Spatio-temporal Analysis of District-level Life Expectancy from 2004 to 2017 in Korea

Age- and cause-specific contributions to increase in life expectancy at birth in Korea, 2000-2019: a descriptive study

BACKGROUND

Korea's life expectancy at birth has consistently increased in the 21st century. This study compared the age and cause-specific contribution to the increase in life expectancy at birth in Korea before and after 2010.

METHODS

The population and death numbers by year, sex, 5-year age group, and cause of death from 2000 to 2019 were acquired. Life expectancy at birth was calculated using an abridged life table by sex and year. The annual age-standardized and age-specific mortality by cause of death was also estimated. Lastly, the age and cause-specific contribution to the increase in life expectancy at birth in the two periods were compared using a stepwise replacement algorithm.

RESULTS

Life expectancy at birth in Korea increased consistently from 2010 to 2019, though slightly slower than from 2000 to 2009. The cause-specific mortality and life expectancy decomposition analysis showed a significant decrease in mortality in chronic diseases, such as neoplasms and diseases of the circulatory system, in the middle and old-aged groups. External causes, such as transport injuries and suicide, mortality in younger age groups also increased life expectancy. However, mortality from diseases of the respiratory system increased in the very old age group during 2010-2019.

CONCLUSIONS

Life expectancy at birth in Korea continued to increase mainly due to decreased mortality from chronic diseases and external causes during the study period. However, the aging of the population structure increased vulnerability to respiratory diseases. The factors behind the higher death rate from respiratory disease should be studied in the future.

Effects of Pear Extracts on Microbiome and Immunocytokines to Alleviate Air Pollution-Related Respiratory Hypersensitivity

Pears are ancient functional foods for modern times. Particularly, Korean pears (Pyrus pyrifolia cv.) have been used as folk medicine for respiratory diseases and have strong potential for the treatment of hazardous aerosol-related diseases. Thus, the effects of pear ethanol extracts on air pollution-related respiratory hypersensitivity were studied by toxicokinetics, pro-inflammatory cytokines, and microbiomics in preclinical and randomized double-blind clinical studies. The mild-asthma subjects, who lived in the same city, Seoul, Korea, were separated into the placebo and the treatment (pear extracts, as brix 55; arbutin 5.01 mg and chlorogenic acid 0.18 mg/3 mL per day) groups for 4 weeks (n = 20). As results, there were positive associations between urinary 2-naphthol (NT) or 1-hydroxypyrene (OHP), exposure biomarkers for polyaromatic hydrocarbons in PM_2.5, and pro-inflammatory cytokines, interleukin (IL)-4 or IgE, respectively, in the human subjects. The pear extracts somewhat reduced 2-NT and 1-OHP levels. The proportions of fiber-degrading bacteria that stimulate growth of beneficial microflora for immune defense, that is, Bifidobacterium and Eubacterium, were significantly higher in the pear consuming group than in the placebo group. Moreover, pro-inflammatory cytokines, including IgE, IL-4, IL-5, and IL-13, were significantly suppressed by the pear extracts in the preclinical tests of the ovalbumin-induced asthma mice. Thus, we suggest that air pollution-related respiratory hypersensitivity can be alleviated by Korean pear extracts by modulation of microbiome and immunocytokines.

Social Determinants of Remaining Life Expectancy at Age 60: A District-Level Analysis in Germany

Remaining life expectancy at age 60 (in short: RLE) is an important indicator of the health status of a population's elders. Until now, RLE has not been thoroughly investigated at the district level in Germany. In this study we analyzed, based on recent publicly available data (2015-2017), and for men and women separately, how large the RLE differences were in Germany across the 401 districts. Furthermore, we examined a wide range of potential social determinants in terms of their bivariate and multivariate (i.e., partial) impact on men's and women's RLE. Men's district-level RLE ranged between 19.89 and 24.32 years, women's district-level RLE between 23.67 and 27.16 years. The best single predictor both for men's and women's RLE at district level was 'proportion of employees with academic degree' with standardized partial regression coefficients of 0.42 (men) and 0.51 (women). Second and third in rank were classic economic predictors, such as 'household income' (men), 'proportion of elder with financial elder support' (women), and 'unemployment' (men and women). Indicators expressing the availability of medical services and staffing levels of nursing homes and services had at best a marginal partial impact. This study contributes to the growing body of evidence that a population's educational level is a decisive determinant of population health resp. life expectancy in contemporary industrialized societies.

Income-Related Mortality Inequalities and Its Social Factors among Middle-Aged and Older Adults at the District Level in Aging Seoul: An Ecological Study Using Administrative Big Data

This study investigated income-related health inequality at sub-national level, focusing on mortality inequality among middle-aged and older adults (MOAs). Specifically, we examined income-related mortality inequality and its social factors among MOAs across 25 districts in Seoul using administrative big data from the National Health Insurance Service (NHIS). We obtained access to the NHIS's full-population micro-data on both incomes and demographic variables for the entire residents of Seoul. Slope Index of Inequality (SII) and Relative Index of Inequality (RII) were calculated. The effects of social attributes of districts on SIIs and RIIs were examined through ordinary least squares and spatial regressions. There were clear income-related mortality gradients. Cross-district variance of mortality rates was greater among the lowest income group. SIIs were smaller in wealthier districts. Weak spatial correlation was found in SIIs among men. Lower RIIs were linked to lower Gini coefficients of income for both genders. SIIs (men) were associated with higher proportions of special occupational pensioners and working population. Lower SIIs and RIIs (women) were associated with higher proportions of female household heads. The results suggest that increasing economic activities, targeting households with female heads, reforming public pensions, and reducing income inequality among MOAs can be good policy directions.

Cancer-free Life Expectancy in Small Administrative Areas in Korea and Its Associations with Regional Health Insurance Premiums

BACKGROUND

To determine the priorities and resource allocation of community cancer-related health policies, it is necessary to measure cancer-related health indicators and the burden of cancer by region. This study calculated the cancer-free life expectancy at the eup/myeon/dong level (small administrative units in South Korea) for the first time, and analyzed its association with regional health insurance premiums.

METHODS

We used aggregate data from the 2008-2017 National Health Information Database provided by the National Health Insurance Service. Cancer-free life expectancy was calculated by applying Sullivan's method to mortality and cancer prevalence by age group and sex for the 10-year period in 3,396 eups/myeons/dongs. Correlation analyses were performed to analyze the relationship between cancer-free life expectancy and regional health insurance premiums.

RESULTS

Cancer-free life expectancy in eups/myeons/dongs of metropolitan areas tended to be higher than in non-metropolitan areas. However, some eups/myeons/dongs of non-metropolitan areas showed quite a high cancer-free life expectancy, especially for females. The median values of differences between cancer-free life expectancy and life expectancy at the eup/myeon/dong level (total: 1.6 years, male: 1.8 years, female: 1.4 years) indicated that a person's healthy life can be shortened by a number of years due to cancer. The association of cancer-free life expectancy by eup/myeon/dong with the regional health insurance premium was statistically significant (β = 1.0, P < 0.001) and more prominent for males (β = 1.3, P < 0.001) than for females (β = 0.5, P < 0.001). The relationship between the regional health insurance premium and the burden of cancer (life expectancy minus cancer-free life expectancy) was also statistically significant (β = 0.2 for the total population, β = 0.2 for males, and β = 0.1 for females, all P values < 0.001).

CONCLUSION

This study showed a significant regional gap with regard to cancer-free life expectancy and the burden of cancer at the eup/myeon/dong level. This work makes a meaningful contribution by presenting new and firsthand summary measures of cancer-related health across small areas in Korea. The results will also help the authorities to evaluate the effectiveness of local cancer management projects in small administrative areas and determine regional priorities for implementing cancer control policies.