부산대학교 도서관

Tuberculosis (TB) remains a serious global health concern. Improvement of living conditions with economic growth is considered as a main driver to reduce TB burden in 19th century. After the discovery of TB medicine, the priority in TB area is headed to developing new diagnostic tool and novel treatment regimen. However, the emergence of multidrug-resistant TB and Human Immunodeficiency Virus (HIV) co-infected cases is turned the global concern to the social determinants of TB. Therefore, fundamental social causes of the two biologic issues have been explored. Meanwhile, South Korea has an intermediate burden of TB. The absolute burden on TB might be related to the explosive transmission of TB infection during the Korean War. However, there were little investigations why TB incidence did not continuously decrease during the last 2 decades in South Korea. I think the reason would be related to the social causes of TB. My purpose of the study is to identify social determinants of TB for explaining the rout case of the current trend in South Korea. From the literature review, I found some key areas to be investigated to understand the association between socioeconomic position (SEP) and TB in South Korea. As a result, I performed two empirical studies. The purpose of the first study is to identify the association between individual SEP and treatment adherence of TB. Multivariate logistic regression is performed to find if low SEPs is associated with poor TB adherence after adjusting potential confounders. The second study aims to investigate the impact of individual SEP and economic crisis on TB cases with low prior SEP. Multinomial logistic regression is conducted to examine if TB experiences with low prior SEP is associated with lower current household income after adjusting covariates. Moreover, recursive analysis was applied to elucidate the impact of economic crisis on TB experiences with low prior SEP.Firstly, Individual SEPs is adversely related to the treatment adherence. In addition the association is differed by previous TB history. Secondly, TB experiences with low prior SEPs are associated with lower current household income compared with non-TB cases with high prior SEPs. Moreover, the trend of point estimates is increased after the Korean economic crisis. As a conclusion, on the one hand, reducing social inequity in terms of TB adherence is a way to protect the right to health. On the other hand, recovering the resilience from the financial burden of TB should be incorporated into the TB policy in order to mitigate its adverse effects on people with TB experiences.