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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2016

Open Access 01-12-2016 | Research

Socioeconomic Inequality in mortality using 12-year follow-up data from nationally representative surveys in South Korea

Authors: Young-Ho Khang, Hye-Ryun Kim

Published in: International Journal for Equity in Health | Issue 1/2016

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.
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Literature
1.
Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health: Final report of the commission on social determinants of health. Geneva: World Health Organization; 2008.
2.
WHO Regional Office for Europe. Review of social determinants and the health divide in the WHO European Region: final report. Copenhagen, Denmark: WHO Regional Office for Europe; 2014.
3.
Mackenbach JP, Stirbu I, Roskam AJ, Schaap MM, Menvielle G, Leinsalu M, Kunst AE, European Union Working Group on Socioeconomic Inequalities in Health. Socioeconomic inequalities in health in 22 European countries. N Engl J Med. 2008;358:2468–81.CrossRefPubMed
4.
Huisman M, Kunst AE, Bopp M, Borgan JK, Borrell C, Costa G, et al. Educational inequalities in cause-specific mortality in middle-aged and older men and women in eight western European populations. Lancet. 2005;365:493–500.CrossRefPubMed
5.
Bessudnov A, McKee M, Stuckler D. Inequalities in male mortality by occupational class, perceived status and education in Russia, 1994-2006. Eur J Public Health. 2012;22:332–7.CrossRefPubMed
6.
Nandi A, Glymour MM, Subramanian SV. Association among socioeconomic status, health behaviors, and all-cause mortality in the United States. Epidemiology. 2014;25:170–7.CrossRefPubMed
7.
Stringhini S, Rousson V, Viswanathan B, Gedeon J, Paccaud F, Bovet P. Association of socioeconomic status with overall and cause specific mortality in the Republic of Seychelles: results from a cohort study in the African region. PLoS One. 2014;9(7), e102858.CrossRefPubMedPubMedCentral
8.
Tjepkema M, Wilkins R, Long A. Cause-specific mortality by education in Canada: a 16-year follow-up study. Health Rep. 2012;23:23–31.PubMed
9.
Toch-Marquardt M, Menvielle G, Eikemo TA, Kulhánová I, Kulik MC, Bopp M, et al. Occupational class inequalities in all-cause and cause-specific mortality among middle-aged men in 14 European populations during the early 2000s. PLoS One. 2014;9(9), e108072.CrossRefPubMedPubMedCentral
10.
Vathesatogkit P, Batty GD, Woodward M. Socioeconomic disadvantage and disease-specific mortality in Asia: systematic review with meta-analysis of population-based cohort studies. J Epidemiol Community Health. 2014;68:375–83.CrossRefPubMed
11.
Woodward M, Peters SAE, Batty GD, Ueshima H, Woo J, Giles GG, et al. Socioeconomic status in relation to cardiovascular disease and cause specific mortality: a comparison of Asian and Australasian populations in a pooled analysis. BMJ Open. 2015;5, e006408.CrossRefPubMedPubMedCentral
12.
Liang J, Bennett J, Krause N, Kobayashi E, Kim H, Brown JW, et al. Old age mortality in Japan: does the socioeconomic gradient interact with gender and age? J Gerontol B Psychol Sci Soc Sci. 2002;57:S294–307.CrossRefPubMed
13.
Liu X, Hermalin AI, Chuang YL. The effect of education on mortality among older Taiwanese and its pathways. J Gerontol B Psychol Sci Soc Sci. 1998;53:S71–82.CrossRefPubMed
14.
Ferri CP, Acosta D, Guerra M, Huang Y, Llibre-Rodriguez JJ, Salas A, et al. Socioeconomic factors and all cause and cause-specific mortality among older people in Latin America, India, and China: a population-based cohort study. PLoS Med. 2012;9, e1001179.CrossRefPubMedPubMedCentral
15.
Fujino Y, Tamakoshi A, Iso H, Inaba Y, Kubo T, Ide R, et al. A nationwide cohort study of educational background and major causes of death among the elderly population in Japan. Prev Med. 2005;40:444–51.CrossRefPubMed
16.
Ito S, Takachi R, Inoue M, Kurahashi N, Iwasaki M, Sasazuki S, et al. Education in relation to incidence of and mortality from cancer and cardiovascular disease in Japan. Eur J Public Health. 2008;18:466–72.CrossRefPubMed
17.
Huang C, Elo IT. Mortality of the oldest old Chinese: the role of early-life nutritional status, socio-economic conditions, and sibling sex-composition. Popul Stud. 2009;63:7–20.CrossRef
18.
Khang YH. Relation of childhood socioeconomic position with mortality risk in adult males of Korea Labor and Income Panel Study (KLIPS). Public Health. 2006;120:724–31.CrossRefPubMed
19.
Khang YH, Bahk J, Yi N, Yun SC. Age- and cause-specific contributions to income difference in life expectancy at birth: findings from nationally representative data on one million South Koreans. Eur J Public Health. 2015 Jun 30. pii: ckv128. [Epub ahead of print]
20.
Kim MH, Subramanian SV, Kawachi I, Kim CY. Association between childhood fatal injuries and socioeconomic position at individual and area levels: a multilevel study. J Epidemiol Community Health. 2007;61:135–40.CrossRefPubMedPubMedCentral
21.
Khang YH, Kim HR. Relationship of education, occupation, and income with mortality in a representative longitudinal study of South Korea. Eur J Epidemiol. 2005;20:217–20.CrossRefPubMed
22.
Khang YH, Kim HR. Explaining socioeconomic inequality in mortality among South Koreans: An examination of multiple pathways in a nationally representative longitudinal study. Int J Epidemiol. 2005;34:630–7.CrossRefPubMed
23.
Khang YH, Kim HR. Socioeconomic mortality inequality in Korea: Mortality follow-up of the 1998 National Health and Nutrition Examination Survey (NHANES) data. J Prev Med Public Health. 2006;39:115–22.PubMed
24.
Khang YH, Lynch JW, Harper S, Harper S, Yun SC, Jung-Choi K, et al. The contribution of material, psychosocial, and behavioral factors to explain educational and occupational mortality inequalities in a nationally representative sample of South Koreans: relative and absolute perspectives. Soc Sci Med. 2009;68:858–66.CrossRefPubMed
25.
Lynch J, Kaplan G. Socioeconomic position. In: Berkman LF, Kawachi I, editors. Social Epidemiology. New York: Oxford University Press; 2000. p. 13–35.
26.
Geyer S, Hemström O, Peter R, Vagero D. Education, income, and occupational class cannot be used interchangeably in social epidemiology. Empirical evidence against a common practice. J Epidemiol Community Health. 2006;60:804–10.CrossRefPubMedPubMedCentral
27.
Kim HR, Khang YH, Yeo JY. Socioeconomic, behavioral, nutritional, and biological determinants of mortality in South Korea: analysis of Korea National Health and Nutrition Examination Survey (K-NHANES) linked data. Seoul: Korea Institute of Health and Social Affairs; 2014.
28.
Khang YH, Lynch JW, Kaplan GA. Health inequalities in Korea: age- and sex-specific educational differences in the 10 leading causes of death. Int J Epidemiol. 2004;33:299–308.CrossRefPubMed
29.
Hong DS, Kim BJ, Cho DK. Occupational structure of Korea. Seoul: Seoul National University; 1999.
30.
Son M, Cho Y, Oh J, Kawachi I, Yi J, Kwon S. Social inequalities in life expectancy and mortality during the transition period of economic crisis (1993-2010) in Korea. Int J Equity Health. 2012;11:71.CrossRefPubMedPubMedCentral
31.
Khang YH, Lynch JW, Yun S, Lee SI. Trends in socioeconomic health inequalities in Korea: use of mortality and morbidity measures. J Epidemiol Community Health. 2004;58:308–14.CrossRefPubMedPubMedCentral
32.
Kim YM, Kim MH. Health inequalities in Korea: Current conditions and implications. J Prev Med Public Health. 2007;40(6):431–8.CrossRefPubMed
33.
Probst C, Roerecke M, Behrendt S, Rehm J. Socioeconomic differences in alcohol-attributable mortality compared with all-cause mortality: a systematic review and meta-analysis. Int J Epidemiol. 2014;43:1314–27.CrossRefPubMedPubMedCentral
34.
Probst C, Roerecke M, Behrendt S, Rehm J. Gender differences in socioeconomic inequality of alcohol-attributable mortality: A systematic review and meta-analysis. Drug Alcohol Rev. 2015;34:267–77.CrossRefPubMed
35.
Son M, Armstrong B, Choi JM, Yoon TY. Relation of occupational class and education with mortality in Korea. J Epidemiol Community Health. 2002;56:798–9.CrossRefPubMedPubMedCentral
36.
Guilley E, Bopp M, Faeh D, Paccaud F. Socioeconomic gradients in mortality in the oldest old: a review. Arch Gerontol Geriatr. 2010;51:e37–40.CrossRefPubMed
37.
Reques L, Santos JM, Belza MJ, Martinez D, Regidor E. Inequalities in mortality at older ages decline with indicators of material wealth but persist with educational level. Eur J Public Health. 2015 Jun 16. pii: ckv110. [Epub ahead of print]
38.
House JS, Lepkowski JM, Kinney AM, Mero RP, Kessler RC, Herzog AR. The social stratification of aging and health. J Health Social Behav. 1994;35:213–34.CrossRef
39.
40.
41.
Sacker A, Firth D, Fitzpatrick R, Lynch K, Bartley M. Comparing health inequality in men and women: prospective study of mortality 1986-96. BMJ. 2000;320:1303–7.CrossRefPubMedPubMedCentral
42.
Galobardes B, Shaw M, Lawlor DA, Davey Smith G, Lynch J. Indicators of socioeconomic position. In: Oakes JM, Kaufman JS, editors. Methods in social epidemiology. San Francisco: Jossey-Bass; 2006. p. 47–85.
43.
World Bank. The East Asian Miracle: economic growth and public policy. New York: Oxford University Press; 1993.
44.
Suh SM. Economic growth and change in income distribution: the Korean case. Seoul: Korea Development Institute; 1985.
45.
Cline WR. Can the East Asian model of development be generalized. World Dev. 1982;10:81–90.CrossRef
46.
Amsden AH. Why isn’t the whole world experimenting with the East-Asian model to develop - review of the East-Asian miracle. World Dev. 1994;22:627–33.CrossRef
47.
Domjahn TM. What (if anything) can developing countries learn from South Korea? Asian Culture History. 2013;5:16–24.CrossRef
Metadata
Title
Socioeconomic Inequality in mortality using 12-year follow-up data from nationally representative surveys in South Korea
Authors
Young-Ho Khang
Hye-Ryun Kim
Publication date
01-12-2016
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2016
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-016-0341-9

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