Exploring avoidable, preventable, treatable mortality trends and effect factors by income level

Abstract Background Avoidable mortality (AM) mean death caused by insufficient health policy and health care intervention, and is a rising public health issue. Income polarization in healthcare utilization is a significant concern. The aim of this study was to derive the trend and effect factors of AM, treatable mortality (TM), preventable mortality (PM) according to income levels in South Korea over the period 2008-2017. Methods This serial cross-sectional analysis was conducted using national health information data from 2008 to 2017. AM was classified based on criteria presented by the Office for National Statistics in 2011. Age-standardized AM was analyzed annually according to income levels. The odds ratio of AM was examined using multivariable logistic regression after adjusting health behaviors and clinical variables collected in 2016-2017. Results There were persistent income inequalities in AM, and the degree of inequality was larger in PM than in TM throughout the period. Medical benefit recipients had an AM of about 8.5 times higher than the highest income quartiles, and men were three times higher than women. In 2016-2017, compared to the highest income quartile, the risk of TM and PM of medical benefit recipients was about 10 times higher and 1.5 times higher in the first quintile. The risk of AM remained significantly higher in low-income levels even after adjusting for health behaviors and clinical variables. Conclusions While AM in South Korea has decreased over time, it remains high in low-income levels. There was a statistically significant difference in AM based on income level. Therefore, inclusion in health policy and services development and in health promotion programs is urgently required to address avoidable deaths and health inequalities for low-income levels. Key messages • AM in South Korea have declined over time, but, compared to the highest income quartile, the risk of TM and PM of medical benefit recipients was about 10 times higher. • Among health insurance eligible people, the first quintile, the more the proportion of TM and PM, and the highest income quartile, the lower the proportion of non-avoidable deaths.