Annals of Occupational and Environmental Medicine

Original Article

Educational disparities in labor market participation among middle-aged Koreans with chronic diseases: evidence from the Korean Longitudinal Study of Elderly Employment: Seung Yeon Jeon, Dong-Wook Lee, Jaesung Choi, Mo-Yeol Kang; Ann Occup Environ Med 2025;37:e19. Published online July 17, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e19

Abstract Abstract in Korean PDF Supplementary Material: Background
As South Korea experiences rapid population aging, preventing early retirement has become a critical concern. Ill health contributes to early retirement, and educational level moderates this relationship. Although well-studied in Europe, it remains less explored in Northeast Asia, where labor markets and educational attainment differ significantly. This study investigated the moderating role of education in the relationship between chronic diseases and labor force non-participation in South Korea, considering disease severity, type, and employment status.
Methods
Using data from the Korean Longitudinal Study of Elderly Employment, this study analyzed 5,758 individuals born between 1964 and 1976. Chronic diseases were categorized by severity and type. Labor force participation and retirement from lifetime primary occupation were measured. Education was categorized as low (≤high school) or high (≥college). Logistic regression analyses were conducted, adjusting for sociodemographic and lifestyle covariates, with stratification by education level, employment status, severity, and disease characteristics.
Results
Chronic diseases were significantly associated with labor market non-participation and early retirement, with stronger associations among individuals with lower educational levels. Educational disparities were particularly evident for severe and psychiatric disorders. Among wage workers, those with lower education were more likely to exit the labor market due to chronic diseases, whereas those with higher education generally maintained employment, except in cases of musculoskeletal diseases. Low-educated individuals with chronic diseases were also more likely to retire early from their lifetime primary occupations.
Conclusions
Education moderates the relationship between chronic diseases and labor non-participation, with greater disparities in severe or psychiatric illnesses and among wage workers. Low-educated workers are more vulnerable to early retirement due to ill health, highlighting the need for targeted policy interventions to support this group and prevent early exit from the workforce.; 연구 배경: 한국은 빠른 고령화를 겪고 있으며, 이에 따라 조기 퇴직을 예방하는 것이 중요한 과제로 대두되고 있다. 건강 악화는 조기 퇴직의 주요 원인 중 하나로, 교육 수준은 이 관계에 영향을 미치는 조절 변수로 작용한다. 본 연구는 만성질환과 경제활동 미참여 간의 관계에서 교육 수준이 어떤 역할을 하는지, 질병의 중증도, 유형, 고용 형태를 고려하여 분석하였다.
연구 방법: 고령화고용패널 자료를 활용하여 1964년부터 1976년 사이에 출생한 5,758명을 분석하였다. 만성질환은 중증도와 유형에 따라 분류되었으며, 경제활동 참여 여부 및 주된 생애 일자리에서의 퇴직 여부를 측정하였다. 교육 수준은 고졸 이하(저학력)와 전문대 이상(고학력)으로 구분하였다. 연령, 성별, 결혼 여부, 가계 소득, 건강 관련 생활습관(흡연, 운동, 음주)를 통제하고, 교육 수준과 질병의 중증도 및 유형에 따라 층화된 로지스틱 회귀 분석을 수행하였다.
연구 결과: 만성질환은 경제활동 미참여 및 생애 주된 일자리 퇴직과 유의한 관련성을 보였으며, 특히 교육 수준이 낮은 집단에서 이러한 경향이 더욱 뚜렷하게 나타났다. 교육 수준에 따른 격차는 중증 질환과 정신질환에서 더욱 두드러지게 나타났다. 임금 근로자의 경우, 저학력자는 만성질환이 있을 경우, 노동 시장에서 이탈하는 경향을 보였으나 고학력자는 근골격계 질환을 제외하면 대체로 이탈하지 않았다. 또한 저학력자의 경우, 만성질환이 있을 때 생애 주된 일자리에서 퇴직하는 경향을 더욱 보였다.
결론
교육 수준은 만성질환과 경제활동 미참여 및 생애 주된 일자리에서의 퇴직 간의 관계를 조절하며, 중증 또는 정신질환 및 임금근로자 집단에서 그 격차가 더욱 뚜렷하게 나타난다.

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Original Article

Sex difference in musculoskeletal disabilities among Korean fishers: a cross-sectional study: Hye-min Kim, Soo Hyeong Park, Bong Gyun Joo, Ki-Soo Park, Jeong Ho Kim, Hansoo Song; Ann Occup Environ Med 2025;37:e18. Published online July 7, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e18

Abstract Abstract in Korean PDF: Background
Fishing is a physically demanding occupation with a high risk of musculoskeletal disabilities (MSDs). Although previous studies have focused on ergonomic risk factors, little attention has been paid to sex differences in the prevalence of MSDs among fishers. This study aimed to assess whether female fishers experience a higher prevalence of MSDs than male fishers and to examine whether this difference persists after adjusting for socioeconomic and occupational factors.
Methods
We analyzed cross-sectional data from 898 Korean fishers (513 men and 385 women) who participated in the 2021–2022 Fisher Health Survey. MSDs in the upper extremities, lower back, and knees were defined as scores in the top 25% of the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Oswestry Disability Index, and Western Ontario and McMaster Universities Arthritis Index Short Form (WOMAC-SF), respectively. Modified Poisson regression was used to calculate the prevalence ratios (PRs) by sex, with stepwise adjustments for age, socioeconomic factors, and occupational factors.
Results
Female fishers had significantly higher MSD risk than male fishers across all body regions (fully adjusted PRs: upper extremity, 1.59; lower back, 1.63; knee, 1.44). Sex disparities were most pronounced among those under 60 years of age and remained significant even in older age groups.
Conclusions
The elevated MSD risk among female fishers persisted despite adjusting for conventional risk factors, suggesting the influence of additional factors such as biological susceptibility, domestic labor, and gendered health reporting. Therefore, MSD prevention strategies should include sex-sensitive multidimensional approaches beyond ergonomic interventions.; 한국 어업인에서의 근골격계 장애의 성별 차이: 단면 연구
배경

어업은 육체적으로 힘든 직업으로 근골격계 장애의 위험이 높습니다. 기존 연구들은 주로 인간공학적 위험요인에 집중해 왔으나, 어업인의 근골격계 장애 유병률에 대한 성별 차이는 상대적으로 덜 주목받아 왔습니다. 본 연구는 여성 어업인이 남성 어업인보다 근골격계 장애 유병률이 더 높은지를 평가하고, 이러한 차이가 사회경제적 및 직업적 요인을 보정한 후에도 지속되는지를 살펴보았습니다.
방법

2021–2022년 어업인 건강조사에 참여한 한국 어업인 898명(남성 513명, 여성 385명)의 단면 자료를 분석하였습니다. 상지, 요추, 무릎의 근골격계 장애는 각각 QuickDASH, ODI, WOMAC-SF 점수 상위 25%에 해당할 경우로 정의하였습니다. 수정된 포아송 회귀(modified Poisson regression)를 사용하여 성별에 따른 유병비를 산출하였으며, 연령, 사회경제적 요인, 직업적 요인 순으로 단계적으로 보정하였습니다.
결과

여성 어업인은 남성 어업인보다 모든 신체 부위에서 근골격계 장애의 위험이 유의하게 높았습니다(보정 유병비: 상지 1.59, 요추 1.63, 무릎 1.44). 성별 격차는 60세 미만 집단에서 가장 두드러졌으며, 고령 집단에서도 유의한 차이가 지속되었습니다.
결론

여성 어업인의 높은 근골격계 장애의 위험은 잘 알려진 위험요인을 보정한 후에도 유지되었으며, 이는 생물학적 취약성, 가사노동, 성별에 따른 건강보고 차이 등의 추가적인 요인이 작용했을 가능성을 시사합니다. 따라서 근골격계 장애 예방 전략은 인간공학적 개입을 넘어 성 감수성을 가져야 하며, 다차원적으로 접근해야 합니다.

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Review

A socioecological framework for research on work and obesity in diverse urban transit operators based on gender, race, and ethnicity: BongKyoo Choi, Peter Schnall, Marnie Dobson, Haiou Yang, Dean Baker, YoungJu Seo; Ann Occup Environ Med 2017;29:15. Published online May 17, 2017; DOI: https://doi.org/10.1186/s40557-017-0171-2

Abstract PDF

Urban transit (bus and rail) operators, totaling nearly 700,000 persons, are one of the heaviest occupational groups in the United States (US). Little is known about occupational risk factors for weight gain and obesity and their interrelationship with health-related behaviors, particularly among female minority (African Americans and Hispanics) transit operators who are at greater risk for obesity. As a step towards developing successful obesity interventions among urban transit operators, this paper aims to present a new socioecological framework for studying working conditions, chronic strain, health-related behaviors, weight gain/obesity, and obesity disparity in diverse urban transit operators based on gender, race, and ethnicity. Our framework is a synthesis of several different theories and disciplines: the resource-work load model (work stress), occupational ergonomics, the theory of intersectionality, and worksite health promotion. The framework was developed utilizing an extensive literature review, results from our on-going research on obesity, input from focus groups conducted with Los Angeles transit operators as well as interviews and meetings with transit operator stakeholders (management, unions, and worksite transit wellness program), and ride-along observations. Our hypotheses highlighted in the framework (see Fig. 1) are that adverse working conditions, largely characterized as a combination of high demands and low resources, will increase the risk for weight gain/obesity among transit operators directly through chronic strain and hypothalamic dysfunction (hyper-and hypo-activations), and indirectly through health-related behaviors and injuries/chronic severe pain. We also hypothesize that the observed increase in adiposity among female minority operators is due to their greater exposure to adverse occupational and non-occupational conditions that reflect their intersecting social identities of lower social class and being a minority woman in the US. Our proposed framework could greatly facilitate future transit worksite obesity studies by clarifying the complex and important roles of adverse working conditions in the etiology of weight gain/obesity and obesity disparity among transit operators and other working populations.

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Research Article

Participation inequality in the National General Health Examination based on enterprise size: Young Joong Kang, Jong Heun Park, Huisu Eom, Bohwa Choi, Seyoung Lee, Ji-Won Lee, Jun-Pyo Myong; Ann Occup Environ Med 2017;29:3. Published online February 22, 2017; DOI: https://doi.org/10.1186/s40557-017-0159-y

Abstract PDF

Background

Health examinations are performed so that diseases can be identified and treated earlier. Several studies have evaluated the determinants of participation in health examinations including cancer screening, but few have evaluated the relationship between the size of the enterprise and their participation in Workers’ General Health Examinations (WGHE). The aim of the present study was to estimate the association of WGHE participation with the size of the enterprise and the type of policyholder.

Methods

The eligible population from 2006 through 2013 was extracted from the National Health Insurance Service (NHIS) database. The population size ranged from 14–17 million. After adjustment for age and gender, multiple logistic regression analysis was performed to estimate the odds ratios of participating in the WGHE (by age group) based on the type of policyholder (reference: public officers) and the size of the enterprise (reference: enterprise size ≥300 employees), respectively.

Results

Workers employed at enterprises with <50 persons were less likely to participate in WGHEs than those employed at enterprises with ≥300 persons. After policyholders were stratified by type (non-office workers vs. public officers), a disparity in the WGHE participation rate was found between the different types of policyholders at enterprises with <50 employees (reference: those employed at enterprises with ≥300 employees); the odds ratios for subjects in their 40s and 50s were 0.2–0.3 for non-office workers vs. 0.8–2.0 for public officers.

Conclusion

Workplace policyholders at small enterprises comprised a vulnerable group less likely to participate in WGHEs. Efforts should be made to raise the WGHE participation rate among the vulnerable employees belonging to small enterprises, as well as among their dependents.

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Palgrave Communications.2018;[Epub] CrossRef
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Annals of Occupational and Environmental Medicine.2018;[Epub] CrossRef

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Original Article

Comparison of the Self-rated Health Status of Wage Workers in Korea according to Income Index by Gender: Dae Ho Kim, Dong Mug Kang, Jong Eun Kim, Young Ki Kim, Jin Kon Sul, Soon Choy; Korean Journal of Occupational and Environmental Medicine 2011;23(4):360-370. Published online December 31, 2011; DOI: https://doi.org/10.35371/kjoem.2011.23.4.360

Abstract PDF

OBJECTIVES
This study aims to find differences that reflect the magnitude of health disparities in wage workers in Korea according to income index(personal income, household income, equivalized income) by gender.
METHODS
Data was obtained from the 11th wave of Korean Labor and Income Panel Survey in 2008. This study analyzed 4,205 subjects(2,570 males and 1,635 females) aged 19-65 years. To compare the health effects of each income index by gender, unconditional multiple logistic regression, health-related behaviors, and working conditions were used. The unconditional multiple logistic regression was adjusted by socio-demographic characteristics. All statistics were estimated using SAS survey procedures.
RESULTS
According to unconditional multiple logistic regression, significant differences in ORs between men and women were observed in this study for those wage workers who self-rated their health status to be poor. This was consistent between each income index. Men had an OR of 1.76 (95% CI, 1.28~2.43) by personal income, 1.70 (95%CI, 1.25~2.32) by household income and 1.69 (95% CI, 1.23~2.31) by equivalized income. Women had an 2.09 (95% CI, 1.47~2.97) by household income and OR of 1.95 (95% CI, 1.36~2.79) by equivalized income, but personal income did not have a significant effect on OR for women.
CONCLUSIONS
The study of occupational and environmental medicine should consider that each income index has different effects on the self-rated health status according to gender. Household income index and equivalized income index would represent a health status for women.

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Korean Journal of Occupational Health Nursing.2016; 25(4): 249. CrossRef

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