An individual’s behavior related to health may have an effect on their physical health or ability to recover from illness. In particular, health-related behavior, such as a lack of exercise, smoking, and drinking, are some of the main factors that can contribute to morbidity and mortality [1
]. Health behavior affects 40% of premature deaths; in order to reduce premature mortality, improving health behaviors is more cost-effective than improving the social and physical environments or health-care systems [4
]. These health behaviors are important in maintaining good health, which is influenced by biological and socioeconomic factors, among others [5
]. Rapid economic growth, high health-care costs, lifestyle changes, and population aging have been associated with an increased prevalence of chronic diseases worldwide. Chronic diseases may cause complications, and thus, require continuous care and are among the types of diseases with high health-care costs due to their long disease duration [7
Chronic diseases, one of the leading causes of death worldwide, especially cardiocerebrovascular diseases, diabetes, and hypertension, have a high mortality rate. However, the mortality rate of chronic diseases can be reduced through prevention [10
]. Chronic disease is closely related to changes in health behaviors; the main health behaviors affecting the development of chronic diseases include health risk behavioral factors, such as smoking, drinking, and physical activities, and clinicopathologic factors, including obesity, hypertension, and hypercholesterolemia [13
]. In particular, since health-related lifestyles have increased the risk of mortality, the significance of managing health risk behavioral factors has also been increasing. Thus, it is necessary to prevent chronic diseases and delay the aggravation of symptoms by improving individual lifestyles [15
]. In addition, individual health behaviors may differ according to sociodemographic characteristics including age and sex [18
]. In the identification of the individual physical condition, sociodemographic and socioeconomic factors are known to act as important factors, and prevalence rates vary in accordance with the individual’s income level, education level, and socioeconomic factors [19
Previous studies have analyzed the relationship between chronic diseases and health promotion behaviors, but were only conducted in predetermined age groups, such as in older patients, or examined the relationship between chronic diseases and health behaviors while only targeting certain chronic diseases [20
]. As the number of polychronic patients has increased, a comprehensive analysis of chronic diseases is required. To date, the number of studies evaluating patients with chronic diseases is limited. Accordingly, in this study, we aimed to analyze the sociodemographic characteristics and health behaviors related to the development of chronic diseases and to identify factors that may have an effect on the morbidity of chronic diseases. Through this and by suggesting measures to contribute to the effective management and prevention of chronic diseases, we intend to promote the health of the people.
In this study, we analyzed the factors affecting the development of chronic diseases through logistic regression analysis using the data from the Korea National Health and Nutrition Examination Survey (2017). Of the sociodemographic characteristics, sex, age, education and income level, types of health insurance, and private insurance were found to have an effect on chronic diseases. In terms of sex, the proportion of women with chronic diseases was higher than that of men. Compared with women, men had a higher rate of chronic disease morbidity and the risk of developing chronic diseases. These results are inconsistent with those of previous studies, which reported that the prevalence of chronic diseases is higher among women than in men because men can maintain their economic level for longer than women. Women who have a lower income level than men have relatively low medical accessibility and find it difficult to manage their chronic diseases [37
]. The number of chronic disease patients is increasing due to the lack of physical activity and the increasing prevalence of hypercholesterolemia and obesity, and considering that previous studies have shown that the prevalence of chronic disease was lower among men who received management, managing chronic diseases according to sex seems to be of utmost importance [38
]. In addition, the number of patients aged 65 years or older who had chronic diseases was higher; therefore, the higher the age, the higher the risk of developing chronic diseases. This finding is consistent with those of a previous study, which reported that as age increases, the prevalence of chronic diseases also increases due to the decreased amount of physical activities and habit-based health risk behaviors [8
It was also found that the higher the income and education levels, the lower the risk of chronic diseases. This finding is consistent with those of previous studies reporting that socioeconomic status, including income, education, and occupation levels, affects the health-related lifestyles and risk of chronic diseases [40
]. Because of the low rates of physical activity and exercise practice and as the provision of medical services for managing chronic diseases has still not been ensured owing to lower educational levels or living standards, the prevalence of chronic diseases is increasing. Among medical care beneficiaries, the risk of developing chronic diseases was high, which was similar to the results of a previous study reporting that the incidence of chronic disease increased among individuals who belonged to the lower social class, like those in the low-income bracket. Social determinants, such as income, education, and social class, may cause health-related inequality but create an environment in which quality medical care can be provided for the treatment of chronic diseases. In addition, non-medical factors, such as social determinants, play a more substantial role in the management of chronic diseases than medical factors. It seems that medical care beneficiaries with low income may have more difficulty in managing chronic diseases [41
]. There were many chronic disease patients who obtained a private medical insurance policy; the results showed that patients with private medical insurance had a lower risk of developing chronic diseases. These findings are similar to those of a previous study, which indicated that those who have private medical insurance policies tend to receive outpatient and inpatient treatments. In line with these findings, among patients with chronic diseases who require continuous health care, those with private medical insurance have a reduced burden in terms of medical expenses, leading to better health-care outcomes [44
]. Considering these results, there are limitations in managing chronic diseases with national health insurance only. Furthermore, it is estimated that people obtain commercial medical insurance policies due to the burden of medical expenses caused by the recent increase in polychronic diseases. Therefore, since health-related inequalities in the low-income group patients, who find it difficult to pay the private medical insurance premiums, will become a serious problem if we only rely on private medical insurance for the management of chronic diseases, the coverage of the national health insurance should be reinforced for the management of chronic diseases.
Among health behaviors, the factors affecting the risk of developing chronic diseases included health checkups, exercise, obesity, and hypercholesterolemia. Those who underwent periodic health checkups had a risk of developing chronic diseases, which is similar to previous findings showing that periodic health checkups promote health and help prevent chronic diseases [8
]. In addition, considering the results of previous studies reporting that those who benefit from health insurance are more likely to receive health checkups depending on the nature of the health insurance system in Korea, chronic diseases could be effectively managed through modifying the nature of the insurance provided. Previous studies have shown that health behavior factors related to chronic diseases include smoking, drinking, exercise, body mass index, and regular life and eating habits [7
]. However, in this study, drinking and smoking did not have a statistically significant effect on the prevalence of chronic diseases, and these results are different from those of existing research. Furthermore, exercise, obesity, and hypercholesterolemia were associated with the risk of developing chronic diseases, consistent with existing research. Among those who performed exercises, the risk of developing chronic diseases was lower, while among those with obesity and hypercholesterolemia, the risk of developing chronic diseases was higher. Weight loss via exercise programs reduces the risk of developing chronic diseases. Maintaining a standard body weight can prevent chronic diseases by alleviating hypercholesterolemia. Management of chronic diseases should be comprehensively performed with weight management through exercise; however, there seems to be a limitation in this regard according to patients’ behavioral changes [50
]. In order to overcome this limitation, wearable medical devices, which use ICT (Information & Communication Technology), have recently been developed for chronic disease management. Prevention and management of chronic diseases can be ensured through exercise [52
]. The use of medical devices to promote physical activity leads to obesity and hypercholesterolemia management, and through the linkage between these medical devices and local clinic-centered, effective management of chronic diseases can be achieved through periodic monitoring. The results of this study also suggest that gender, age, education, and income levels have impacts on chronic disease, and it is significant to add these as risk factors and to continue monitoring in local clinic-centered facilities. Through this, a personalized chronic disease management system could be established.
This study has some limitations. First, chronic disease patients aged 40 years or below were not included. Recently, the number of younger chronic disease patients has increased owing to changes in lifestyle, therefore, further studies to analyze the factors influencing the risk of developing chronic diseases in this age group will be required, with the patients stratified as follows: youth, middle-aged, and older adults. Second, analyses according to the number of chronic diseases were not performed. In this study, only the presence or absence of chronic diseases in patients was assessed. Further studies to determine the influencing factors according to the number of chronic diseases are required. Third, there was no analysis of factors affecting chronic disease according to the residential area. Accessibility to medical services varies depending on where you live; therefore, chronic disease management may be different. Hence, it is necessary to analyze the factors affecting chronic diseases according to urban and rural areas. Despite these limitations, we comprehensively analyzed the factors influencing the prevalence of chronic diseases. Our study is significant as we were able to determine the risk factors for chronic diseases, which can be used as a basis for developing policies for the comprehensive management of chronic diseases, based on sex, age, and social factors.
In order to manage chronic diseases, the management approach should be based on patients’ socioeconomic characteristics to address the differences related to sex, education, income, and medical care. The management should also include approaches to improve health behaviors, including the use of wearable medical devices and digital healthcare products. Based on our findings, we presume that chronic diseases develop due to a combination of factors. Age, socioeconomic factors, obesity, and hypercholesterolemia are factors that can be controlled to prevent and manage chronic diseases through comprehensive programs rather than through individual management. Moreover, those who belong to the lower social class, are more likely to require chronic disease management via primary healthcare institutions in the community. In order to improve health behaviors, continuous observation is required, and local clinic-centered chronic disease management can help improve health behaviors. It is significant to establish a comprehensive management system and promote efficient medical delivery systems for chronic diseases focused on local clinic-centered facilities. However, Korea’s medical delivery system urgently needs reorganization due to the concentration of university hospitals and the weakening of a local clinic-centered structure. Therefore, in order to expand the role of local clinic-centered facilities and to efficiently manage chronic diseases, the integrated local clinic-centered care chronic disease management project is being implemented. Through this, medical treatment for chronic disease management and education for improving lifestyle, are applied to lower the patient’s copayment. If the burden reduction of chronic disease management is expanded, the dependency on private health insurance will be reduced, which will prevent excessive medical expenses for chronic patients. In addition, strengthening the role of local clinic-centered facilities will lead to strengthening medical access for low-income people, thereby relieving health inequalities. For older adults, when included in the community care project in line with community-based primary healthcare service, comprehensive management of chronic diseases, including health improvement and lifestyle modification, could be implemented. In particular, in Europe, where public health policies are in place, chronic diseases are effectively managed by strengthening the local clinic-centered services, such as the attending physician, to manage chronic diseases. For common goals such as chronic disease management, community care is implemented to ensure continuous health care. In view of this, chronic disease management through public health policy should be implemented prior to private medical insurance. Patients with private medical insurance have a lower risk of developing chronic diseases, but this can be seen as a problem of low insurance coverage for chronic diseases. This can be resolved through community care projects such as in Europe. Because of this, patient-centered chronic disease management will ultimately improve the health of chronic disease patients.