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.2017.17.3.161 kjhp-17-161 Original Article Perception about Age at the Start and End of Periodic Health Examinations: a Survey-based Study on University Hospital in Korea ShinSujeong 1 SongYun-Mi 1 KoHyeonyoung 1 ChoiYoon-Ho 2 LeeWoo Yong 2 ChungSon Mi 2 ParkSunyoung 1 KimInsub 1 ShinJinyoung 3 Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Department of Family Medicine, Konkuk University School of Medicine, Seoul, Korea Corresponding author : Jinyoung Shin, MD, PhD Department of Family Medicine, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Korea Tel: +82-2-2030-7683, Fax: +82-2-2030-7748 E-mail: jinyoung.shin17@gmail.com 012017 19012017 173161 167 17042017 13072017 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:

Based on scientific evidence, the Korean National Health Examination recommends age 40 as an appropriate time for screening. However, awareness of the health examination itself or of the appropriate age for screening has not been discussed extensively with examinees. This study aims to evaluate the perception about age at the start and end of periodic health examinations (PHE).

 Methods:

A self-administered survey was completed by 887 subjects who visited either the health promotion center or the outpatient clinic at a university hospital in Korea between February 15 and May 18, 2016. Participants were divided into two groups: 587 were periodic health examinees, and 300 were visitors to the family medicine clinic. Their awareness of PHE was compared using the Chi-square test and multiple logistic regression.

 Results:

Both groups had similar (P>0.05) perceptions regarding the awareness, knowledge and usefulness of the PHE. Both groups preferred to continue taking a PHE with no upper limit on the age when it could be taken. This tendency was more prominent among subjects with higher levels of education and household income. In both groups with individuals under age 50 said that the appropriate age to begin screening is 40 or younger.

 Conclusions:

The perception regarding the ages at which to start and end the PHE was confirmed according to the subject of visit; a wider range of appropriate ages was preferred than is included in the current recommendations.

 Health service Age factors Socioeconomic factors REFERENCESLarson JS The World Health Organization's definition of health: social versus spiritual health Soc Indic Res 1996382 18192 Boulware LE Marinopoulos S Phillips KA Hwang CW Maynor K Merenstein D Systematic review: the value of the periodic health evaluation Ann Intern Med 20071464 289300 Maciosek MV Coffield AB Edwards NM Flottemesch TJ Goodman MJ Solberg LI Priorities among effective clinical preventive services: results of a systematic review and analysis Am J Prev Med 2006311 5261 The Korean Academy of Family Medicine Life-Long Health Care of Koreans 3rd ed. Seoul Kukjin Paper & Design 2009 43180 Kang S You CH Kwon YD The determinants of the use of opportunistic screening programs in Korea J Prev Med Public Health 2009423 17782 Cohen JT Neumann PJ Weinstein MC Does preventive care save money? Health economics and the presidential candidates N Engl J Med 20083587 6613 Burton LC Steinwachs DM German PS Shapiro S Brant LJ Richards TM Preventive services for the elderly: would coverage affect utilization and costs under medicare? Am J Public Health 1995853 38791 Shin YS Park CY Jung SH Jung HY Kang HY Comparison of customer satisfaction with health examination programs provided by the Korea National Health Insurance and private healthcare organizations in Korea J Korean Soc Qual Health Care 2006121 4051 Seong SC 2015 National Health Screening Statistical Yearbook Seoul National Health Inssurance Service 2016 4264 Finkelstein MM Preventive screening What factors influence testing? Can Fam Physician 2002489 1494501 Lee SA Choi KS Hwang SY Lee JY Park EC Lee KJ The effect of socioeconomic factors on health screening on Korea: the 2001 Korean National Examination Health and Nutrition Surveys (KNEHANS) J Korean Assoc Cancer Prev 200493 18898 Chun EJ Jang SN Cho SI Cho Y Moon OR Disparities in participation in health examination by socioeconomic position among adult Seoul residents J Prev Med Public Health 2007405 34550 Moyer VA U.S Preventive Services Task Force. Screening for cervical cancer: U.S. Preventive Services Task Force recommendation statement Ann Intern Med 201215612 88091 W312. Lee WC Lee SY National Health screening program of Korea J Korean Med Assoc 2010535 36370 Kim RB Park KS Hong DY Lee CH Kim JR Factors associated with cancer screening intention in eligible persons for national cancer screening program J Prev Med Public Health 2010431 6272 Cho B Lee CM Current situation of national health screening systems in Korea J Korean Med Assoc 2011547 6669 Lee EH Park B Kim NS Seo HJ Ko KL Min JW The Korean guideline for breast cancer screening J Korean Med Assoc 2015585 40819 Park HA Nam SY Lee SK Kim SG Shim KN Park SM The Korean guideline for gastric cancer screening J Korean Med Assoc 2015585 37384 Lee WC Kim Y Background and significance of Korean national cancer screening guideline revision J Korean Med Assoc 2015584 2746 Boer R de Koning H Threlfall A Warmerdam P Street A Friedman E Cost effectiveness of shortening screening interval or extending age range of NHS breast screening programme: computer simulation study BMJ 19983177155 3769 Moon KS Kim YK Chang HJ Determinants of the use and type of comprehensive medical examination services Korean J Health Policy Adm 2016102 8397 Tables

Baseline characteristics of study population

Variable Periodic health examinee (n=587) FM visitorsa (n=300) Pb
Age, y 55.1 (23-79) 49.1 (18-79) <0.001c
Sex      
Male 308 (52.5) 110 (36.7) <0.001
Female 279 (47.5) 190 (63.3)  
Health condition      
Healthy 498 (90.2) 258 (86.3) 0.082
Unhealthy 54 (9.8) 41 (13.7)  
Marital statusd      
Married 458 (88.6) 204 (74.7) <0.001
Unmarried Education 59 (11.4) 69 (25.3)  
High school or less 139 (27.0) 121 (42.2) <0.001
College 275 (53.4) 138 (48.1)  
Graduate school or more 101 (19.6) 28 (9.8)  
Occupation      
Employed 301 (58.1) 159 (53.7) 0.224
Unemployed 217 (41.9) 137 (46.3)  
Household income, KRW      
<4,000,000 67 (13.4) 116 (44.4) <0.001
4,000,000-5,990,000 80 (16.0) 71 (27.2)  
6,000,000-9,990,000 164 (32.7) 53 (20.3)  

≥10,000,000 190 (37.9) 21 (8.0) Abbreviation: FM, family medicine. Values are presented as median (range) or number (%).

The visitors who visited family medicine outpatient clinic.

P-values are obtained by Chi-square test.

P-value is obtained by t-test.

Marital status was categorized as married and unmarried (included single, separate, divorce, bereavement).

Perception about health examination between Periodic health examinee and FM visitors

  Periodic health examinee e FM visitorsa Pb
Starting age of health examination, y     0.009
≤34 89 (15.5) 61 (25.4)  
35-39 112 (19.5) 38 (15.8)  
40-49 231 (40.2) 90 (37.5)  
≥50 142 (24.7) 51 (21.3)  
Proper starting age of health examination, y     <0.001
20-29 27 (4.8) 26 (8.7)  
30-34 72 (12.9) 55 (18.5)  
35-39 123 (22.0) 66 (22.1)  
40-45 213 (38.0) 131 (44.0)  
45-49 81 (14.5) 7 (2.3)  
≥50 44 (7.9) 13 (4.4)  
Upper age limit of health examination     <0.001
Up to 60 years 5 (0.9) 1 (0.3)  
Up to 65 years 9 (1.6) 2 (0.7)  
Up to 70 years 83 (15.0) 22 (7.4)  
Up to 75 years 111 (20.0) 24 (8.1)  
Up to 80 years 116 (20.9) 52 (17.6)  
No cut-off age 230 (41.5) 195 (65.9)  
Views about usefulness of health examination      
Routine health examination is needed even if healthy 374 (65.2) 183 (62.0) 0.363
It's effective in preventing lifestyle-related diseases (including cancer) 343 (60.3) 150 (51.5) 0.014
To gain self-confidence about health 320 (55.8) 153 (52.9) 0.418
Views about influence factor of health examination      
Family history 141 (29.2) 66 (25.3) 0.257
Acquaintances medical history 57 (12.6) 26 (10.0) 0.314
Health information from the media 68 (14.4) 31 (11.8) 0.323
Views about important factor of taking health examination      
Offer various examination 521 (96.1) 247 (86.1) <0.001
Hospital size 494 (89.7) 248 (83.5) 0.010
Proximity home 396 (72.1) 223 (74.8) 0.397
Hospital familiarity 411 (75.6) 230 (77.7) 0.484

Abbreviation: FM, family medicine. Values are presented as number (%).

The visitors who visited family medicine outpatient clinic.

P-values are obtained by Chi-square test

Perception about age of health examination classified according to the age and the object of the visit

  Views about age of health examination
  Age at start of health examination <40 years Age at end of health examination ≥80 years
FM visitorsa ≥50, y 1 1
FM visitors <50, y 1.38 (1.22-1.57) 1.03 (0.91-1.16)
Periodic health examinee ≥50, y 0.94 (0.85-1.04) 1.28 (1.16-1.40)
Periodic health examinee <50, y 1.36 (1.20-1.54) 1.14 (1.01-1.28)
Pb <0.001 <0.001

Abbreviation: FM, family medicine. Values are presented as odds ratios (95% confidence intervals). Odds ratios (95% confidence intervals) were estimated by multiple logistic regression analysis after adjusting for sex, education, household income, marital status.

The visitors who visited family medicine outpatient clinic.

P-values are obtained by General linear model.

Perception of periodic health examinee about age of health examination compared with FM visitors according to the education status and household income

  Views about age of health examination
  Age at start of health examination <40 years Age at end of health examination ≥80 years
Education    
High school or less 0.65 (0.33-1.31) 2.39 (1.14-5.00)
College 0.94 (0.49-1.78) 2.91 (1.41-6.00)
Graduate school or more 1.74 (0.67-4.52) 2.34 (0.80-6.87)
P-interactiona 0.041 <0.001
House income, KRW    
<4,000,000 1.30 (0.73-2.32) 2.76 (1.45-5.22)
4,000,000-5,990,000 1.53 (0.82-2.85) 2.10 (1.06-4.16)
6,000,000-9,990,000 1.54 (0.77-3.08) 4.76 (1.78-12.73)
≥10,000,000 0.98 (0.37-2.63) 2.15 (0.69-6.70)
P-interaction 0.885 <0.001

Abbreviation: FM, family medicine. Values are presented as odds ratios (95% confidence intervals). Odds ratios (95% confidence intervals) were estimated by multiple logistic regression analysis after adjusting for age, sex, education, household income, marital status, except for the selected stratification variable. Each statistics were calculated from subjects who visited FM outpatient clinic, and longer education or the highest household income group, respectively. The reference group for each OR is FM visitors with the selected stratification variable.

The P value for interaction was obtained by multiple logistic regression analysis. The value depicts the interaction between periodic health examinee and education or periodic health examinee and household income level.