People of low socioeconomic status are vulnerable to health problems during disasters such as the COVID-19 pandemic. Using data from the 2019 and 2021 Korea Community Health Survey, this study analyzed the associations between Korean adults’ mental health and their national and regional-level household incomes during the pandemic. The prevalence of perceived stress and depression experience for each risk factor category was calculated through univariate analyses. A multivariate logistic regression analysis helped identify the association between two types of income levels (national or regional) and perceived stress and experience of depression. Additionally, we investigated the effect of income levels by subgroup (gender and residential area) on perceived stress and the experience of depression. During the pandemic, the crude prevalence of an experience of depression was higher (6.24% to 7.2%) but that of perceived stress remained unchanged. Regarding regional-income based mental health disparities, even after adjusting for each independent variable, perceived stress (2019 odds ratio (OR): 1.26, 95% confidence interval (CI):1.26–1.27, 2021 OR: 1.32, 95% CI: 1.32–1.32) and experience of depression (2019 OR: 1.56, 95% CI: 1.55–1.56, 2021 OR: 1.63, 95% CI: 1.63–1.64) increased as the income level decreased. The perceived stress based on the two income levels was higher in women than in men. For both income levels, the experience of depression of women was higher than that of men before COVID-19 and vice versa during the COVID-19 period. National income had a more pronounced effect on mental health in urban areas than in rural areas. Contrarily, the effect of regional income level on mental health was not consistent across residential areas (urban and rural areas). Our findings demonstrated that mental health disparities based on income level were more likely to occur during the COVID-19 pandemic and are better reflected through disparities in regional income levels.

Families caring for patients with dementia are more vulnerable to depression. This cross-sectional study compared differences in socioeconomic status and gender related to depression among families of patients with dementia and identified associated factors. Inequality in depression according to household income level among families of patients with dementia was assessed using the Korean Community Health Survey, which included a sample of over 200,000 participants. Depression prevalence was assessed using the Patient Health Questionnaire-9 (PHQ-9) and each independent variable was calculated. Significant differences were analyzed using the chi-square test. Complex-sample multivariate logistic regression was performed to examine the association between the income levels of families of patients with dementia and depression. Additionally, an analysis of depression, stratified by income level and gender, was conducted. The prevalence of depression among families of patients with dementia was 4.41%. The odds ratio (OR) for depression among families of patients with dementia compared to the population of families without patients with dementia was 1.49. Depression was significantly more likely in families with lower income levels (adjusted OR [aOR]: 2.17, 95% confidence interval [CI]: 2.16–2.18). The magnitude of the impact of having a family member with dementia on depression varied by income level, being highest in the lowest income group (aOR: 1.64, 95% CI: 1.63–1.66) and lowest in the highest income group (aOR: 1.26, 95% CI: 1.24–1.27). Stratification by gender showed that both men and women in families of patients with dementia were more likely to experience depression than those in families without patients with dementia. Women had a higher likelihood of depression across all income levels than men; however, the impact of having a family member with dementia was more pronounced among men, especially those from lower-income groups. Our findings suggest the necessity for support policies tailored to low-income groups and women among families of patients with dementia. This is crucial given the higher prevalence of depression among families of patients with dementia than among families without patients with dementia.

OBJECTIVES: Vulnerability to coronavirus disease 2019 (COVID-19) is significantly greater in regions with lower socioeconomic status (SES). However, detailed analyses of regional socioeconomic disparities have rarely been conducted in Korea. This study aimed to identify and compare mortality inequalities associated with regional SES across different areas of Korea during the COVID-19 pandemic.METHODS: Using cause-of-death statistics from 2020 to 2022, we calculated age-standardized mortality rates (ASMRs) for total mortality, COVID-19 mortality, and pneumonia mortality. The SES of each region was assessed using the regional deprivation index. Additionally, we calculated the rate difference, rate ratio, slope index of inequality (SII), and relative index of inequality (RII) for each socioeconomic level to examine the extent of mortality inequality and its temporal changes. These analyses were stratified by gender and urban-rural classification.RESULTS: The total mortality rate, as well as COVID-19-specific and pneumonia-specific mortality rates, increased during the COVID-19 pandemic. The ASMR for COVID-19 was higher in rural areas (ASMR, 27.79), which have lower healthcare accessibility, compared to urban areas (ASMR, 26.63). However, mortality inequality indicators for COVID-19 were more pronounced in urban areas compared to rural areas (SII: urban, 2.72; rural, -0.05, RII: urban, 0.10; rural, 0.00). Notably, significant inequalities were observed among men residing in urban areas.CONCLUSIONS: In disaster situations such as the COVID-19 pandemic, it is essential to implement strategies aimed at reducing overall mortality rates and addressing regional socioeconomic inequalities.

Background and Objectives: Monteggia fracture-dislocations are rare but critical injuries in children. Accurate early diagnosis is essential to avoid long-term complications; however, such injuries are frequently missed. Therefore, this study aimed to assess the diagnostic accuracy of Monteggia fractures among physicians of varying specialties and experience levels and to identify factors influencing diagnostic performance. Materials and Methods: This retrospective study analyzed the radiographic interpretations of pediatric elbow and forearm injuries by six physician groups: orthopedic residents, general orthopedic surgeons, pediatric orthopedic surgeons, general radiologists, and subspecialized musculoskeletal radiologists. The final diagnosis established by pediatric radiology experts served as the reference standard. Influential variables, such as image quality, splint application, and age-related ossification, were evaluated. Results: In total, 120 patients were included, 40 (33.3%) of whom were diagnosed with Monteggia fractures and 80 (66.7%) with other fracture types. The diagnostic accuracy of Monteggia fractures varied significantly according to the physician’s experience. First-year residents and non-subspecialty radiologists had the highest rate of missed diagnoses. While other fracture types were occasionally influenced by technical factors, most missed Monteggia fracture cases stemmed from recognition failure. Subtle imaging features, plastic deformation of the ulna, and the omission of dedicated elbow views contributed to the misdiagnosis. Awareness and training improved performance, and a high index of suspicion was identified as crucial. Early follow-ups and standardized imaging protocols were identified as effective safeguards. Conclusions: Experience level, awareness, and imaging protocol quality were identified as being central to the accurate diagnosis of pediatric Monteggia fractures. Implementing educational strategies, promoting systematic imaging reviews, and reinforcing team-based approaches may reduce the rate of missed diagnoses.

People of lower socioeconomic status are much more likely to be vulnerable to COVID-19. This study aimed to compare the associations between mental health according to relative national and community income levels during the COVID-19 pandemic. Mental health inequalities according to income level during the COVID-19 pandemic were assessed using the Korea Community Health Survey before (2019) and after the COVID-19 pandemic (2021). Univariate analyses were used to calculate the perceived stress and depression rates according to the risk factor categories. A multivariate logistic regression analysis was performed to identify the association between two types of income levels (Korean or community) and perceived stress and depression. In addition, we investigated the effect of relative income levels by subgroup (gender and region) on perceived stress and the experience of depression. During COVID-19, although depression crude rates increased (from 6.24% to 7.2%), perceived stress crude rates remained similar. In addition, as for mental health inequality according to community income level, even after adjusting for each independent variable, perceived stress [Odds Ratio (OR): 1.31, 95% Confidence Interval (CI):1.31–1.32] and experience of depression (OR: 1.63, 95% CI: 1.62–1.63) increased as the income level decreased. The effect of relative income level on perceived stress rate was found to be more pronounced in urban areas than in rural areas in terms of community income levels. Contrarily, the effect of relative income level on the depression rate was found to be weaker. Our findings demonstrated that mental health inequalities based on income level were more likely to occur during the COVID-19 pandemic and that disparities in community income levels may better reflect mental health inequalities.

Background: The prevalence of adhesive capsulitis (AC) is estimated to be 2–5% in the general population. However, the etiology of AC remains unclear. Among the various proposed factors, the precise role of cervical disease, and the severity of cervical degeneration, in the development of AC has not been fully elucidated. This study aimed to analyze the contribution of cervical disease to AC in patients with shoulder pain. Methods: A total of 409 patients who visited the Department of Rehabilitation Medicine for shoulder pain were retrospectively reviewed. The outcome variable was the presence of AC. In addition to cervical disease, other independent variables affecting AC, including sex, diabetes, obesity, dyslipidemia, thyroid disease, immobilization after surgery, rotator cuff tear, subacromial spur, and shoulder joint osteoarthritis were reviewed. To compare the two groups, an independent t-test or chi-square test was performed for continuous and categorical data. Multivariate regression analysis was used to assess the effects of independent factors on AC, adjusting for confounders. Results: Among the 409 patients, 176 (43.0%) were diagnosed with AC. Multivariate analysis demonstrated that diabetes (OR 3.03, 95% CI 1.55–5.91, p = 0.001) and cervical disease (OR 3.03, 95% CI 1.75–5.25, p < 0.001) were significantly associated with increased odds of AC. In contrast, increasing age (OR 0.95, 95% CI 0.92–0.98, p = 0.007), dyslipidemia (OR 0.55, 95% CI 0.31–0.98, p = 0.044), and postoperative immobilization (OR 0.64, 95% CI 0.41–0.99, p = 0.046) were associated with decreased odds of AC. The prevalence of AC increased with the severity of cervical degeneration. Conclusion: In patients with shoulder pain, diabetes and cervical disease were positively associated with AC, whereas age, dyslipidemia, and postoperative immobilization showed inverse associations. These findings suggest that both metabolic and cervical factors may contribute to the development of AC, highlighting the importance of considering cervical pathology in patients with shoulder pain.