Regional Contextual Factors and Self-Rated Health: a Multilevel Study of Korean Adults

다국어 초록 (Multilingual Abstract)

Objectives: To examine whether the socioeconomic characteristics of communities (contextual effects) are related to the self-rated health of community residents after controlling individual characteristics (compositional effects). Methods: A linked data set including information on individuals from raw data of 1998 Korean National Health and Nutrition Survey(KNHNS) and information on the regions where the individuals lived from the socioeconomic statistical indices of Si-Gun-Gu (city-county-ward) in 1998 was established. The contextual factors of communities were generated from these socioeconomic indices through factor analysis. The contextual effects of community over and above the individual characteristics on the self-rated health were investigated using multilevel analysis. Results: The contextual factors of the community expressed as the factor scores have influence on the self-rated health of their residents above the compositional factors. When the communities were categorized into 5 groups (highest, high, middle, low, lowest) according to each of their factor scores, for factor 1 reflecting urbanization reversely, the residents of the communities that had the high, middle, and low factor scores showed significantly poor subjective health status than the residents of the lowest (most urbanized) group. For factor 2 reflecting community services and health resources, the subjective health status of the residents gradually became poorer when the group went from the highest to the lowest, and the low and lowest groups showed a significant difference. For factor 3 reflecting the manufacturing industry, as compared with the communities that have the highest factor scores, the other 4 groups showed significantly poorer subjective health status. And for factor 4 reflecting the scale of the regional government, as compared with the middle group, the rest of the 4 groups showed significantly better self-rated health. Conclusions: There existed regional contextual effects on their residents' health in Korean adults. To make policies tackling these contextual effects possible, more elaborate researches to find more specific factors and to explain the mechanisms of how health is influenced by the contextual factors are needed.