PDF(Pubmed)
Abstract：
OBJECTIVE: Urban-rural inequities in health and mortality exist in Korea, a highly centralized developed country. The potential impact of multiple health-related lifestyle behaviors on mortality and difference between urban and rural areas is not fully understood. This study aimed to investigate the effect of high-risk health behaviors on all-cause mortality among residents living in urban and rural in Korea.
METHODS: Cross-sectional analyses were conducted on 8,298 adults aged 40 yrs and older from the Korea National Health and Nutrition Examination Survey 2013-2015. High-risk behaviors were defined as having poor diet quality, current smoking, high-risk drinking, or insufficient physical activity. Mortality status was linked to the Cause of Death data followed up to December 31, 2019. The associations between all-cause mortality and high-risk behaviors were evaluated using Cox proportional hazard regression models adjusted for age, sex, education, income, and survey year. Population attributable fractions (PAFs) were calculated, and effect modification analysis was conducted. Participants were stratified by residential area (urban or rural).
RESULTS: During the follow-up (median: 5.4 yrs), 313 deaths occurred. A higher proportion of rural residents than urban residents engaged in multiple high-risk behaviors (28.9% vs. 22.6%; P < 0.0001). As individual factors, a greater risk of mortality was associated with poor diet quality, current smoking, and inadequate physical activity, and these tendencies persisted in rural residents, especially for diet quality. Multiple high-risk behaviors were positively associated with a higher risk of mortality in Koreans living in urban and rural areas. PAF (95% confidence interval) was 18.5% (7.35-27.9%) and 29.8% (16.1-40.2%) in urban and rural residents, respectively. No additive or multiplicative effect of the region was observed.
CONCLUSIONS: The higher prevalence of multiple high-risk lifestyle behaviors in rural residents may explain the higher mortality in rural areas compared to urban areas. Comprehensive public health policies to improve health-related behaviors in rural populations may be needed.
METHODS: Cross-sectional analyses were conducted on 8,298 adults aged 40 yrs and older from the Korea National Health and Nutrition Examination Survey 2013-2015. High-risk behaviors were defined as having poor diet quality, current smoking, high-risk drinking, or insufficient physical activity. Mortality status was linked to the Cause of Death data followed up to December 31, 2019. The associations between all-cause mortality and high-risk behaviors were evaluated using Cox proportional hazard regression models adjusted for age, sex, education, income, and survey year. Population attributable fractions (PAFs) were calculated, and effect modification analysis was conducted. Participants were stratified by residential area (urban or rural).
RESULTS: During the follow-up (median: 5.4 yrs), 313 deaths occurred. A higher proportion of rural residents than urban residents engaged in multiple high-risk behaviors (28.9% vs. 22.6%; P < 0.0001). As individual factors, a greater risk of mortality was associated with poor diet quality, current smoking, and inadequate physical activity, and these tendencies persisted in rural residents, especially for diet quality. Multiple high-risk behaviors were positively associated with a higher risk of mortality in Koreans living in urban and rural areas. PAF (95% confidence interval) was 18.5% (7.35-27.9%) and 29.8% (16.1-40.2%) in urban and rural residents, respectively. No additive or multiplicative effect of the region was observed.
CONCLUSIONS: The higher prevalence of multiple high-risk lifestyle behaviors in rural residents may explain the higher mortality in rural areas compared to urban areas. Comprehensive public health policies to improve health-related behaviors in rural populations may be needed.
摘要：
目标：韩国存在城乡健康和死亡率不平等，高度集中的发达国家。多种健康相关的生活方式行为对死亡率和城乡差异的潜在影响尚不完全清楚。本研究旨在调查高风险健康行为对韩国城乡居民全因死亡率的影响。
方法：对2013-2015年韩国国家健康和营养调查的8,298名40岁及以上的成年人进行了横断面分析。高风险行为被定义为饮食质量差，目前吸烟,高风险饮酒，或体力活动不足。死亡率状况与截至2019年12月31日的死亡原因数据有关。使用Cox比例风险回归模型对全因死亡率和高危行为之间的关联进行评估，性别,教育,收入,和调查年。计算了人口归因分数(PAF)，并进行了效果修正分析。参与者按居住区（城市或农村）分层。
结果：在随访期间（中位数：5.4年），发生313人死亡。农村居民从事多种高风险行为的比例高于城镇居民(28.9%vs.22.6%；P<0.0001）。作为个体因素,较高的死亡风险与不良的饮食质量有关，目前吸烟,身体活动不足，这些趋势在农村居民中仍然存在，特别是饮食质量。在居住在城市和农村地区的韩国人中，多种高风险行为与较高的死亡风险呈正相关。城乡居民PAF(95%置信区间)分别为18.5%(7.35-27.9%)和29.8%(16.1-40.2%),分别。没有观察到该区域的加法或乘法效应。
结论：农村居民中多种高危生活方式行为的患病率较高，这可能解释了农村地区死亡率高于城市地区的原因。可能需要全面的公共卫生政策来改善农村人口的健康相关行为。
方法：对2013-2015年韩国国家健康和营养调查的8,298名40岁及以上的成年人进行了横断面分析。高风险行为被定义为饮食质量差，目前吸烟,高风险饮酒，或体力活动不足。死亡率状况与截至2019年12月31日的死亡原因数据有关。使用Cox比例风险回归模型对全因死亡率和高危行为之间的关联进行评估，性别,教育,收入,和调查年。计算了人口归因分数(PAF)，并进行了效果修正分析。参与者按居住区（城市或农村）分层。
结果：在随访期间（中位数：5.4年），发生313人死亡。农村居民从事多种高风险行为的比例高于城镇居民(28.9%vs.22.6%；P<0.0001）。作为个体因素,较高的死亡风险与不良的饮食质量有关，目前吸烟,身体活动不足，这些趋势在农村居民中仍然存在，特别是饮食质量。在居住在城市和农村地区的韩国人中，多种高风险行为与较高的死亡风险呈正相关。城乡居民PAF(95%置信区间)分别为18.5%(7.35-27.9%)和29.8%(16.1-40.2%),分别。没有观察到该区域的加法或乘法效应。
结论：农村居民中多种高危生活方式行为的患病率较高，这可能解释了农村地区死亡率高于城市地区的原因。可能需要全面的公共卫生政策来改善农村人口的健康相关行为。
