Kim Ye-Seul, Kim Joungyoun, Kim Yonghoon, Kang Hee-Taik
Department of Family Medicine, Chungbuk National University Hospital, 776 1-Soonwhan-Ro, Seowon-Gu, Cheongju, 28644, Republic of Korea.
Department of Artificial Intelligence, University of Seoul, 163 Seoulsiripdae-Ro, Dongdaemun-Gu, Seoul, 02504, Republic of Korea.
BMC Public Health. 2024 Jun 12;24(1):1577. doi: 10.1186/s12889-024-19088-3.
Although one's socioeconomic status affects health outcomes, limited research explored how South Korea's National Health Insurance (NHI) system affects mortality rates. This study investigated whether health insurance type and insurance premiums are associated with mortality.
Based on the National Health Insurance Service-Health Screening cohort, 246,172 men and 206,534 women aged ≥ 40 years at baseline (2002-2003) were included and followed until 2019. Health insurance type was categorized as employee-insured (EI) or self-employed-insured (SI). To define low, medium, and high economic status groups, we used insurance premiums at baseline. Death was determined using the date and cause of death included in the cohort. Cox proportional hazard models were used to analyze the association between insurance factors and the overall and cause-specific mortality.
The SI group had a significantly higher risk of overall death compared to the EI group (adjusted hazard ratio (HR) [95% confidence interval]: 1.13 [1.10-1.15] for men and 1.18 [1.15-1.22] for women), after adjusting for various factors. This trend extended to death from the five major causes of death in South Korea (cancer, cardiovascular disease, cerebrovascular disease, pneumonia, and intentional self-harm) and from external causes, with a higher risk of death in the SI group (vs. the EI group). Further analysis stratified by economic status revealed that individuals with lower economic status faced higher risk of overall death and cause-specific mortality in both sexes, compared to those with high economic status for both health insurance types.
This nationwide study found that the SI group and those with lower economic status faced higher risk of overall mortality and death from the five major causes in South Korea. These findings highlight the potential disparities in health outcomes within the NHI system. To address these gaps, strategies should target risk factors for death at the individual level and governments should incorporate such strategies into public health policy development at the population level.
This study was approved by the Institutional Review Board of Chungbuk National University Hospital (CBNUH-202211-HR-0236) and adhered to the principles of the Declaration of Helsinki (1975).
尽管一个人的社会经济地位会影响健康结果，但针对韩国国民健康保险（NHI）系统如何影响死亡率的研究却很有限。本研究调查了健康保险类型和保险费是否与死亡率相关。
基于国民健康保险服务健康筛查队列，纳入了基线期（2002 - 2003年）年龄≥40岁的246,172名男性和206,534名女性，并随访至2019年。健康保险类型分为雇员参保（EI）或个体经营者参保（SI）。为了定义低、中、高经济状况组，我们使用了基线期的保险费。根据队列中包含的死亡日期和死因确定死亡情况。采用Cox比例风险模型分析保险因素与总体死亡率和特定原因死亡率之间的关联。
在调整各种因素后，与EI组相比，SI组总体死亡风险显著更高（调整后的风险比（HR）[95%置信区间]：男性为1.13[1.10 - 1.15]，女性为1.18[1.15 - 1.22]）。这一趋势延伸至韩国五大死因（癌症、心血管疾病、脑血管疾病、肺炎和故意自残）导致的死亡以及外部原因导致的死亡，SI组的死亡风险更高（与EI组相比）。按经济状况分层的进一步分析显示，与两种健康保险类型下经济状况高的个体相比，经济状况低的个体在两性中面临的总体死亡和特定原因死亡率风险更高。
这项全国性研究发现，SI组和经济状况较低的个体面临更高的总体死亡率以及韩国五大死因导致的死亡风险。这些发现凸显了NHI系统内健康结果的潜在差异。为了弥补这些差距，策略应针对个体层面的死亡风险因素，政府应将此类策略纳入人群层面的公共卫生政策制定中。
本研究经忠北国立大学医院机构审查委员会批准（CBNUH - 202211 - HR - 0236），并遵循了《赫尔辛基宣言》（1975年）的原则。
