status observed in our study appeared to be more prominent when compared with findings from a previous study.…”

The Influence of Socioeconomic Status on the Prognosis and Profile of Patients Admitted for Acute Heart Failure during COVID-19 Pandemic: Overestimated Aspects or a Multifaceted Hydra of Cardiovascular Risk Factors?

“…Moreover, people with poor SES are very prone to pseudo-science, to “off the record” non-medical advice and to the “fake-news” phenomenon concerning specific therapies, which can further prevent an early presentation to hospital and adequate treatment, thereby possibly inducing HF decompensation. This aspect is particularly evident during the COVID-19 pandemic period, when less developed countries, with a lower human development index or GDP/capita (mutually interchangeable with a low SES), present lower rates of vaccination and decreased adherence to sanitary preventive measures [ 38 ], a similar pattern also being observed in the case of reduced adherence to cardiometabolic medication or increased prevalence of various cardiovascular risk factors amongst individuals with modest SES [ 39 , 40 ]. Our results showed that residents of rural areas presented more severe systolic disfunction ( p = 0.009) and an increased need for positive inotropic support ( p = 0.0015) compared to urban dwellers; in this situation, delayed medical presentation or low treatment adherence are commonly incriminated risk factors [ 20 ].…”

The influence of medical and social risk factors on the development of hypertension in the adult population at the regional level

“…The authors concluded that higher life-course socioeconomic status for both men and women was associated with increased odds of overweight/obesity, and additionally diabetes and hypertension for men in middle-income countries. Interestingly, that among the factors influencing cardiovascular disease (CVD) risk, both lower income and residence in rural areas were associated with higher CVD risk for male and female workers [14].…”