Health Behavior and Chronic Disease Management Status in the Chungcheong Region: The Results of 2023 Korea Community Health Survey

Abstract

Using the 2023 Korea Community Health Survey, this study verified and summarized healthcare-related indicators including health behaviors, chronic disease morbidity, and management status in the Chungcheong region (Daejeon, Sejong, Chungbuk, and Chungnam). Based on this, we identified health vulnerability indicators such as current smoking rate, current smoking rate of males, monthly drinking rate, high-risk drinking rate, obesity rate (self-reported), diabetes diagnosis experience rate, and stress awareness rate in the Chungcheong region in 2023. Regarding the seven health vulnerability indicators in 2023, the current smoking rate and current smoking rate of males were 22.2% and 39.2%, respectively. The monthly drinking rate and high-risk drinking rate were 59.2% and 14.4%, respectively. The obesity rate (self-reported) and diabetes diagnosis rate were 34.0% and 9.8%, respectively. The stress awareness rate was 27.9%. It is hoped that these data can be used as basic data for exploring intervention projects for chronic disease prevention and management in consideration of local characteristics.

Key messages

① What is known previously?

Since 2008, the Korea Community Health Survey has been conducted annually to produce local health statistics for use by local governments as a basis for local healthcare planning and evaluation.

② What new information is presented?

Among the main health indicators, the current smoking rate, current smoking rate of males, monthly drinking rate, high-risk drinking rate, obesity rate (self-reported), stress awareness rate, and diabetes diagnosis experience rate (30 years and older) were identified as health vulnerability indicators in the Chungcheong region in 2023.

③ What are implications?

When implementing interventions for chronic disease prevention and management at the regional level, it is necessary to select priority areas in consideration of local characteristics.

Introduction

As of 2022, chronic diseases accounted for 74.3% of all fatalities in the Republic of Korea (ROK), and medical expenses for chronic diseases were KRW 83 trillion (80.9% of all medical expenses) and increasing annually [1]. According to Statistics Korea, the elderly population, those aged 65 and over, is expected to reach 20.6% of the total population by 2025, as ROK transitions to a super-aged society. The increase in the elderly population also affects the multimorbidity [2,3], which among elderly persons-those aged 65 and older-is 54.9% in ROK. While the prevalence of three or more chronic conditions is 18.2% for those aged 65–69 years, it rapidly increases to 42.1% for those aged 85 years and older [4], highlighting the necessity of chronic disease management to enjoy a healthy elderly life. Since 6 out of 10 adults over age 30 have hypertension, diabetes, or pre-diabetes because of Westernized diets and sedentary lifestyles, health risk factors must be managed among young adults as well to prevent chronic diseases [5].

The purpose of chronic disease management is to prevent hypertension, diabetes, dyslipidemia, obesity, etc., through lifestyle modifications such as smoking cessation, alcohol abstinence, and physical activity, and fatal diseases such as cancer, cardiovascular disease, and chronic kidney disease, by supporting people with these pre-existing conditions with ongoing treatment and health promotion activities. It is also intended to prevent early death and improve the quality of life of people with chronic diseases [6]. To achieve these goals, not only are individual efforts needed but interventions at the national and community levels are required as well. It is also necessary to identify the health behavior and chronic disease management status in the region and promote customized chronic disease preventive care intervention programs according to community characteristics.

In ROK, the Community Health Survey has been conducted annually since 2008 to produce health statistics data on health behavior, chronic disease morbidity, and management status at the regional level, and local governments have been utilizing the data of the Community Health Survey as evidence when establishing and evaluating regional healthcare plans.

This study aimed to investigate health behaviors and chronic disease morbidity and management at the regional level by focusing on the statistical results of the Chungcheong region (Daejeon, Sejong, Chungbuk, and Chungnam) in “Korea Community Health at a Glance 2023,” which is published according to the data of the Community Health Survey in 2023, and to provide foundational data for the development of chronic disease preventive care intervention programs in the Chungcheong region.

Methods

1. Data Sources and Analysis Methods

To investigate the health behavior and chronic disease morbidity and management status of the residents of the Chungcheong region, the appendix statistics of the statistical report “Korea Community Health at a Glance 2023,” published by the Korea Disease Control and Prevention Agency, were used. Of the 43 indicators included in the report, 18 indicators (10 related to health behavior and 8 related to morbidity including health knowledge) were selected as the main health indicators for analysis. The data for each health indicator were standardized by sex and age, and the representative value of each indicator in the Chungcheong region was calculated using the median value of 36 Si-Gun-Gu in the region. To evaluate the health status of the Chungcheong region in 2023, deteriorated indicators were selected as vulnerability indicators according to whether the value of the Chungcheong region’s representative value for each indicator increased or decreased from the previous year, and the status of each of the four cities and provinces and 36 Si-Gun-Gu in the Chungcheong region was presented for each vulnerable indicator.

Results

Of the 18 major health indicators, 7 indicators, which were related to smoking, alcohol drinking, obesity, stress, and diabetes, were considered health vulnerability indicators in the Chungcheong region in 2023. In particular, the current smoking rate and the current smoking rate of males in the Chungcheong region were 22.2% and 39.2% in 2023, respectively, an increase of 2.0%p and 3.4%p, respectively, from the previous year, while the monthly drinking rate and high-risk drinking rate were 59.2% and 14.4%, respectively, an increase of 1.9%p and 1.1%p, respectively, from the previous year. The obesity rate (self-reported) was 34.0%, an increase of 1.6%p from the previous year, while the stress awareness rate and diabetes diagnosis rate were 27.9% and 9.8%, corresponding to increases of 3.4%p and 0.3%p, respectively, from the previous year. As for the current smoking rate of males, the disparity between cities and provinces in the Chungcheong region was 16.1%p, which is the largest disparity in the area among health vulnerability indicators (Table 1).

Table 1. Status of 18 health indicators in the Chungcheong region in 2023.

Indicator		Nationwidea) (2023)	Chungcheng rigion
			2022	2023	Increase/ decrease (2023–2022)	Status of indicator improvement	Gap within the regionb)
Health behavior	Current smoking rate	20.3	20.0	22.2	+2.0	Deterioration	9.0
	Current smoking rate of males	36.1	35.8	39.2	+3.4	Deterioration	16.1
	Monthly drinking rate	58.0	57.3	59.2	+1.9	Deterioration	5.0
	High risk drinking rate	13.2	13.3	14.4	+1.1	Deterioration	6.9
	Walking practice rate	47.9	43.9	46.3	+2.4	Improvement	5.1
	Moderate or higher physical activity practice rate	25.1	24.1	26.2	+2.1	Improvement	3.9
	Obesity rate (self-reported)	33.7	32.4	34.0	+1.6	Deterioration	6.1
	Annual weight control attempt rate	66.9	65.1	65.9	+0.8	Improvement	8.3
	Stress awareness rate	25.7	24.5	27.9	+3.4	Deterioration	2.5
	Depression experience rate	7.3	7.6	7.5	-0.1	Improvement	1.3
Morbidity	Blood pressure level awareness rate	62.8	66.9	69.1	+2.2	Improvement	7.6
	Hypertension diagnosis experience rate (≥30 yr)	20.6	21.6	21.4	-0.2	Improvement	2.7
	Treatment rate for people diagnosed with hypertension (≥30 yr)	93.6	94.1	94.5	+0.4	Improvement	2.9
	Blood sugar level awareness rate	30.6	32.2	34.7	+2.5	Improvement	6.9
	Diabetes diagnosis experience rate (≥30 yr)	9.1	9.5	9.8	+0.3	Deterioration	0.8
	Treatment rate for people diagnosed with diabetes(≥30 yr)	92.8	90.8	92.0	+1.2	Improvement	4.2
	Awareness rate for early symptoms of stroke	62.0	55.2	61.0	+5.8	Improvement	15.5
	Awareness rate for early symptoms of myocardial infarction	52.9	45.9	52.3	+6.4	Improvement	16.1

Unit: %, %p. ^a)Median among 258 cities, counties, and districts, ^b)Difference between the maximum and minimum values of indicator values of four metropolitan cities and provinces in the Chuncheong region.

1. Smoking Rate

The current smoking rate by City-Province in the Chungcheong region declined from 22.2% in Daejeon, 22.8% in Sejong, 25.0% in Chungbuk, and 24.0% in Chungnam in 2014 to 19.0%, 13.2%, 21.9%, and 22.2% in Daejeon, Sejong, Chungbuk, and Chungnam, respectively, in 2023. However, the current smoking rates of Chungbuk and Chungnam were higher than the national rate (20.3%) (Figure 1A).

Figure 1. Trend of health vulnerability indicators in the Chungcheong region (2014–2023).

(A) Current smoking rate, (B) Current smoking rate of males, (C) Monthly drinking rate, (D) High risk drinking rate, (E) Obesity rate (self-reported), (F) Stress awareness rate, (G) Diabetes diagnosis experience rate (≥30 years). N/A=not available.

In terms of the current smoking rate of males by City-Province in the Chungcheong region, the 10-year comparison showed a decrease from 41.0% in Daejeon, 42.6% in Sejong, 46.6% in Chungbuk, and 45.0% in Chungnam in 2014 to 34.0%, 23.7%, 38.1%, and 39.8% in Daejeon, Sejong, Chungbuk, and Chungnam, respectively, in 2023. However, Chungbuk and Chungnam had a higher current smoking rate of males than the national rate (36.1%) (Figure 1B). In 2023, the current smoking rate and the current smoking rate of males by Si-Gun-Gu in the Chungcheong region were the highest in Cheongyang-gun of Chungnam at 28.3% and 53.6%, respectively, and the lowest in Sejong at 13.2% and 23.7%, respectively (Figure 2A, B).

Figure 2. Status of health vulnerability indicators in cities/countries/districts (2023).

(A) Current smoking rate, (B) Current smoking rate of males, (C) Monthly drinking rate, (D) High risk drinking rate, (E) Obesity rate (self-reported), (F) Stress awareness rate, (G) Diabetes diagnosis experience rate (≥30 years).

2. Alcohol Drinking Rate

The monthly drinking rate by City-Province in the Chungcheong region (in a 10-year comparison) was 59.6% in Daejeon, 57.2% in Sejong, 60.1% in Chungbuk, and 60.6% in Chungnam in 2014, and 59.4%, 57.2%, 62.2%, and 58.4% in Daejeon, Sejong, Chungbuk, and Chungnam, respectively, in 2023, with all three cities and provinces except Sejong having higher monthly drinking rates than the national rate (58.0%) (Figure 1C). In 2023, the monthly drinking rate by Si-Gun-Gu in the Chungcheong region was highest in Cheongwon-gu of Cheongju-si, Chungbuk, at 66.2% and lowest in Geumsan-gun of Chungnam at 50.2% (Figure 2C).

The high-risk drinking rate (in a 10-year comparison) by City-Province in the Chungcheong region decreased from 13.4% in Daejeon, 13.5% in Sejong, 16.9% in Chungbuk, and 14.7% in Chungnam in 2014 to 12.0%, 9.3%, 16.2%, and 14.0% in Daejeon, Sejong, Chungbuk, and Chungnam, respectively, in 2023, but Chungbuk and Chungnam had a higher high-risk drinking rate than the national rate (13.2%) (Figure 1D). In 2023, the high-risk drinking rate by Si-Gun-Gu in the Chungcheong region was highest in Taean-gun of Chungnam at 21.1% and lowest in Sejong at 9.3% (Figure 2D).

3. Obesity Rate

The obesity rate (self-reported) by City-Province in the Chungcheong region (in a 10-year comparison) increased from 24.1% in Daejeon, 25.2% in Sejong, 27.4% in Chungbuk, and 26.2% in Chungnam in 2014 to 28.4%, 29.3%, 34.5%, and 34.4% in Daejeon, Sejong, Chungbuk, and Chungnam, respectively, in 2023, with Chungbuk and Chungnam having higher obesity rates (self-reported) than the national rate (33.7%) (Figure 1E). In 2023, the obesity rate (self-reported) by Si-Gun-Gu in the Chungcheong region was highest in Boeun-gun of Chungbuk at 44.1% and lowest in Seo-gu of Daejeon at 23.2% (Figure 2E).

4. Stress Awareness Rate

The stress awareness rate by City-Province in the Chungcheong region (in a 10-year comparison) decreased from 28.7% in Daejeon, 28.5% in Sejong, 29.4% in Chungbuk, and 30.1% in Chungnam in 2014 to 28.3%, 25.8%, 26.3%, and 27.7% in Daejeon, Sejong, Chungbuk, and Chungnam, respectively, in 2023, but all four cities and provinces had higher stress awareness rates than the national rate (25.7%) (Figure 1F). In 2023, the stress awareness rate by Si-Gun-Gu in the Chungcheong region was highest in Dongnam-gu of Cheonan-si, Chungnam, at 33.3%, and lowest in Chungju-si, Chungbuk, at 21.1% (Figure 2F).

5. Diabetes Diagnosis Rate

The diabetes diagnosis rate by City-Province in the Chungcheong region (in a 10-year comparison) increased from 8.6% in Daejeon, 7.9% in Sejong, 8.0% in Chungbuk, and 7.9% in Chungnam in 2014 to 9.0%, 9.0%, 9.0%, and 9.8% in Daejeon, Sejong, Chungbuk, and Chungnam, respectively, in 2023, with Chungnam having a higher diabetes diagnosis rate than the national rate (9.1%) (Figure 1G). In 2023, the diabetes diagnosis rate by Si-Gun-Gu in the Chungcheong region was highest in Boryeong-si, Chungnam, at 12.3% and lowest in Nonsan-si, Chungnam, at 7.1% (Figure 2G).

Conclusion

Using data from the “Korea Community Health at a Glance 2023” statistics report, we examined health behaviors and chronic disease morbidity and management levels in the Chungcheong region. We found that, among the indicators related to health behaviors, current smoking rate, current smoking rate of males, monthly drinking rate, high-risk drinking rate, obesity rate (self-reported), and stress awareness rate in the Chungcheong region worsened compared with the previous year. On the other hand, the walking activity rate, moderate or intense physical activity rate, annual weight control attempts rate, and depression experience rate improved compared with the previous year, but the walking activity rate and annual weight control attempts were lower than the national rate. Of the indicators related to morbidity, the diabetes diagnosis rate in the Chungcheong region worsened compared with the previous year, while the blood pressure level awareness rate, hypertension diagnosis rate, treatment rate for those diagnosed with hypertension, blood glucose level awareness rate, treatment rate for those diagnosed with diabetes, and awareness rate of early symptoms of stroke (acute stroke) and myocardial infarction improved compared with the previous year. However, the treatment rate for those diagnosed with diabetes and the awareness rate of early symptoms of stroke and myocardial infarction were lower than the national rate.

In particular, the current smoking rate, current smoking rate of males, monthly drinking rate, high-risk drinking rate, obesity rate (self-reported), stress awareness rate, and diabetes diagnosis rate in the Chungcheong region were identified as health vulnerability indicators, which are also related to the indicators for evaluating the effects of chronic disease management proposed in the policy research project to develop a mid- to long-term strategy for chronic disease management in the Chungcheong region. That study proposed the current smoking rate as a short-term indicator; the high-risk drinking rate, hypertension, diabetes, and obesity prevalence as medium-term indicators; and cardiovascular disease incidence as a long-term indicator for evaluating the effects of chronic disease management [7].

Thus, the health vulnerability indicators identified in this analysis should be intensively managed to drive improvements. Among the four cities and provinces in the Chungcheong region, Chungbuk and Chungnam have a higher proportion of elderly people [8], and the indicators related to smoking, alcohol drinking, and obesity, which are major risks for chronic diseases, are higher than those of Daejeon and Sejong. Thus, it is necessary to promote chronic disease preventive care intervention programs focusing on these areas. In particular, major indicators related to health behaviors, such as the current smoking rate and high-risk drinking rate in the Chungcheong region, are spatially clustered with neighboring communities; however, some clusters lack medical resources, and hence it is necessary to select priority areas for implementing intervention programs [9].

In July 2024, the Chungcheong Regional Center for Disease Control and Prevention (RCDC) published “Chungcheong region Community Health at a Glance 2023,” a report that presents the current health statistics at the regional level and health indicators that require priority intervention by local area, and distributed it to Si-Gun-Gu and competent organizations in the region; Si-Gun-Gu was instructed to use it when planning local health programs. In cooperation with RCDC, City-Province, and Si-Gun-Gu, we also conducted awareness-raising campaigns for the prevention and management of chronic diseases in vulnerable areas to improve health vulnerability indicators by encouraging people to practice healthy lifestyles. Since local governments differ in their degree of activation and content of chronic disease prevention management programs, it is necessary to systematically develop and disseminate guidelines for chronic disease prevention management programs to improve the effectiveness of the programs [7,10]. Mid- to long-term efforts are also needed to improve health indicators in the region by securing financial resources to promote chronic disease preventive care intervention programs and implement the programs.