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Original article Did the socioeconomic inequalities in avoidable and unavoidable mortality worsen during the first year of the COVID-19 pandemic in the Republic of Korea?
Rora Oh2orcid , Myoung-Hee Kim1orcid , Juyeon Lee3orcid , Rangkyoung Ha2orcid , Jungwook Kim4orcid
Epidemiol Health 2023;e2023072
DOI: https://doi.org/10.4178/epih.e2023072 [Accepted]
Published online: August 3, 2023
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1Center for Public Health Data Analytics, National Medical Center, Seoul, Korea
2Department of Public Health, Graduate School of Public Health, Seoul National University, Seoul, Korea
3Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
4Department of Social Welfare, Seoul National University, Seoul, Korea
Corresponding author:  Myoung-Hee Kim,
Email: mhkim1871@gmail.com
Received: 16 March 2023   • Revised: 20 June 2023   • Accepted: 3 July 2023
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Abstract

OBJECTIVES
This study examined changes in socioeconomic inequalities in mortality in the Republic of Korea before and after the outbreak of COVID-19.
METHODS
From 2017 to 2020, age-standardized mortality rates were calculated for all-cause deaths, avoidable deaths (preventable deaths, treatable deaths), and unavoidable deaths using National Health Insurance claims data and Statistics Korea’s cause of death data. In addition, the slope index of inequality (SII) and the relative index of inequality (RII) by six income levels (Medical Aid beneficiary group and quintile of health insurance premiums) were computed to analyze the magnitude and change of mortality inequalities.
RESULTS
All-cause and avoidable mortality rates decreased steadily between 2017 and 2020, whereas unavoidable mortality remained relatively stable. In the case of mortality inequalities, the disparity in all-cause mortality between income classes was exacerbated in 2020 compared to 2019, with the SII increasing from 185.44 to 189.22 and the RII increasing from 3.99 to 4.29. In particular, the preventable and unavoidable mortality rates showed an apparent increase in inequality, as both the SII (preventable: 91.31 to 92.01, unavoidable: 69.99 to 75.38) and RII (preventable: 3.42 to 3.66, unavoidable: 5.02 to 5.89) increased.
CONCLUSIONS
In the first year of the COVID-19 pandemic, mortality inequality continued to increase, although there was no sign of exacerbation. It is necessary to continuously evaluate mortality inequalities, particularly for preventable and unavoidable deaths.

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