Excess mortality from avoidable and non-avoidable causes in men of low socioeconomic status: a prospective study in Korea

Yun‐Mi Song

75 citations0/0 files storedJournal of Epidemiology & Community Health

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Health disparities and outcomes Public Health and Social Inequalities Healthcare Systems and Public Health

Abstract

STUDY OBJECTIVE: The objective of this study was to evaluate the magnitude and contributory factors of socioeconomic differentials in mortality in a cohort of Korean male civil servants. DESIGN: A prospective observational study of male civil servants followed up for five years after baseline measurement. SETTING: All civil service offices in Korea. PARTICIPANTS AND MEASUREMENTS: The study was conducted on 759,665 Korean male public servants aged 30-64 at baseline examination in 1992. The grade of monthly salary of these participants divided into four groups, a proxy indicator of socioeconomic status (SES), was the main predictive variable. Mortality of the participants was followed up from 1992 to 1996. The causes of deaths were categorised into four groups according to the medical amenability: avoidable, partly avoidable, non-avoidable, and external causes of death. The risk of mortality associated with SES was estimated using the Cox proportional hazard model. MAIN RESULTS: Lowest SES group had significantly higher risk of mortality from most causes compared with the highest SES group in the order of external cause (relative risk (RR): 2.26), avoidable (RR: 1.65), all cause (RR: 1.59), and non-avoidable mortality (RR: 1.54). With the adjustment of known risk factors, significantly higher risks of mortality in lowest SES group were attenuated but persisted. Looking at the deaths from partly avoidable causes, significantly higher risks of mortality in the lowest SES group was observed from cerebrovascular disease but not from coronary heart disease. CONCLUSIONS: Socioeconomic differentials in non-avoidable as well as avoidable mortality, persisting even under the control of risk factors, suggest that mortality is influenced not only by the quality of health care and different distribution of risk factors but also by other aspects of SES that are yet unknown.

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References

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2005Health Inequalities in Australia: mortality 2007Explaining age-specific inequalities in mortality from all causes, cardiovascular disease and ischaemic heart disease among South Korean male public servants: relative and absolute perspectives 2010Decomposition of socio-economic differences in life expectancy at birth by age and cause of death among 4 million South Korean public servants and their dependents 2005Relationship of education, occupation, and income with mortality in a representative longitudinal study of South Korea

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