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.2017.17.3.152 kjhp-17-152 Original Article The Association between Chronic Diseases and Active Patient Participation KimYang Keun KimHye Won PaikJae Yong HongChang Bin LeeKayoung ParkTae-Jin KimJinseung Department of Family Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea Corresponding author : Jinseung Kim, MD Department of Family Medicine, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan 47392, Korea Tel: +82-51-890-6683, Fax: +82-51-894-7554 E-mail: jinseungkim@inje.ac.kr 012017 19012017 173152 160 14062017 09082017 Copyright © 2017 The Korean Society of Health Promotion and Disease Prevention 2017 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:

Active patient participation in health care decision-making can results in better medical outcomes. This study's purpose is to investigate the association between the patient participation and the diseases often encountered in primary care.

 Methods:

We used the data from the Korean National Health and Nutrition Examination Survey conducted in 2015 which included 4,158 adults aged older than 19 and who had no missing data. The association between the presence of disease or the number of accompanying diseases and the active patient participation in the treatment decision was studied. Logistic regression analysis was conducted using complex sampling design in each sex.

 Results:

After adjusting for confounding variables, the relationship between active patient participation and the diagnosis of hypertension, odds ratio (OR) was 1.95 (95% confidence interval [CI], 1.25-3.04) for men and 1.83 (95% CI, 1.27-2.65) for women. In women diagnosed with diabetes, OR was 0.58 (95% CI, 0.35-0.97). Between active patient participation and increasing number of accompanying diseases have positive tendency but not statistically significant.

 Conclusions:

This study suggests that active patient participation is related to the diagnosis of hypertension, and the number of accompanying diseases and active patient participation were not significantly associated. This is a rare study related to the active patient participation in the Korean population, that it may be helpful in establishing further relevant research and strategies to increase the patient participation rate.

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Flow chart of subjects’ selection.

The relationships of active patient participation with age, household income, education level, private insurance, and disease

  Men Women
  % (SE) Pa % (SE) Pa
Age (y) 　 0.493   0.238
19-29 85.2 (2.5) 　 84.9 (2.0)  
30-39 85.4 (2.6) 　 89.1 (1.6)  
40-49 84.3 (2.7) 　 87.0 (1.9)  
50-59 87.2 (2.3) 　 87.8 (1.7)  
60-69 89.8 (1.7) 　 89.6 (1.6)  
70-79 90.3 (2.3) 　 91.6 (1.7)  
More than 80 90.7 (5.0) 　 84.9 (4.6)  
Household income 　 0.171   0.459
Low 86.1 (2.5) 　 89.7 (1.4)  
Low-middle 83.6 (2.3) 　 86.8 (1.4)  
High-middle 89.5 (1.7) 　 88.6 (1.3)  
High 85.9 (1.8) 　 87.0 (1.4)  
Education level 　 0.920   0.179
Less than elementary school 88.0 (2.5) 　 88.5 (1.6)  
Middle school 86.5 (3.1) 　 92.2 (1.7)  
High school 86.7 (1.6) 　 87.4 (1.4)  
College or higher 86.0 (1.6) 　 86.8 (1.3)  
Private insurance 　 0.995   0.201
Yes 86.5 (1.2) 　 87.5 (0.8)  
No 86.5 (2.0) 　 89.7 (1.4)  
Chronic disease 　 　    
Diabetes mellitus 　 0.675   0.454
Yes 87.7 (2.8) 　 85.9 (2.7)  
No 86.4 (1.1) 　 88.0 (0.8)  
Asthma 　 0.251   0.702
Yes 79.3 (7.0) 　 86.4 (4.2)  
No 86.8 (1.0) 　 87.9 (0.7)  
Hypertension 　 <0.001   0.001
Yes 92.1 (1.2) 　 91.9 (1.1)  
No 84.9 (1.2) 　 86.9 (0.9)  
Dyslipidemia 　 0.060   0.332
Yes 90.7 (2.1) 　 89.5 (1.6)  
No 85.9 (1.1) 　 87.6 (0.9)  
Stroke 　 0.060   0.312
Yes 93.4 (3.8) 　 91.6 (3.3)  
No 86.4 (1.0) 　 87.8 (0.7)  
Angina pectoris or MI 　 0.136   0.628
Yes 92.7 (3.6) 　 89.7 (3.5)  
No 86.4 (1.0) 　 87.8 (0.8)  
Depression   0.203   0.592
Yes 78.7 (6.9) 　 86.3 (3.0)  
No 86.7 (1.0) 　 88.0 (0.8) 　  

Abbreviations: MI, myocardial infarction; N, partispants number; SE, standard error.

Categorical variables were calculated by chi-square test.

Odds ratio for active patient participation according to the diagnosis of disease by logistic regression

Disease Sex Adjusted OR (95% CI)a Pb
Diabetes mellitus Men 0.82 (0.43-1.55) 0.538
Women 0.58 (0.35-0.97) 0.038
Asthma Men 0.57 (0.24-1.36) 0.204
Women 0.85 (0.41-1.74) 0.649
Hypertension Men 1.95 (1.25-3.04) 0.003
Women 1.83 (1.27-2.65) 0.001
Dyslipidemia Men 1.27 (0.72-2.26) 0.408
Women 1.04 (0.66-1.64) 0.863
Stroke Men 1.66 (0.46-6.01) 0.437
Women 1.03 (0.41-2.59) 0.949
Angina pectoris or MI Men 1.65 (0.58-4.67) 0.346
Women 0.90 (0.39-2.06) 0.800
Depressive disorder Men 0.59 (0.24-1.46) 0.252
Women 0.77 (0.44-1.32) 0.337

Abbreviations: OR, odds ratio; CI, confidence interval; MI, myocardial infarction.

Logistic regression for active participants according to disease after adjustment for age, household incomes, education level, private insurance, and disease (diabetes mellitus, asthma, hypertension, dyslipidemia, stroke, angina pectoris or MI, depressive disorder) except for Independent variable.

Assessed by logistic regression analysis.

Odds ratio for active patient participation according to the number of diseases by logistic regression

Sex Number of diseases Adjusted OR (95% CI)a
Both (n=4,158)    
0 (n=2,386, 57.4) 1
1 (n=969, 23.3) 1.12 (0.84-1.50)
2 (n=526, 12.7) 1.22 (0.81-1.83)
More than 3 (n=277, 6.7) 1.55 (0.90-2.65)
Men (n=1,702)    
0 (n=958, 56.3) 1
1 (n=416, 24.4) 1.145 (0.74-1.77)
2 (n=222, 13.0) 1.376 (0.78-2.44)
More than 3 (n=106, 6.2) 2.570 (0.94-7.01)
Women (n=2,456)    
0 (n=1,428, 58.1) 1
1 (n=553, 22.5) 1.11 (0.75-1.65)
2 (n=304, 12.4) 1.10 (0.62-1.96)
More than 3 (n=171, 7.0) 1.11 (0.59-2.05)

Abbreviations: OR, odds ratio; CI, confidence interval; n, participants number.

Logistic regression for active participants according to the number of diseases after adjustment for age, household incomes, education level, and private insurance.

Analysis of changes in outcome with or without hypertension in dyslipidemia patients

Sex Controla Hypertension without dyslipidemia Dyslipidemia without hypertension Dyslipidemia with hypertension
OR (95% CI)b
Men 1,099 (64.6) 339 (19.9) 98 (5.8) 166 (9.8)
  1 2.01 (1.24-3.27) 1.32 (0.60-2.94) 2.30 (1.10-4.81)
Women 1,615 (65.8) 337 (13.7) 218 (8.9) 286 (11.6)
  1 1.60 (1.01-2.54) 0.92 (0.54-1.57) 2.19 (1.25-3.83)

Abbreviations: OR, odds ratio; CI, confidence interval. Values are presented as participants number (%) unless otherwise indicated.

Patients with diseases except hypertention and dyslipidemia.

Logistic regression for active participants according to changes in outcome with hypertension in dyslipidemia patients after adjustment for age, household incomes, education level, private insurance, and disease (diabetes mellitus, asthma, stroke, angina pectoris or MI, depressive disorder).

Analysis of changes in outcome with or without hypertension in stroke patients

Sex Controla Hypertension without stroke Stroke without hypertension Stroke with hypertension
OR (95% CI)b
Men 1,181 (69.4) 466 (27.4) 16 (0.9) 39 (2.3)
1 1.88 (1.185-2.981) 0.98 (0.17-5.57) 6.38 (1.40-29.13)
Women 1,821 (74.1) 581 (23.7) 12 (0.5) 42 (1.7)
1 1.84 (1.26-2.68) 1.10 (0.21-5.70) 1.80 (0.61-5.34)

Abbreviations: OR, odds ratio; CI, confidence interval. Values are presented as participants number (%) unless otherwise indicated.

Patients with diseases except hypertention and stroke.

Logistic regression for active participants according to changes in outcome with hypertension in stroke patients after adjustment for age, household incomes, education level, private insurance, and disease (diabetes mellitus, asthma, dyslipidemia, angina pectoris or MI, depressive disorder).