Perception about Age at the Start and End of Periodic Health Examinations: a Survey-based Study on University Hospital in Korea

Sujeong Shin; Yun-Mi Song; Hyeonyoung Ko; Yoon-Ho Choi; Woo Yong Lee; Son Mi Chung; Sunyoung Park; Insub Kim; Jinyoung Shin

doi:10.15384/kjhp.2017.17.3.161

Korean J Health Promot > Volume 17(3); 2017 > Article

Perception about Age at the Start and End of Periodic Health Examinations: a Survey-based Study on University Hospital in Korea

Original Article

Korean Journal of Health Promotion 2017;17(3):161-167.

Published online: January 19, 2017

DOI: https://doi.org/10.15384/kjhp.2017.17.3.161

Perception about Age at the Start and End of Periodic Health Examinations: a Survey-based Study on University Hospital in Korea

Sujeong Shin¹, Yun-Mi Song¹, Hyeonyoung Ko¹, Yoon-Ho Choi², Woo Yong Lee², Son Mi Chung², Sunyoung Park¹, Insub Kim¹, Jinyoung Shin³

¹Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

²Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

³Department 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

Received April 17, 2017 Accepted July 13, 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.

요약

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.

Keywords: Health service, Age factors, Socioeconomic factors

Table 1.

Baseline characteristics of study population

Variable	Periodic health examinee (n=587)	FM visitors^a (n=300)	P^b
Age, y	55.1 (23-79)	49.1 (18-79)	<0.001^c
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 status^d
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 (%).

^aThe visitors who visited family medicine outpatient clinic.

^bP-values are obtained by Chi-square test.

^cP-value is obtained by t-test.

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

Table 2.

Perception about health examination between Periodic health examinee and FM visitors

	Periodic health examinee	e FM visitors^a	P^b
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 (%).

^aThe visitors who visited family medicine outpatient clinic.

^bP-values are obtained by Chi-square test

Table 3.

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 visitors^a ≥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)
P^b	<0.001	<0.001

^aThe visitors who visited family medicine outpatient clinic.

^bP-values are obtained by General linear model.

Table 4.

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-interaction^a	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.

^aThe 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.

REFERENCES

1.. Larson JS. The World Health Organization's definition of health: social versus spiritual health. Soc Indic Res 1996;38(2):181-92.

2.. Boulware LE, Marinopoulos S, Phillips KA, Hwang CW, Maynor K, Merenstein D, et al. Systematic review: the value of the periodic health evaluation. Ann Intern Med 2007;146(4):289-300.

3.. 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 2006;31(1):52-61.

4.. The Korean Academy of Family Medicine. Life-Long Health Care of Koreans. 3rd ed.. Seoul: Kukjin Paper & Design; 2009. p. 43-180.

5.. Kang S, You CH, Kwon YD. The determinants of the use of opportunistic screening programs in Korea. J Prev Med Public Health 2009;42(3):177-82.

6.. Cohen JT, Neumann PJ, Weinstein MC. Does preventive care save money? Health economics and the presidential candidates. N Engl J Med 2008;358(7):661-3.

7.. Burton LC, Steinwachs DM, German PS, Shapiro S, Brant LJ, Richards TM, et al. Preventive services for the elderly: would coverage affect utilization and costs under medicare? Am J Public Health 1995;85(3):387-91.

8.. 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 2006;12(1):40-51.

9.. Seong SC. 2015 National Health Screening Statistical Yearbook. Seoul: National Health Inssurance Service; 2016. p. 42-64.

10.. Finkelstein MM. Preventive screening. What factors influence testing? Can Fam Physician 2002;48(9):1494-501.

11.. Lee SA, Choi KS, Hwang SY, Lee JY, Park EC, Lee KJ, et al. 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 2004;9(3):188-98.

12.. 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 2007;40(5):345-50.

13.. Moyer VA. U.S. Preventive Services Task Force. Screening for cervical cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2012;156(12):880-91. W312..

14.. Lee WC, Lee SY. National Health screening program of Korea. J Korean Med Assoc 2010;53(5):363-70.

15.. 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 2010;43(1):62-72.

16.. Cho B, Lee CM. Current situation of national health screening systems in Korea. J Korean Med Assoc 2011;54(7):666-9.

17.. Lee EH, Park B, Kim NS, Seo HJ, Ko KL, Min JW, et al. The Korean guideline for breast cancer screening. J Korean Med Assoc 2015;58(5):408-19.

18.. Park HA, Nam SY, Lee SK, Kim SG, Shim KN, Park SM, et al. The Korean guideline for gastric cancer screening. J Korean Med Assoc 2015;58(5):373-84.

19.. Lee WC, Kim Y. Background and significance of Korean national cancer screening guideline revision. J Korean Med Assoc 2015;58(4):274-6.

20.. Boer R, de Koning H, Threlfall A, Warmerdam P, Street A, Friedman E, et al. Cost effectiveness of shortening screening interval or extending age range of NHS breast screening programme: computer simulation study. BMJ 1998;317(7155):376-9.

21.. Moon KS, Kim YK, Chang HJ. Determinants of the use and type of comprehensive medical examination services. Korean J Health Policy Adm 2016;10(2):83-97.