J Prev Med Public Health.
2011 Nov;44(6):242-248. 10.3961/jpmph.2011.44.6.242.
Deprivation and Mortality at the Town Level in Busan, Korea: An Ecological Study
- Affiliations
-
- 1Department of Preventive & Occupational Medicine, School of Medicine, Pusan National University, Busan, Korea. yoonth@pusan.ac.kr
- 2Office of Public Health Care Service, Pusan National University Hospital, Busan, Korea.
- 3People's Health Institute, Seoul, Korea.
- 4Department of Social & Preventive Medicine, School of Medicine, Inha University, Inchon, Korea.
- 5Graduate School of Public Health, Seoul National University, Seoul, Korea.
- KMID: 1031139
- DOI: http://doi.org/10.3961/jpmph.2011.44.6.242
Abstract
OBJECTIVES
Busan is reported to have the highest mortality rate among 16 provinces in Korea, as well as considerable health inequality across its districts. This study sought to examine overall and cause-specific mortality and deprivation at the town level in Busan, thereby identifying towns and causes of deaths to be targeted for improving overall health and alleviating health inequality.
METHODS
Standardized mortality ratios (SMRs) for all-cause and four specific leading causes of death were calculated at the town level in Busan for the years 2005 through 2008. To construct a deprivation index, principal components and factor analysis were adopted, using 10% sample data from the 2005 census. Geographic information system (GIS) mapping techniques were applied to compare spatial distributions between the deprivation index and SMRs. We fitted the Gaussian conditional autoregressive model (CAR) to estimate the relative risks of mortality by deprivation level, controlling for both the heterogeneity effect and spatial autocorrelation.
RESULTS
The SMRs of towns in Busan averaged 100.3, ranging from 70.7 to 139.8. In old inner cities and towns reclaimed for replaced households, the deprivation index and SMRs were relatively high. CAR modeling showed that gaps in SMRs for heart disease, cerebrovascular disease, and physical injury were particularly high.
CONCLUSIONS
Our findings indicate that more deprived towns are likely to have higher mortality, in particular from cardiovascular disease and physical injury. To improve overall health status and address health inequality, such deprived towns should be targeted.
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