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Original article Inequality in mortality according to regional deprivation during the COVID-19 pandemic
Min Hui Moon1,2orcid , Min-Hyeok Choi1,2orcid , Young Gyu Ko3orcid
Epidemiol Health 2025;e2025022
DOI: https://doi.org/10.4178/epih.e2025022 [Accepted]
Published online: April 29, 2025
1Pusan National University, Yangsan, Korea
2Pusan National University Yangsan Hospital, Yangsan, Korea
3Busan Public Health Policy Institute, Busan, Korea
Corresponding author:  Min-Hyeok Choi,
Email: come2mh@gmail.com
Received: 29 July 2024   • Revised: 14 March 2025   • Accepted: 9 April 2025
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Abstract

OBJECTIVES
Vulnerability to coronavirus disease 2019 (COVID-19) is significantly greater in regions with lower socioeconomic status. However, detailed analyses of regional socioeconomic disparities have rarely been conducted in South Korea. This study aimed to identify and compare mortality inequalities associated with regional socioeconomic status across different areas of South Korea during the COVID-19 pandemic.
METHODS
Using cause-of-death statistics from 2020 to 2022, we calculated age-standardized mortality rates (ASMRs) for total mortality, COVID-19 mortality, and pneumonia mortality. The socioeconomic status of each region was assessed using the regional deprivation index. Additionally, we calculated the rate difference (RD), rate ratio (RR), slope index of inequality (SII), and relative index of inequality (RII) for each socioeconomic level to examine the extent of mortality inequality and its temporal changes. These analyses were stratified by sex and urban-rural classification.
RESULTS
The total mortality rate, as well as COVID-19-specific and pneumonia-specific mortality rates, increased during the COVID-19 pandemic. The ASMR for COVID-19 was higher in rural areas (ASMR, 27.79), which have lower healthcare accessibility, compared to urban areas (ASMR, 26.63). However, mortality inequality indicators for COVID-19 were more pronounced in urban areas compared to rural areas (SII [urban: 2.72; rural: -0.05], RII [urban: 0.10; rural: 0.00]). Notably, significant inequalities were observed among men residing in urban areas.
CONCLUSIONS
In disaster situations such as the COVID-19 pandemic, it is essential to implement strategies aimed at reducing overall mortality rates and addressing regional socioeconomic inequalities.

Epidemiol Health : Epidemiology and Health
© Korean Society of Epidemiology.
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