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Shahid M, Tadakamadla SK, Kroon J, Peres MA. Do dental anxiety and satisfaction with dental professionals modify the association between affordability and dental service use? A population-based longitudinal study of Australian adults. J Public Health Dent 2024; 84:136-146. [PMID: 38506129 DOI: 10.1111/jphd.12608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 10/06/2023] [Accepted: 12/23/2023] [Indexed: 03/21/2024]
Abstract
OBJECTIVES This study aimed to assess the association between affordability in terms of difficulty paying dental bills in Australian dollars and dental service use in the presence of sociodemographic confounders, and to assess the role of dental anxiety and satisfaction with dental professionals as mediators. The second aim was to investigate how dental anxiety and satisfaction with dental professionals modify the association between affordability and use of dental services in Australian adults. METHODS Longitudinal data from the Australian National Study of Adult Oral Health (2004-06 and 2017-18) was used. Poisson regression and path analysis were conducted to determine the association between affordability and frequency of use of dental services. Effect measure modification (EMM) analysis was performed by stratification of dental anxiety and satisfaction with dental professionals. RESULTS The study included 1698 Australian adults and identified that the prevalence of low frequency of dental visits was 20% more for those who had difficulty paying dental bills. Adults with dental anxiety (prevalence ratio [PR] = 1.14) and those who were dissatisfied with dental professionals (PR = 1.17) had a higher prevalence of low frequency of dental visits in the presence of difficulty paying dental bills. This indicated that dental anxiety and dissatisfaction with dental professionals were effect modifiers on this pathway. CONCLUSIONS Adults who experience dental anxiety and dissatisfaction with dental professionals are more likely to avoid dental visits when faced with difficulty paying dental bills. However, it is important to note that these associations do not necessarily imply a causal relationship.
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Affiliation(s)
- Mishel Shahid
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Santosh Kumar Tadakamadla
- Department of Rural Clinical Sciences, Violet Vines Marshman Centre for Rural Health Research, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Jeroen Kroon
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Marco A Peres
- National Dental Research Institute, National Dental Centre, Singapore, Singapore
- Health Services and Systems Research Program, Duke-NUS Medical School, Singapore, Singapore
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Feng Y, Tuan TD, Shi J, Li Z, Maimaitiming M, Jin Y, Zheng Z. Progress towards health equity in Vietnam: evidence from nationwide official health statistics, 2010-2020. BMJ Glob Health 2024; 9:e014739. [PMID: 38503427 PMCID: PMC10952956 DOI: 10.1136/bmjgh-2023-014739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/26/2024] [Indexed: 03/21/2024] Open
Abstract
INTRODUCTION One of the ultimate goals of strengthening the health system is to achieve health equity. Vietnam is considered one of the 'fast-track countries' to achieve the health-related Millennium Development Goals, but research on its equity strategies remains inadequate. METHODS Using Vietnamese official health statistics, we investigated inequity in four dimensions including health resources, service delivery, service utilisation and residents' health status from the perspectives of income levels, poverty rates and subnational regions. The Slope Index of Inequality, concentration curve/Concentration Index, absolute difference and Theil Index were used. RESULTS Four indicators showed 'pro-poor' inequality in health resources, including the per capita health budget, per capita health personnel, per capita health personnel at the community level and per capita hospital beds at the community level, while provincial hospital beds showed 'pro-rich' inequality. Two health service delivery indicators (delivery of antenatal care ≥3 times and proportion of community health service centres with medical doctors) show 'pro-rich' inequality, although two health status indicators, mortality and malnutrition rates for children under five, showed 'pro-poor' inequality. The Northern Midlands and Mountain Areas, and the Central Highlands were disadvantaged regarding service delivery and health status. Intraregional differences were the main factors contributing to the inequalities in delivery of antenatal care ≥3 times, provincial hospital beds and percentage of community health centres with medical doctors, with the Red River Delta and the South East region experiencing the greatest inequalities. CONCLUSION The overall level of health equity in Vietnam has increased over the past decade, although inequality in health service delivery has hindered progress towards health equity based on income, poverty and subnational regions. Targeted policies need to be introduced to reduce inequities relating to the health workforce and service delivery capacity.
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Affiliation(s)
- Yikai Feng
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Tran Diep Tuan
- University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam
| | - Junyi Shi
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Zhuo Li
- Institute of Area Studies, Peking University, Beijing, China
| | - Mailikezhati Maimaitiming
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Yinzi Jin
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Zhijie Zheng
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
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Cobiac LJ, Rogers NT, Adams J, Cummins S, Smith R, Mytton O, White M, Scarborough P. Impact of the UK soft drinks industry levy on health and health inequalities in children and adolescents in England: An interrupted time series analysis and population health modelling study. PLoS Med 2024; 21:e1004371. [PMID: 38547319 PMCID: PMC11008889 DOI: 10.1371/journal.pmed.1004371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 04/11/2024] [Accepted: 03/06/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND The soft drinks industry levy (SDIL) in the United Kingdom has led to a significant reduction in household purchasing of sugar in drinks. In this study, we examined the potential medium- and long-term implications for health and health inequalities among children and adolescents in England. METHODS AND FINDINGS We conducted a controlled interrupted time series analysis to measure the effects of the SDIL on the amount of sugar per household per week from soft drinks purchased, 19 months post implementation and by index of multiple deprivation (IMD) quintile in England. We modelled the effect of observed sugar reduction on body mass index (BMI), dental caries, and quality-adjusted life years (QALYs) in children and adolescents (0 to 17 years) by IMD quintile over the first 10 years following announcement (March 2016) and implementation (April 2018) of the SDIL. Using a lifetable model, we simulated the potential long-term impact of these changes on life expectancy for the current birth cohort and, using regression models with results from the IMD-specific lifetable models, we calculated the impact of the SDIL on the slope index of inequality (SII) in life expectancy. The SDIL was found to have reduced sugar from purchased drinks in England by 15 g/household/week (95% confidence interval: -10.3 to -19.7). The model predicts these reductions in sugar will lead to 3,600 (95% uncertainty interval: 946 to 6,330) fewer dental caries and 64,100 (54,400 to 73,400) fewer children and adolescents classified as overweight or obese, in the first 10 years after implementation. The changes in sugar purchasing and predicted impacts on health are largest for children and adolescents in the most deprived areas (Q1: 11,000 QALYs [8,370 to 14,100] and Q2: 7,760 QALYs [5,730 to 9,970]), while children and adolescents in less deprived areas will likely experience much smaller simulated effects (Q3: -1,830 QALYs [-3,260 to -501], Q4: 652 QALYs [-336 to 1,680], Q5: 1,860 QALYs [929 to 2,890]). If the simulated effects of the SDIL are sustained over the life course, it is predicted there will be a small but significant reduction in slope index of inequality: 0.76% (95% uncertainty interval: -0.9 to -0.62) for females and 0.94% (-1.1 to -0.76) for males. CONCLUSIONS We predict that the SDIL will lead to medium-term reductions in dental caries and overweight/obesity, and long-term improvements in life expectancy, with the greatest benefits projected for children and adolescents from more deprived areas. This study provides evidence that the SDIL could narrow health inequalities for children and adolescents in England.
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Affiliation(s)
- Linda J. Cobiac
- School of Medicine and Dentistry, Griffith University, Queensland, Australia
| | - Nina T. Rogers
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, United Kingdom
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, United Kingdom
| | - Steven Cummins
- Population Health Innovation Lab, Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Richard Smith
- Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - Oliver Mytton
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, United Kingdom
| | - Peter Scarborough
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK & NIHR Oxford Health Biomedical Research Centre at Oxford, Oxford, United Kingdom
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Currie J, Boyce T, Evans L, Luker M, Senior S, Hartt M, Cottrell S, Lester N, Huws D, Humphreys C, Little K, Adekanmbi V, Paranjothy S. Life expectancy inequalities in Wales before COVID-19: an exploration of current contributions by age and cause of death and changes between 2002 and 2018. Public Health 2021; 193:48-56. [PMID: 33735693 DOI: 10.1016/j.puhe.2021.01.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/26/2020] [Accepted: 01/28/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The COVID-19 pandemic in Wales and the UK has highlighted significant and historic inequalities in health between social groups. To better understand the composition of these inequalities and inform planning after the pandemic, we undertook a decomposition of life expectancy inequalities between the most and least deprived quintiles for men and women by age and cause of death and explored trends between 2002 and 2018. STUDY DESIGN Statistical decomposition of life expectancy inequalities by age and cause of death using routine population mortality datasets. METHODS We used routine statistics from the Office for National Statistics for the period 2002-2018 on population and deaths in Wales stratified by age, gender, Welsh Index of Multiple Deprivation (WIMD) 2019 quintile and cause of death, categorised by International Classification of Disease, version 10, code into 15 categories of public health relevance. We aggregated data to 3-year rolling figures to account for low numbers of events in some groups annually. Next, we estimated life expectancy at birth by quintile, gender and period using life table methods. Lastly, we performed a decomposition analysis using the Arriaga method to identify the specific disease categories and ages at which excess deaths occur in more disadvantaged areas to highlight potential areas for action. RESULTS Life expectancy inequalities between the most and least WIMD quintiles rose for both genders between 2002 and 2018: from 4.69 to 6.02 years for women (an increase of 1.33 years) and from 6.34 to 7.42 years for men (an increase of 1.08 years). Exploratory analysis of these trends suggested that the following were most influential for women: respiratory disease (1.50 years), cancers (1.36 years), circulatory disease (1.35 years) and digestive disease (0.51 years). For men, the gap was driven by circulatory disease (2.01 years), cancers (1.39 years), respiratory disease (1.25 years), digestive disease (0.79 years), drug- and alcohol-related conditions (0.54 years) and external causes (0.54 years). Contributions for women from respiratory disease, cancers, dementia and drug- and alcohol-related conditions appeared to be increasing, while among men, there were rising contributions from respiratory, digestive and circulatory disease. CONCLUSIONS Life expectancy inequalities in Wales remain wide and have been increasing, particularly among women, with indications of worsening trends since 2010 following the introduction of fiscal austerity. As agencies recover from the pandemic, these findings should be considered alongside any resumption of services in Wales or future health and public policy.
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Affiliation(s)
- J Currie
- Division of Population Medicine, School of Medicine, Cardiff University, Division of Population Medicine, School of Medicine, Cardiff University, UHW Main Building, Heath Park, Cardiff, CF14 4XN, UK.
| | - T Boyce
- Institute of Health Equity, Department for Epidemiology & Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - L Evans
- Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK
| | - M Luker
- Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK
| | - S Senior
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - M Hartt
- Department of Geography and Planning, Queen's University, Mackintosh-Corry Hall, Room E208, Kingston, Ontario, Canada
| | - S Cottrell
- Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK
| | - N Lester
- Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK
| | - D Huws
- Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK
| | - C Humphreys
- Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK
| | - K Little
- Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK
| | - V Adekanmbi
- Department of Population Health Sciences, Faculty of Life Sciences & Medicine, Great Maze Pond, Addison House, Guy's Campus, London SE1 9RT, UK
| | - S Paranjothy
- Division of Population Medicine, School of Medicine, Cardiff University, Division of Population Medicine, School of Medicine, Cardiff University, UHW Main Building, Heath Park, Cardiff, CF14 4XN, UK
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Lim HK, Kang HY, Kim I, Khang YH. Spatio-temporal Analysis of District-level Life Expectancy from 2004 to 2017 in Korea. J Korean Med Sci 2021; 36:e8. [PMID: 33429472 PMCID: PMC7801148 DOI: 10.3346/jkms.2021.36.e8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/22/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Health indicators, such as mortality rates or life expectancy, need to be presented at the local level to improve the health of local residents and to reduce health inequality across geographic areas. The aim of this study was to estimate life expectancy at the district level in Korea through a spatio-temporal analysis. METHODS Spatio-temporal models were applied to the National Health Information Database of the National Health Insurance Service to estimate the mortality rates for 19 age groups in 250 districts from 2004 to 2017 by gender in Korea. Annual district-level life tables by gender were constructed using the estimated mortality rates, and then annual district-level life expectancy by gender was estimated using the life table method and the Kannisto-Thatcher method. The annual district-level life expectancies based on the spatio-temporal models were compared to the life expectancies calculated under the assumption that the mortality rates in these 250 districts are independent from one another. RESULTS In 2017, district-level life expectancy at birth ranged from 75.5 years (95% credible interval [CI], 74.0-77.0 years) to 84.2 years (95% CI, 83.4-85.0 years) for men and from 83.9 years (95% CI, 83.2-84.6 years) to 88.2 years (95% CI, 87.3-89.1 years) for women. Between 2004 and 2017, district-level life expectancy at birth increased by 4.57 years (95% CI, 4.49-4.65 years) for men and by 4.06 years (95% CI, 3.99-4.12 years) for women. To obtain stable annual life expectancy estimates at the district level, it is recommended to use the life expectancy based on spatio-temporal models instead of calculating life expectancy using observed mortality. CONCLUSION In this study, we estimated the annual district-level life expectancy from 2004 to 2017 in Korea by gender using a spatio-temporal model. Local governments could use annual district-level life expectancy estimates as a performance indicator of health policies to improve the health of local residents. The approach to district-level analysis with spatio-temporal modeling employed in this study could be used in future analyses to produce district-level health-related indicators in Korea.
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Affiliation(s)
- Hwa Kyung Lim
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Korea
| | - Hee Yeon Kang
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Korea
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
| | - Ikhan Kim
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
- Department of Health Policy and Management, Jeju National University College of Medicine and Graduate School of Medicine, Jeju, Korea
| | - Young Ho Khang
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Korea
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea.
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Huang R, Ghose B, Tang S. Effect of financial stress on self-rereported health and quality of life among older adults in five developing countries: a cross sectional analysis of WHO-SAGE survey. BMC Geriatr 2020; 20:288. [PMID: 32787806 PMCID: PMC7425413 DOI: 10.1186/s12877-020-01687-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/03/2020] [Indexed: 11/10/2022] Open
Abstract
In developing countries, older adults (65 years of age and above) share an increased vulnerability to catastrophic health expenditures and financial stress which can have significant bearing on their health and well-being. Currently, research evidence on how financial stress correlates with health and well-being among older adults in the developing countries is limited. Therefore, in this study, we aimed to assess the relationship between financial stress and subjective 1) health, 2) depression, 3) quality of life, and 4) life satisfaction among older adults in five developing countries. METHODS Data used in this study were cross-sectional which were collected from the first wave of Study on Global AGEing and Health (SAGE) survey of World Health Organization. Sample population were 12,299 community dwelling men and women in China (n = 4548), Ghana (n = 1968), India (n = 2441), South Africa (n = 1924), and Russia (n = 1418). Using generalized linear models with logit links, we assessed the correlation between self-reported financial stress and income inequality with the four outcome measures by adjusting for various sociodemographic factors. RESULTS Overall, the prevalence of good self-reported health, quality of life and positive life-satisfaction was 47.11, 79.25 and 44.40% respectively, while 20.13% of the participants reported having depression during past 12 months. Only about a fifth (18.67%) of the participants reported having enough money to meet daily their necessities completely, while more than quarter (28.45%) were in the lowest income quintile. With a few exceptions, the odds of reporting good self-reported health, quality of life, and life satisfaction were generally lower among those with varying degrees of financial stress, and larger among those in the higher income quintiles. Conversely, the likelihood of self-reported depression was significantly higher among those with any level of financial stress, and lower among those in the higher income quintiles. CONCLUSION This study concludes that both subjectively and objectively measured financial stress are inversely associated with good self-reported health, quality of life, life satisfaction, and positively associated with self-reported depression among older adults.
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Affiliation(s)
- Rui Huang
- School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Bishwajit Ghose
- School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Shangfeng Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Bahk J, Kang HY, Khang YH. Inequality in Life Expectancy in Korea according to Various Categorizations of the National Health Insurance Premiums as a Marker of Income. Yonsei Med J 2020; 61:640-643. [PMID: 32608209 PMCID: PMC7329743 DOI: 10.3349/ymj.2020.61.7.640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 11/28/2022] Open
Abstract
The purpose of this study was to examine the degree to which the magnitude of income inequality in life expectancy according to different categorization across beneficiary types under the National Health Insurance Service (NHIS) in Korea. We used population and death data in 2017 from the National Health Information Database of the NHIS. Income quintile groups were classified in four ways according to beneficiary type (employee insured, self-employed insured, and Medical Aid beneficiaries). Standard life table procedures were used to calculate life expectancy. The life expectancy gap between the lowest and highest income quintiles was the largest when the entire population was divided into quintiles without distinguishing among types of beneficiaries. In conclusion, we suggest that income quintile indicators in NHIS data, measured without distinguishing among types of beneficiaries, may best represent the magnitude of health inequalities in Korean society. This indicator could be used for future research on health inequalities, as well as for monitoring health inequalities in Korea.
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Affiliation(s)
- Jinwook Bahk
- Department of Public Health, Keimyung University, Daegu, Korea
| | - Hee Yeon Kang
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
| | - Young Ho Khang
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Korea.
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Bahk J, Kang HY, Khang YH. Life expectancy and inequalities therein by income from 2016 to 2018 across the 253 electoral constituencies of the National Assembly of the Republic of Korea. J Prev Med Public Health 2020; 53:jpmph.20.050. [PMID: 32172547 PMCID: PMC7142002 DOI: 10.3961/jpmph.20.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 03/03/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE We calculated life expectancy and inequalities therein by income for the period of 2016-2018 across the 253 electoral constituencies of the 20th National Assembly election in Korea. METHODS We obtained population and death data between 2016 and 2018 from the National Health Information Database and constructed abridged life tables using standard life table procedures according to sex and income quintiles for the electoral constituencies of the 20th National Assembly election held in 2016. RESULTS Life expectancy across the 253 constituencies ranged from 80.51 to 87.05 years, corresponding to a gap of 6.54 years. The life expectancy difference by income across the 253 constituencies ranged from 2.94 years to 10.67 years. In each province, the difference in life expectancy by income across electoral constituencies was generally greater than the inter-constituency differences. Constituencies in capital and metropolitan areas showed a higher life expectancy and a lower life expectancy difference by income than constituencies in rural areas. CONCLUSIONS Pro-rich inequalities in life expectancy by income existed in every electoral constituency in Korea. Both intra-constituency and inter-constituency socioeconomic inequalities in health should be highlighted in future policy-making in the National Assembly.
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Affiliation(s)
- Jinwook Bahk
- Department of Public Health, Keimyung University, Daegu, Korea
| | - Hee-Yeon Kang
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
| | - Young-Ho Khang
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Korea
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