kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2016.16.1.20 kjhp-16-20 Original Article Influenza Vaccination Status in Korean Adult Population in Relation with Socioeconomic and Medical Factors ByeonGyeong-Ran HurYang-Im KangJae-Heon ParkHyun-Ah KimKyoung-Woo ChoYoung-Gyu ShinKoh-Eun KangBong-Hee Department of Family Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea Corresponding author: Yang-Im Hur, MD Department of Family Medicine, Seoul Paik Hospital, Inje University College of Medicine, 9 Mareunnae-ro, Jung-gu, Seoul 04551, Korea Tel: +82-2-2270-0097, Fax: +82-2-2272-0908 E-mail: yangim.hur@gmail.com 01 2016 20 01 2016 16 1 20 31 17082015 26102015 Copyright © 2016 The Korean Society of Health Promotion and Disease Prevention 2016 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background

Influenza causes morbidity and mortality, resulting in the medical and socioeconomic costs. We aimed to analyse whether socioeconomic and medical factors may affect influenza vaccination status divided into 2 groups; one aged 19 to 64 years old and the other aged 65 or over who are eligible for free vaccination.

 Methods

The study included 1,412 individuals aged 19 and over who responded to influenza vaccination survey, based on 2013 National Health and Nutrition Examination Survey. Related factors were categorized into socioeconomic factors and medical factors. Univariate analyses were conducted to examine the correlations between vaccination rate and each variables. Multivariate analysis was obtained after adjusting variables which were statistcally significant.

 Results

Influenza vaccination rate was significantly different in the population aged 19 to 64 (24.9%) and the population aged 65 or over (80.5%). In the former population, high vaccination rate was associated with healthcare usage (odds ratio [OR]=1.37, 95% confidence interval [CI]=1.03–1.83), underlying chronic diseases (OR=2.21, 95% CI=1.43–3.40), and public assistance recipient households (OR＝2.21, 95% CI=1.03–4.78), while low vaccination rate was correlated with no use of medical check up (OR＝0.70, 95% CI=0.52–0.94) and heavy alcoholics (OR＝0.41, 95% CI=0.24–0.70). In the latter population aged 65 or over, high vaccination rate was associated with healthcare usage (OR＝1.82, 95% CI=1.28–2.59), and underlying malignancies (OR＝ 4.79, 95% CI=1.07–21.54), whereas low vaccination rate was associated with public assistance recipient households (OR＝0.33, 95% CI=0.14–0.76), and no use of medical check up (OR＝0.37, 95% CI=0.19–0.73).

 Conclusions

In the population below 65 years old, vaccination rate would be expected to rise by the recommendation of medical care providers and expanding the coverage of free vaccination. In elderly, individualized care for those who have less access to medical care and high susceptibility is highly recommended.

 Influenza vaccines Vaccination Adult References World Health Organization Influenza (Seasonal) factsheet 2014 Geneva World Health Organization 2014 [Accessed July 2, 2015] http://www.who.int/mediacentre/factsheets/fs211/en/ Lu PJ O'Halloran A Bryan L Kennedy ED Ding H Graitcer SB Trends in racial/ethnic disparities in influenza vaccination coverage among adults during the 2007–08 through 2011–12 seasons Am J Infect Control 201442 7 7639 Suh M Kang DR Lee DH Choi YJ Tchoe B Nam CM Socioeconomic Burden of Influenza in the Republic of Korea, 2007–2010 PLoS One 20138 12): e84121. Song JY Lee JS Wie SH Kim HY Lee J Seo YB Prospective cohort study on the effectiveness of influenza and pneumococcal vaccines in preventing pneumonia development and hospitalization Clin Vaccine Immunol 201522 2 22934 Osterholm MT Kelley NS Sommer A Belongia EA Efficacy and effectiveness of influenza vaccines: a systematic review and metaanalysis Lancet Infect Dis 201212 1 3644 Korea Centers for Disease Control and Preventions Influenza (Flu) Cheongju Korea Centers for Disease Control and Preventions 2015 [Accessed July 22, 2015]. http://www.cdc.go.kr/CDC/contents/CdcKrContentView.jsp?cid=61188&menuIds=HOME001-MNU1130-MNU1765-MNU1767-MNU1792 Centers for Disease Control and Preventions Seasonal Influenza: Flu Basics Atlanta Centers for Disease Control and Preventions 2014 [Accessed July 22, 2015]. http://www.cdc.gov/flu/about/disease/index.htm Korea Centers for Disease Control and Prevention Annual influenza coverage trends Cheongju Korea Centers for Disease Control and Preventions 2015 [Accessd July 22, 2015]. http://www.cdc.go.kr/CDC/contents/CdcKrContentView.jsp?cid=2 7739&menuIds=HOME001-MNU1130-MNU1124-MNU15 63MNU1566 Park MB Kim CB Joo HS Factors influencing on influenza vaccination coverage The J Contents Association 201313 4 30011 Kim WJ Chun BC Cheong HJ Lee JS Management Policy Development for influenza vaccination efficiency Atlanta Centers for Disease Control and Prevention 2005 Kee SY Lee JS Cheong HJ Chun BC Song JY Choi WS Influenza vaccine coverage rates and perceptions on vaccination in South Korea J Infect 200755 3 27381 Kee SY Cheong HJ Chun BC Kim WJ Influenza vaccination coverage rate and factors associated with vaccination in people with chronic disease Infect Chemother 201143 5 40611 Kang HS Lee HJ Kim MW The correlates of influenza vaccination among Korean elderly men and women J Korean Acad Community Health Nurs 201122 1 4555 Cho HS Factors associated with influenza vaccination behavior among high-risk adults Korea J Health Educ Promot 200219 2 12738 Korea National Health & Nutritions Examination Survey Survey Data Cheongju Korea National Health & Nutritions Examination Survey 2014 [Accessed May 20, 2015]. https://knhanes.cdc.go.kr/knhanes/index.do Ministry of Health and Welfare Press Release Reston Ministry of Health and Welfare 2015 [Accessed May 20, 2015]. http://www.mohw.go.kr/front_new/al/sal0301vw.jsp?PAR_MENU_ID=04&MENU_ID=0403&BOARD_ID=140&BOARD_F LAG=00&CONT_SEQ=318814&page=1. Korea National Health & Nutritions Examination Survey Alcohol use Cheongju Korea National Health & Nutritions Examination Survey 2014 [Accessed July 20, 2015]. https://knhanes.cdc.go.kr/knhanes/index.do Yang HJ Cho SI Influenza vaccination coverage among adults in Korea: 2008–2009 to 2011–2012 seasons Int J Environ Res Public Health 201411 12 1216273 Takayama M Wetmore CM Mokdad AH Characteristics associated with the uptake of influenza vaccination among adults in the United States Prev Med 201254 5 35862 Palache A Seasonal influenza vaccine provision in 157 countries (2004–2009) and the potential influence of national public health policies Vaccine 201129 51 945966 Blank PR Schwenkglenks M Szucs TD Vaccination coverage rates in eleven European countries during two consecutive influenza seasons J Infect 200958 6 44658 Lim HS Bae GR Min YS Kim YT Lee YK Status on influenza vaccination in some community health centers Korean J Epidemiol 200426 2 6270 Cho HM Kim JY Hwang SE Kim JC Kim MY Lee SH Association between living arrangements and influenza vaccination rates among elderly south korean people: the fifth Korea National Health and Nutrition Examination Survey (KNHANES V-2) Korean J Fam Med 201536 4 18690 Yim HJ Park HA Kang JH Kim KW Cho YG Hur YI Marital status and health behaviors in middle-aged Korean adults: from the 2007–2010 Korea National Health and Nutrition Examination Survey Korean J Health Promot 201212 4 17886 Nichol KL Baken L Nelson A Relation between influenza vaccination and outpatient visits, hospitalization, and mortality in elderly persons with chronic lung disease Ann Intern Med 1999130 5 397403 Udell JA Zawi R Bhatt DL Keshtkar-Jahromi M Gaughran F Phrommintikul A Association between influenza vaccination and cardiovascular outcomes in high-risk patients: a metaanalysis JAMA 2013310 16 171120 Lee KC Han K Kim JY GE Han BD Shin KE Socioeconomic status and other related factors of seasonal influenza vaccination in the South Korean adult population based on a nationwide cross-sectional study PLoS One 201510 2): e0117305. Song YM Oh JS Han SH Choi CH Effectiveness of telephone and postcard reminders for the influenza vaccination: a study in the elderly who have visited a family practice center in a tertiary care hospital Korean J Prev Med 200033 1 10916 Figures and Tables

Place of influenza vaccination. (A) Aged 19–64 years. (B) Aged ≥ 65 years.

Timing of influenza vaccination in adults.

Influenza vaccination rates by age

Characteristics Age 19–64 years (n＝1,073) Age 65 years (n＝339)
N, Vaccinated P value N, Vaccinated P value
Weighted% Weighted Weighted% Weighted
  %(S.E.)   %(S.E.)
Total 1,073 (83.8) 24.9 (1.6)   339 (16.2) 80.5 (2.7)  
Age group     ＜0.001     0.127
＜50 653 (66.3) 21.2 (1.9)        
50–64 420 (33.7) 32.3 (2.1)        
65–74       228 (62.9) 78.3 (3.1)  
≥ 75       111 (37.1) 84.2 (3.3)  
Sex     0.004     0.005
Man 453 (50.8) 21.2 (2.2)   149 (42.4) 74.5 (4.0)  
Woman 620 (49.2) 28.8 (1.7)   190 (57.6) 84.9 (2.5)  
Education     0.086     0.024
Elementary 135 (10.0) 31.9 (4.6)   206 (62.5) 84.5 (3.0)  
Middle 115 (10.2) 32.1 (5.4)   53 (16.2) 71.9 (6.1)  
High 447 (44.2) 20.9 (2.6)   55 (14.6) 71.9 (4.6)  
College 375 (35.6) 25.8 (2.6)   25 (6.7) 82.8 (6.5)  
House incomea     0.904     0.140
Low 123 (11.4) 26.1 (3.9)   168 (50.9) 82.1 (2.9)  
Middle 602 (55.9) 25.1 (2.0)   139 (40.0) 81.0 (3.4)  
High 348 (32.7) 24.2 (2.9)   32 (9.1) 69.5 (7.6)  
Town     0.001     0.413
Urban 759 (72.0) 21.9 (1.3)   222 (64.2) 82.2 (3.4)  
Rural 314 (28.0) 32.7 (3.0)   117 (35.8) 77.5 (4.5)  
Region     0.185     0.537
Mega cityb 484 (49.5) 22.9 (2.1)   151 (44.3) 78.6 (4.3)  
The other 589 (50.5) 26.9 (2.2)   188 (55.7) 82.1 (3.5)  
Public assistance recipient households     0.067     0.112
Yes 15 (1.5) 38.9 (8.3)   29 (10.0) 73.6 (4.2)  
No 1,058 (98.5) 24.7 (1.6)   309 (90.0) 81.2 (2.9)  
Marital status     ＜0.001     0.127
Married/unmarried couple living together 792 (68.6) 29.4 (1.6)   226 (62.8) 77.2 (3.7)  
Divorced/widowed/separated/never married 281 (31.4) 15.0 (2.7)   113 (37.2) 86.2 (3.8)  
Private health insurance     0.450     0.553
Yes 923 (86.4) 25.7 (1.5)   98 (70.3) 77.9 (5.3)  
No 141 (13.6) 22.0 (4.7)   237 (29.7) 81.2 (2.9)  
Perception on my health     0.394     0.017
Good 358 (34.0) 22.7 (2.0)   61 (15.2) 69.8 (5.4)  
Moderate 556 (52.0) 26.3 (2.0)   166 (52.1) 80.5 (2.7)  
Poor 158 (14.0) 25.2 (3.5)   112 (32.7) 85.5 (3.6)  
Medical check upc     0.001     0.011
Yes 708 (63.4) 28.6 (1.5)   215 (61.9) 85.1 (2.8)  
No 365 (36.6) 18.5 (2.4)   124 (38.1) 72.5 (4.5)  
Limited social or physical activityd     0.049     0.119
Yes 64 (5.1) 35.2 (5.8)   67 (21.5) 85.1 (3.3)  
No 1,009 (94.9) 24.4 (1.6)   272 (78.5) 79.2 (3.0)  
Health care usagee     0.001     ＜0.001
Yes 508 (46.7) 29.0 (1.9)   207 (62.5) 85.7 (2.3)  
No 565 (53.3) 21.3 (1.8)   132 (37.5) 71.8 (3.8)  
Occupation     0.046     0.129
Yes 704 (66.4) 23.0 (1.7)   99 (26.9) 76.1 (3.5)  
No 369 (33.6) 28.7 (2.5)   240 (73.1) 82.1 (3.0)  
High risk drinkingf     ＜0.001     0.905
Yes 136 (13.7) 11.4 (2.7)   11 (2.8) 78.3 (2.8)  
No 937 (86.3) 27.1 (1.6)   328 (97.2) 80.5 (2.7)  
Smoking     0.005     0.109
Current smoker 233 (25.8) 17.9 (2.4)   34 (9.2) 66.6 (10.1)  
Ex smoker 165 (16.2) 24.6 (2.8)   101 (30.0) 80.2 (3.6)  
Non smoker 674 (57.9) 28.0 (2.0)   201 (60.8) 82.9 (3.0)  
BMI     0.705     0.488
＜25 708 (66.6) 24.1 (1.8)   236 (69.6) 79.7 (2.9)  
≥ 25 358 (33.4) 25.4 (2.9)   103 (30.4) 82.4 (3.7)  
Chronic diseaseg 220 (17.3) 40.0 (3.6) ＜0.001 203 (59.0) 81.1 (2.9) 0.632
Cardiovascular diseaseh 32 (2.5) 37.4 (10.8) 0.165 53 (15.0) 85.4 (4.7) 0.279
Pulmonary diseasei 65 (6.4) 32.2 (4.5) 0.096 39 (12.0) 87.8 (6.1) 0.294
Hepatic diseasej 23 (2.1) 22.6 (6.6) 0.734 9 (2.9) 73.5 (10.9) 0.473
Malignancies 28 (2.3) 46.6 (8.4) 0.013 39 (13.1) 95.9 (2.6) 0.003
Underlying diseasek     ＜0.001     0.076
Yes 301 (24.9) 35.8 (2.8)   243 (71.4) 82.4 (2.8)  
No 772 (75.1) 21.3 (1.7)   96 (28.6) 75.7 (4.2)  

Abbreviations: BMI, body mass index. P-value by Chi-square test.

Dividing the mean monthly household income into four groups by quartiles and then defined as low (Q1), middle (Q2+Q3), and high (Q4)

Consist of residents in Seoul, Pusan, Daegu, Incheon, Gwangju, Daejeon, Ulsan.

Assesed by asking respondents if they had health checkups or cancer screening within two years.

Assesed by asking respondents if they had a limitation on daily life and social activities as a current health problem or a disability.

Assesed by asking respondents if they had a hospitalization within one year, outpatient care within two weeks or using pharmacy within two weeks.

Means consumption of alcohol more than twice a week, each of which should meet more than seven shots at a time in men and more than five shots at a time in women.

Hypertension, diabetes, and dyslipidemia were asked.

Stroke, myocardiac infarction, and angina were asked.

Tuberculosis, asthma, and chronic obstructive pulmonary disease were asked.

HBV, HCV, and liver cirrhosis were asked.

Chronic disease, cardiovascular disease, pulmonary disease, hepatic disease, and cancer were asked.

Characteristics associated with influenza vaccination in adults aged 19–64 years

Characteristics Crude OR Model 1a Model 2b Model 3c
Odds ratio (95% confidence interval)
Age
＜50 1.00 1.00 1.00 1.00
50–64 1.772 (1.353–2.321) 1.605 (1.196–2.153) 1.249 (0.912–1.710) 1.169 (0.829–1.648)
Sex
Man 1.00 1.00 1.00 1.00
Woman 1.501 (1.148–1.962) 1.446 (1.074–1.947) 1.116 (0.771–1.615) 1.093 (0.734–1.629)
Education
Elementary 1.343 (0.804–2.246) 1.055 (0.533–2.090) 0.997 (0.513–1.938) 0.997 (0.513–1.938)
Middle 1.356 (0.767–2.398) 1.302 (0.733–2.310) 1.300 (0.732–2.309) 1.300 (0.732–2.309)
High 0.758 (0.498–1.153) 0.753 (0.491–1.153) 0.753 (0.491–1.154) 0.753 (0.491–1.154)
College 1.00 1.00 1.00 1.00
House income
Low 1.108 (0.649–1.894) 1.198 (0.695–2.065) 1.109 (0.640–1.920) 1.217 (0.679–2.182)
Middle 1.048 (0.706–1.555) 1.055 (0.688–1.618) 1.165 (0.770–1.763) 1.138 (0.744–1.740)
High 1.00 1.00 1.00 1.00
Town
Urban 1.00 1.00 1.00 1.00
Rural 1.739 (1.275–2.372) 1.670 (1.137–2.451) 1.678 (1.218–2.313) 1.666 (1.162–2.390)
Region
Mega city 1.00 1.00 1.00 1.00
The other 1.237 (0.898–1.703) 0.971 (0.676–1.394) 1.237 (0.907–1.688) 0.997 (0.726–1.368)
Public assistance recipient households
Yes 1.939 (0.939–4.002) 2.214 (1.025–4.781) 1.502 (0.619–3.649) 1.734 (0.737–4.077)
No 1.00 1.00 1.00 1.00
Marital status        
Married/unmarried couple living together 1.00 1.00 1.00 1.00
Divorced/widowed/separated/never married 0.423 (0.275–0.649) 0.495 (0.321–0.764) 0.496 (0.330–0.745) 0.510 (0.339–0.768)
Private health insurance        
Yes 1.00 1.00 1.00 1.00
No 0.816 (0.474–1.405) 0.937 (0.518–1.694) 0.806 (0.465–1.397) 0.886 (0.486–1.614)
Perception on my health        
Good 1.00 1.00 1.00 1.00
Moderate 1.215 (0.905–1.632) 1.095 (0.822–1.459) 1.052 (0.771–1.434) 1.032 (0.753–1.414)
Poor 1.148 (0.763–1.729) 1.013 (0.646–1.587) 0.772 (0.480–1.242) 0.806 (0.469–1.386)
Medical check up        
Yes 1.00 1.00 1.00 1.00
No 0.568 (0.420–0.767) 0.699 (0.524–0.932) 0.594 (0.437–0.807) 0.695 (0.515–0.940)
Limited social or physical activity        
Yes 1.687 (0.998–2.853) 1.534 (0.885–2.658) 1.137 (0.632–2.046) 1.176 (0.649–2.133)
No 1.00 1.00 1.00 1.00
Health care usage        
Yes 1.513 (1.203–1.904) 1.360 (1.050–1.762) 1.429 (1.103–1.851) 1.371 (1.029–1.827)
No 1.00 1.00 1.00 1.00
Occupation        
Yes 1.00 1.00 1.00 1.00
No 1.345 (1.006–1.798) 1.436 (1.046–1.973) 1.272 (0.942–1.717) 1.386 (1.014–1.895)
High risk drinking        
Yes 0.347 (0.208–0.580) 0.365 (0.225–0.592) 0.420 (0.238–0.741) 0.406 (0.237–0.696)
No 1.00 1.00 1.00 1.00
Smoking        
Current smoker 0.560 (0.378–0.829) 0.619 (0.380–1.007) 0.735 (0.426–1.269) 0.719 (0.410–1.260)
Ex smoker 0.836 (0.603–1.161) 0.812 (0.533–1.237) 0.890 (0.541–1.465) 0.837 (0.536–1.3307)
Non smoker 1.00 1.00 1.00 1.00
BMI        
＜25 1.00 1.00 1.00 1.00
≥ 25 1.074 (0.735–1.569) 1.031 (0.681–1.561) 1.065 (0.695–1.631) 1.051 (0.694–1.591)
Chronic disease 2.402 (1.704–3.385) 2.166 (1.424–3.294) 2.211 (1.438–3.401) 2.208 (1.434–3.399)
Cardiovascular disease 1.832 (0.759–4.420) 1.503 (0.624–3.620) 1.223 (0.439–3.411) 1.137 (0.452–2.863)
Pulmonary disease 1.469 (0.928–2.325) 1.376 (0.838–2.261) 1.240 (0.771–1.992) 1.260 (0.734–2.164)
Hepatic disease 0.880 (0.410–1.887) 0.929 (0.447–1.934) 0.788 (0.360–1.723) 0.858 (0.410–1.796)
Malignancies 2.709 (1.222–6.004) 2.279 (1.031–5.041) 2.338 (1.039–5.258) 2.334 (0.988–5.514)
Underlying disease        
Yes 2.058 (1.518–2.789) 1.860 (1.345–2.572) 1.789 (1.264–2.532) 1.799 (1.251–2.587)
No 1.00 1.00 1.00 1.00

Abbreviations: OR, odds ratio; BMI, body mass index. P-value＜0.05 by logistic regression analysis.

Adjusted by age, sex, education, house income, town, marital status.

Adjusted by age, sex, perceived health status, medical check up, health care utilization, high risk drinking, smoking, disease.

Adjusted by age, sex, education, house income, town, marital status, perceived health status, medical check up, health care utilization, high risk drinking, smoking, disease.

Characteristics associated with influenza vaccination in adults aged ≥ 65 years

Characteristics Crude OR Model 1a Model 2b Model 3c
Odds ratio (95% confidence interval)
Age        
65–74 1.00 1.00 1.00 1.00
≥ 75 1.472 (0.885–2.448) 1.311 (0.755–2.278) 1.621 (1.020–2.575) 1.482 (0.865–2.540)
Sex        
Man 1.00 1.00 1.00 1.00
Woman 1.923 (1.218–3.034) 1.537 (0.917–2.576) 1.754 (0.551–5.587) 1.250 (0.388–4.026)
Education        
Elementary 1.134 (0.397–3.245) 0.807 (0.245–2.659) 1.045 (0.250–4.373) 1.017 (0.195–5.309)
Middle school 0.533 (0.171–1.660) 0.445 (0.148–1.340) 0.615 (0.138–2.715) 0.588 (0.131–2.630)
High school 0.533 (0.160–1.770) 0.464 (0.136–1.583) 0.643 (0.137–3.006) 0.589 (0.120–2.885)
College 1.00 1.00 1.00 1.00
House income        
Low 2.009 (0.947–4.265) 1.717 (0.798–3.693) 1.581 (0.749–3.335) 1.416 (0.624–3.211)
Middle 1.864 (0.849–4.089) 2.030 (0.968–4.257) 1.956 (0.872–4.384) 1.983 (0.937–4.197)
High 1.00 1.00 1.00 1.00
Town        
Urban 1.00 1.00 1.00 1.00
Rural 0.748 (0.366–1.528) 0.708 (0.338–1.480) 0.823 (0.411–1.649) 0.786 (0.376–1.642)
Region        
Mega city 1.00 1.00 1.00 1.00
The other 1.248 (0.605–2.574) 1.625 (0.621–4.253) 1.294 (0.647–2.590) 1.887 (0.651–5.469)
Public assistance recipient households        
Yes 0.643 (0.358–1.157) 0.410 (0.181–0.928) 0.454 (0.236–0.872) 0.330 (0.144–0.756)
No 1.00 1.00 1.00 1.00
Marital status        
Married/unmarried couple living together 1.00 1.00 1.00 1.00
Divorced/widowed/separated/never married 1.843 (0.821–4.140) 1.354 (0.571–3.212) 1.543 (0.678–3.516) 1.530 (0.680–3.441)
Private health insurance        
Yes 1.00 1.00 1.00 1.00
No 1.222 (0.617–2.423) 1.049 (0.508–2.163) 1.214 (0.582–2.533) 1.135 (0.492–2.614)
Perception on my health        
Good 1.00 1.00 1.00 1.00
Moderate 1.793 (1.107–2.904) 1.601 (0.900–2.847) 1.563 (0.930–2.627) 1.562 (0.896–2.724)
Poor 2.548 (1.433–4.531) 2.165 (1.084–4.325) 2.084 (1.013–4.290) 1.998 (0.936–4.265)
Medical check up        
Yes 1.00 1.00 1.00 1.00
No 0.460 (0.254–0.834) 0.363 (0.187–0.703) 0.377 (0.197–0.723) 0.372 (0.189–0.734)
Limited social or physical activity        
Yes 1.500 (0.893–2.519) 1.579 (0.867–2.876) 1.054 (0.566–1.964) 1.046 (0.513–2.135)
No 1.00 1.00 1.00 1.00
Health care usage        
Yes 2.350 (1.625–3.400) 2.160 (1.516–3.078) 1.820 (1.276–2.596) 1.824 (1.284–2.593)
No 1.00 1.00 1.00 1.00
Occupation        
Yes 1.00 1.00 1.00 1.00
No 1.448 (0.893–2.348) 1.078 (0.576–2.017) 0.924 (0.481–1.775) 0.861 (0.419–1.772)
High risk drinking        
Yes 0.921 (0.228–3.714) 1.349 (0.369–4.936) 1.449 (0.354–5.931) 1.417 (0.397–5.054)
No 1.00 1.00 1.00 1.00
Smoking        
Current smoker 0.412 (0.163–1.043) 0.690 (0.142–3.349) 0.898 (0.188–4.287) 0.766 (0.161–3.647)
Ex smoker 0.873 (0.490–1.431) 1.380 (0.520–3.659) 1.438 (0.539–3.841) 1.254 (0.472–3.329)
Non smoker 1.00 1.00 1.00 1.00
BMI        
＜25 1.00 1.00 1.00 1.00
≥ 25 1.189 (0.719–1.965) 1.140 (0.652–1.992) 1.100 (0.632–1.916) 1.112 (0.626–1.978)
Chronic disease 1.102 (0.728–1.668) 1.054 (0.700–1.586) 0.865 (0.556–1.347) 0.862 (0.556–1.337)
Cardiovascular disease 1.492 (0.704–3.161) 1.541 (0.721–3.292) 1.391 (0.651–2.971) 1.446 (0.687–3.042)-
Pulmonary disease 1.847 (0.564–6.054) 1.803 (0.476–6.831) 1.699 (0.479–6.028) 1.570 (0.384–6.420)
Hepatic disease 0.664 (0.181–2.437) 0.581 (0.146–2.314) 0.668 (0.145–3.078) 0.610 (0.137–2.707)
Malignancies 6.469 (1.404–29.814) 6.022 (1.344–26.985) 5.353 (1.125–25.465) 4.792 (1.066–21.537)
Underlying disease        
Yes 1.510 (0.949–2.404) 1.474 (0.934–2.327) 1.295 (0.739–2.271) 1.275 (0.738–2.204)
No 1.00 1.00 1.00 1.00

Abbreviations: OR, odds ratio; BMI, body mass index. P-value＜0.05 by logistic regression analysis.

Adjusted by age, sex, education, house income, town, marital status.

Adjusted by age, sex, perceived health status, medical check up, health care utilization, high risk drinking, smoking, disease.

Adjusted by age, sex, education, house income, town, marital status, perceived health status, medical check up, health care utilization, high ris