Khang Young-Ho, Kim Hye-Ryun
Department of Health Policy and Management, Seoul National University College of Medicine, 103 Daehak-ro Jongno-gu, Seoul, 03080, South Korea.
Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, South Korea.
Int J Equity Health. 2016 Mar 22;15:51. doi: 10.1186/s12939-016-0341-9.
Investigations into socioeconomic inequalities in mortality have rarely used long-term mortality follow-up data from nationally representative samples in Asian countries. A limited subset of indicators for socioeconomic position was employed in prior studies on socioeconomic inequalities in mortality. We examined socioeconomic inequalities in mortality using follow-up 12-year mortality data from nationally representative samples of South Koreans.
A total of 10,137 individuals who took part in the 1998 and 2001 Korea National Health and Nutrition Examination Surveys were linked to mortality data from Statistics Korea. Of those individuals, 1,219 (12.1 %) had died as of December 2012. Cox proportional hazard models were used to estimate the relative risks of mortality according to a wide range of socioeconomic position (SEP) indicators after taking into account primary sampling units, stratification, and sample weights.
Our analysis showed strong evidence that individuals with disadvantaged SEP indicators had greater all-cause mortality risks than their counterparts. The magnitude of the association varied according to gender, age group, and specific SEP indicators. Cause-specific analyses using equivalized income quintiles showed that the magnitude of mortality inequalities tended to be greater for cardiovascular disease and external causes than for cancer.
Inequalities in mortality exist in every aspect of SEP indicators, both genders, and age groups, and four broad causes of deaths. The South Korean economic development, previously described as effective in both economic growth and relatively equitable income distribution, should be scrutinized regarding its impact on socioeconomic mortality inequalities. Policy measures to reduce inequalities in mortality should be implemented in South Korea.
在亚洲国家，对死亡率方面社会经济不平等的调查很少使用来自全国代表性样本的长期死亡率随访数据。先前关于死亡率方面社会经济不平等的研究中所采用的社会经济地位指标子集有限。我们利用来自韩国全国代表性样本的12年随访死亡率数据，研究了死亡率方面的社会经济不平等情况。
共有10137名参与1998年和2001年韩国国民健康与营养检查调查的个体与韩国统计局的死亡率数据相链接。截至2012年12月，这些个体中有1219人（12.1%）死亡。在考虑了主要抽样单位、分层和样本权重后，使用Cox比例风险模型根据广泛的社会经济地位（SEP）指标估计死亡率的相对风险。
我们的分析有力地表明，具有不利SEP指标的个体全因死亡风险高于其对应个体。关联的程度因性别、年龄组和特定SEP指标而异。使用等效收入五分位数进行的特定病因分析表明，心血管疾病和外部原因导致的死亡率不平等程度往往高于癌症。
在SEP指标的各个方面、男女两性、各年龄组以及四种主要死因中都存在死亡率不平等。韩国经济发展此前被描述为在经济增长和相对公平的收入分配方面都很有效，应仔细审视其对社会经济死亡率不平等的影响。韩国应实施减少死亡率不平等的政策措施。
