J Korean Med Sci.  2008 Dec;23(6):975-981. 10.3346/jkms.2008.23.6.975.

Trends in Avoidable Death over 20 Years in Korea

• Chung JI
• Song YM
• Choi JS
• Kim BM

• KMID: 1107520
• DOI: http://doi.org/10.3346/jkms.2008.23.6.975

Abstract

To evaluate the achievement of health care services in Korea independent of other socioeconomic factors, we observed the time trend of avoidable death between 1983 and 2004. A list of avoidable causes of death was constructed based on the European Community Atlas of ''Avoidable Death''. We calculated sex- and agestandardized mortality rates of Korean aged 1-64 yr using data of the Korea National Statistical Office. The avoidable mortality rate (per 100,000 persons) decreased from 225 to 84 in men and from 122 to 41 in women. Accordingly, the proportion of avoidable deaths among all classifiable deaths was reduced by 8.1% in men and 6.4% in women. However, mortality rates from some preventable causes such as ischemic heart disease and malignant neoplasms of lung, breast, cervix, and colorectum have been on the rise. Mortality preventable by appropriate medical care showed the greatest reduction (by 77.8%), while the mortality preventable by primary prevention showed the least reduction (by 50.0%). These findings suggest that health care service has significantly contributed to the improvement of health in Korea. However, more effective intervention programs would be needed given the less reduction in mortality avoidable by primary or secondary prevention than expected and unexpectedly increasing mortality from several preventable causes.

Keyword

Avoidable Death; Amenable Death; Cause of Death; South Korea; Mortality; Quality of Health Care

MeSH Terms

Adolescent
Adult
Cause of Death
Child
Child, Preschool
Female
Humans
Infant
Korea
Male
Middle Aged
Mortality/*trends
Neoplasms/mortality
Primary Prevention/*trends
Secondary Prevention/*trends
Sex Factors

Figure

• 

  Fig. 1 Time trend of avoidable mortality from some highly prevalent causes of death among Korean persons aged between 1 and 64 yr according to the category of medical intervention between 1983 and 2004. (A) Avoidable mortality preventable by primary prevention. (B) Avoidable mortality preventable by secondary prevention. (C) Avoidable mortality preventable by proper hygiene and medical care.

Reference

1. Colgrove J. The McKeown thesis: a historical controversy and its enduring influence. Am J Public Health. 2002. 92:725–729.

2. Korea National Statistical Office. Korea statistical yearbook. 2005. Seoul: Korea National Statistical Office.

3. Kim YH. A study on patterns of causes of death obtained from the vital registrations in Korea [dissertation]. 1997. Seoul: Seoul National Univ..

4. World Bank. The East Asian miracle: economic growth and public policy. 1993. New York: Oxford University Press.

5. Korea National Statistical Office. The Future Estimated Population. 1996. Seoul: Korea National Statistical Office.

6. Rutstein DD, Berenberg W, Chalmers TC, Fishman AP, Perrin EB, Zuidema GD. Measuring the quality of medical care: second revision of tables of indexes. N Engl J Med. 1980. 302:1146.

7. Mackenbach JP, Bouvier-Colle MH, Jougla E. "Avoidable" mortality and health services: a review of aggregate data studies. J Epidemiol Community Health. 1990. 44:106–111.

8. Mackenbach JP, Looman CW, Kunst AE, Habbema JD, van der Maas PJ. Post-1950 mortality trends and medical care: gains in life expectancy due to declines in mortality from conditions amenable to medical intervention in The Netherlands. Soc Sci Med. 1988. 27:889–894.

9. Nolte E, McKee M. Measuring the health of nations: analysis of mortality amenable to health care. BMJ. 2003. 327:1129.

10. Nolte E, McKee M. Population health in Europe: how much is attributable to health care? World Hosp Health Serv. 2004. 40:12–14. 4042

11. Song YM, Kim CY. "Avoidable" causes of death in Korea 1982-1991. Korean J Epidemiol. 1993. 14:160–172.

12. Humblet PC, Lagasse R, Leveque A. Trends in Belgian premature avoidable deaths over a 20 year period. J Epidemiol Community Health. 2000. 54:687–691.

13. Westerling R, Smedby B. The European Community 'avoidable death indicators' in Sweden 1974-1985. Int J Epidemiol. 1992. 21:502–510.

14. Treurniet HF, Boshuizen HC, Harteloh PP. Avoidable mortality in Europe (1980-1997): a comparison of trends. J Epidemiol Community Health. 2004. 58:290–295.

15. World Health Organization Regional Publication. The European health report 2002. 2002. Copenhagen: World Health Organization Regional Office for Europe.

16. Holland WW. EC working group. European community atlas of "avoidable death". 1993. 2nd ed. Oxford: Oxford Univercity Press.

17. Meng KH. Problem and improvement of mortality data in Korea. Korean J Epidemiol. 1989. 11:150–154.

18. Gwack J, Choi YH, Shin HR, Hong YC, Yoo KY. Long-term prediction of gastric cancer mortality in Korea. Korean J Epidemiol. 2005. 27:163–172.

19. Korea National Statistical Office. Annual report of the cause of death statistics. 1983-1990. Seoul: Korea National Statistical Office.

20. Kim DS. Changing pattern of the leading cause of death in Korea [dissertation]. 2003. Daegu: Keimyung Univ..

21. Lee SA, Choi KS, Hwang SY, Lee JY, Park EC, Lee KJ, Lee WC, Yoo KY, Shin HR. The effect of socioeconomic factors on health screening on Korea: the 2001 Korean National Examination Health and Nutrition Surveys (KNEHANS). J Korean Assoc Cancer Prev. 2004. 9:188–198.

22. Jee SH. Changes in the smoking rate and the social cost of smoking. Health and Welfare Policy Forum. 2003. 81:16–24.

23. Lee HP, Song YS, Kim JW, Namgung SE, Mok JE, Park IS, Seo HS, Lee KH. Annual report of gynecologic cancer registry program in Korea for 2002 (Jan. 1st, 2002-Dec. 31st, 2002). Korean J Obstet Gynecol. 2005. 48:1130–1180.

24. Shin HR, Park S, Hwang SY, Kim JE, Jung KW, Won YJ, Hwang SS, Yim SH, Choi KS, Park EC, Park SY, Kim JW, Lee HP. Trends in cervical cancer mortality in Korea 1993-2002: corrected mortality using national death certification data and national cancer incidence data. Int J Cancer. 2008. 122:393–397.

25. Lee PH, Ko YM, Han SG, Lee JM. Cervical carcinoma in women aged 35 and younger. Korean J Obstet Gynecol. 1994. 37:1849–1857.

26. Nam JJ. Current trends and desirable direction of changes in health behaviors in Korea. Health and Welfare Policy Forum. 2003. 80:17–31.

27. Sekikawa A, Kuller LH, Ueshima H, Park JE, Suh I, Jee SH, Lee HK, Pan WH. Coronary heart disease mortality trends in men in the post World War II birth cohorts aged 35-44 in Japan, South Korea and Taiwan compared with the United States. Int J Epidemiol. 1999. 28:1044–1049.

28. Li YH, Li Y, Davis CE, Chen Z, Tao S, Folsom AR, Bachorik P, Stamler J, Abernathy JR. Serum cholesterol changes from 1983-1984 to 1993-1994 in the People's Republic of China. Nutr Metab Cardiovasc Dis. 2002. 12:118–126.

29. Ahn YO. Incidence and distribution of primary liver cancer. Medical Postgraduate. 1998. 26:287–290.

30. Lim KJ, Choi JW. Analysis of the OECD health data 2005. 2005. Seoul: Research Institute for Healthcare Policy of Korean Medical Association.