A study on Regional Comparison for the Health Level using GLMM

In this paper, we first examined the problem of the direct standardization method, which is mainly used to measure the regional health level by analyzing the data obtained from the Korea Community Health Survey, and proposed a new standardization method based on the Generalized Linear Mixed Model (GLMM). In order to evaluate the performance of the proposed standardization as an alternative to the existing direct standardization method, we used the data which obtained from the Korea Community Health Survey conducted in 2019. Using this data, we compared and analyzed three regional health level standard values through the new standardization method, GLMM, the direct standardization method based on the national population in 2005, and the direct standardization method based on the national population in 2019. The results of this study can be summarized as follows. First, the direct standardization method currently used is based on the national population estimated in 2005, but it does not reflect the current demographic structure that is aging much. Second, the GLMM-based standard value correlated higher with 2019 standardization rate than with 2005 standardization rate, which implies that the proposed standardization method sufficiently reflects demographic changes. 
Finally, GLMM-based standard value was related to the disease variables and health-related variables, which were mostly similar to those shown in the direct standardization rates.