Age- and cause-specific contributions to the life expectancy gap between Medical Aid recipients and National Health Insurance beneficiaries in Korea, 2008-2017.

Recipients of Medical Aid, a government-funded social assistance program for the poor, have a shorter life expectancy than National Health Insurance beneficiaries in Korea. This study aims to explore the contributions of age and major causes of death to the life expectancy difference between the two groups. We used the National Health Information Database provided by the National Health Insurance Service individually linked to mortality registration data of Statistics Korea between 2008 and 2017. Annual abridged life tables were constructed and Arriaga's life expectancy decomposition method was employed to estimate age- and cause-specific contributions to the life expectancy gap between National Health Insurance beneficiaries and Medical Aid recipients. The life expectancy difference between National Health Insurance beneficiaries and Medical Aid recipients was 14.5 years during the period of 2008-2017. The age groups between 30 and 64 years accounted for 78.7% and 67.5% of the total life expectancy gap in men and women, respectively. Cancer was the leading cause of death contributing to excess mortality among Medical Aid recipients compared to National Health Insurance beneficiaries. More specifically, alcohol-attributable deaths (such as alcoholic liver disease, liver cancer, liver cirrhosis, and alcohol/substance abuse), suicide, and cardiometabolic risk factor-related deaths (such as cerebrovascular disease, ischemic heart disease, and diabetes) were the leading contributors to the life expectancy gap. To decrease excess deaths in Medical Aid recipients and reduce health inequalities, effective policies for tobacco and alcohol regulation, suicide prevention, and interventions to address cardiometabolic risk factors are needed.

Use of the National Health Information Database for Estimating Town-Level Mortality in Korea: Comparison with the National Administrative Data, 2014-2017.

BACKGROUND: This study addressed town-level mortality rates using the National Health Information Database (NHID) of the National Health Insurance Service in Korea in comparison with those derived from the National Administrative Data (NAD) of the Ministry of Interior and Safety. METHODS: We employed the NHID and NAD between 2014 and 2017. We compared the numbers of population and deaths at the national level between these two data sets. We also compared the distribution of the town-level numbers of population and deaths of the two data sets. Correlation analyses were performed to investigate the relation between the NHID and NAD in the town-level numbers of population and deaths, crude mortality rate, and standardized mortality ratio (SMR). RESULTS: The numbers of population and deaths in the NHID were almost identical to those in the NAD, regardless of gender. The distribution of the town-level numbers of population and deaths was also similar between the two data sets during the entire study period. Throughout the study period, the Pearson correlation coefficients between the two databases for the town-level numbers of population and deaths and the crude mortality rate were 0.996 or over. The correlation coefficients for the SMR ranged from 0.937 to 0.972. CONCLUSION: Town-level mortality showed significant correlation and concordance between the NHID and NAD. This result highlights the possibility of producing future analyses of town-level health-related indicators in Korea, including the mortality rate, using the NHID.

Cohort profile: the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) in Korea.

PURPOSE: The National Health Insurance Service-Health Screening Cohort (NHIS-HEALS) is a cohort of participants who participated in health screening programmes provided by the NHIS in the Republic of Korea. The NHIS constructed the NHIS-HEALS cohort database in 2015. The purpose of this cohort is to offer relevant and useful data for health researchers, especially in the field of non-communicable diseases and health risk factors, and policy-maker. PARTICIPANTS: To construct the NHIS-HEALS database, a sample cohort was first selected from the 2002 and 2003 health screening participants, who were aged between 40 and 79 in 2002 and followed up through 2013. This cohort included 514 866 health screening participants who comprised a random selection of 10% of all health screening participants in 2002 and 2003. FINDINGS TO DATE: The age-standardised prevalence of anaemia, diabetes mellitus, hypertension, obesity, hypercholesterolaemia and abnormal urine protein were 9.8%, 8.2%, 35.6%, 2.7%, 14.2% and 2.0%, respectively. The age-standardised mortality rate for the first 2 years (through 2004) was 442.0 per 100 000 person-years, while the rate for 10 years (through 2012) was 865.9 per 100 000 person-years. The most common cause of death was malignant neoplasm in both sexes (364.1 per 100 000 person-years for men, 128.3 per 100 000 person-years for women). FUTURE PLANS: This database can be used to study the risk factors of non-communicable diseases and dental health problems, which are important health issues that have not yet been fully investigated. The cohort will be maintained and continuously updated by the NHIS.

Using the National Health Information Database of the National Health Insurance Service in Korea for Monitoring Mortality and Life Expectancy at National and Local Levels.

This study explores whether the National Health Information Database (NHID) can be used to monitor health status of entire population in Korea. We calculated the crude mortality rate and life expectancy (LE) at birth across the national, provincial, and municipal levels using the NHID eligibility database from 2004 to 2015, and compared the results with the corresponding values obtained from the Korean Statistical Information Service (KOSIS) of Statistics Korea. The study results showed that the ratio of crude mortality rate between the two data was 0.99. The absolute difference between the LE of the two data was not more than 0.5 years, and did not exceed 0.3 years in gender specific results. The concordance correlation coefficients (CCC) between the crude mortality rates from NHID and the rates from KOSIS ranged 0.997-0.999 among the municipalities. For LE, the CCC between the NHID and KOSIS across the municipalities were 0.990 in 2004-2009 and 0.985 in 2010-2015 among men, and 0.952 in 2004-2009 and 0.914 in 2010-2015 among women, respectively. Overall, the NHID was a good source for monitoring mortality and LE across national, provincial, and municipal levels with the population representativeness of entire Korean population. The results of this study indicate that NHID may well contribute to the national health promotion policy as a part of the health and health equity monitoring system.

Age- and cause-specific contributions to income difference in life expectancy at birth: findings from nationally representative data on one million South Koreans.

BACKGROUND: Income is not frequently used to monitor health equity on a national level largely due to the lack of public data on income. Information on income allows policy makers to identify the economically disadvantaged population in a country directly. We examined differences in life expectancy (LE) at birth by income and quantified age- and cause-specific contributions to the LE differences using national health insurance data. METHODS: Data from a nationally representative sample of 1 097 333 South Koreans (2% of the total population) collected between 2002 and 2010 (39 737 deaths) were used. National health insurance premiums were used to estimate income level. Age- and cause-specific contributions to differences in LE at birth by income were estimated using Arriaga's decomposition method. RESULTS: LE at birth gradually increased with income in both genders. Interquintile income LE differences were 7.93 years in males and 3.82 years in females. Most of LE differentials were attributed to differences in mortality in middle-aged and older adults. Suicide and cerebrovascular accidents were the two leading causes of death contributing the most to income LE differences in both males and females. The top 10 causes of death accounted for over 50% of the total LE differences by income in both genders. Alcohol-related causes of death explained the majority of the gender differences in the income LE differentials. CONCLUSIONS: Income differentials in LE at birth according to national health insurance premiums and data linkage systems could provide a valuable opportunity for monitoring and prioritizing population health inequalities in South Korea.

Knowledge of, attitudes toward, and experience of complementary and alternative medicine in Western medicine- and oriental medicine-trained physicians in Korea.

OBJECTIVES: We compared knowledge of, attitudes toward, and experience with complementary and alternative medicine (CAM) among Western medicine-trained doctors (WMDs) and Oriental medicine-trained doctors (OMDs). METHODS: In Korea, 502 WMDs and 500 OMDs were interviewed with a structured questionnaire. RESULTS: OMDs held more favorable attitudes toward CAM than did WMDs. OMDs possessed a deeper understanding of and greater experience with CAM. OMDs more readily endorsed health beliefs congruent with CAM. CONCLUSIONS: In the future, CAM can be more readily used by OMDs than by WMDs. Because evidence for the effectiveness of CAM remains sparse, more research is needed for the prudent use of CAM in Korea. An education and training system for potential CAM providers remains to be developed.