J Korean Med Sci.  2021 Nov;36(42):e269. 10.3346/jkms.2021.36.e269.

Cancer-free Life Expectancy in Small Administrative Areas in Korea and Its Associations with Regional Health Insurance Premiums

• Noh E
• Kang HY
• Bahk J
• Kim I
• Khang YH

• KMID: 2522115
• DOI: http://doi.org/10.3346/jkms.2021.36.e269

Abstract

Background
To determine the priorities and resource allocation of community cancerrelated health policies, it is necessary to measure cancer-related health indicators and the burden of cancer by region. This study calculated the cancer-free life expectancy at the eup/ myeon/dong level (small administrative units in South Korea) for the first time, and analyzed its association with regional health insurance premiums.
Methods
We used aggregate data from the 2008–2017 National Health Information Database provided by the National Health Insurance Service. Cancer-free life expectancy was calculated by applying Sullivan's method to mortality and cancer prevalence by age group and sex for the 10-year period in 3,396 eups/myeons/dongs. Correlation analyses were performed to analyze the relationship between cancer-free life expectancy and regional health insurance premiums.
Results
Cancer-free life expectancy in eups/myeons/dongs of metropolitan areas tended to be higher than in non-metropolitan areas. However, some eups/myeons/dongs of non-metropolitan areas showed quite a high cancer-free life expectancy, especially for females. The median values of differences between cancer-free life expectancy and life expectancy at the eup/myeon/ dong level (total: 1.6 years, male: 1.8 years, female: 1.4 years) indicated that a person's healthy life can be shortened by a number of years due to cancer. The association of cancer-free life expectancy by eup/myeon/dong with the regional health insurance premium was statistically significant (β = 1.0, P < 0.001) and more prominent for males (β = 1.3, P < 0.001) than for females (β = 0.5, P < 0.001). The relationship between the regional health insurance premium and the burden of cancer (life expectancy minus cancer-free life expectancy) was also statistically significant (β = 0.2 for the total population, β = 0.2 for males, and β = 0.1 for females, all P values < 0.001).
Conclusion
This study showed a significant regional gap with regard to cancer-free life expectancy and the burden of cancer at the eup/myeon/dong level. This work makes a meaningful contribution by presenting new and firsthand summary measures of cancerrelated health across small areas in Korea. The results will also help the authorities to evaluate the effectiveness of local cancer management projects in small administrative areas and determine regional priorities for implementing cancer control policies.

Keyword

Health Policy; Health Status Disparities; Insurance; Life Expectancy; Neoplasms; Socioeconomic Factors

Figure

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  Fig. 1 National distributions of life expectancy at birth in 3,396 eups/myeons/dongs for (A) total population, (B) males, and (C) females, shown in 10 color groups with ranges for the categories determined by the deciles of life expectancy at birth: findings from the National Health Information Database, 2008–2017.

• 

  Fig. 2 National distributions of cancer-free life expectancy in 3,396 eups/myeons/dongs for (A) total population, (B) males, and (C) females, shown in 10 color groups with ranges for the categories determined by the deciles of cancer-free life expectancy: findings from the National Health Information Database, 2008–2017.

• 

  Fig. 3 Regional distributions of (A) LE at birth, (B) cancer-free LE, and (C) difference between LE and cancer-free LE for eups/myeons/dongs in 17 metropolitan/provincial cities: findings from the National Health Information Database, 2008–2017.LE = life expectancy.

• 

  Fig. 4 Correlations of standardized health insurance premium with (A) LE at birth, (B) cancer-free LE and (C) difference between LE and cancer-free LE in 3,396 eups/myeons/dongs: findings from the National Health Information Database, 2008–2017. (A) Correlation of standardized health insurance premium with LE in 3,396 eups/myeons/dongs for (a) total population, (b) males and (c) females; solid lines represent fitted regression lines. (B) Correlation of standardized health insurance premium with cancer-free LE in 3,396 eups/myeons/dongs for (a) total population, (b) males and (c) females; solid lines represent fitted regression lines. (C) Correlation of standardized health insurance premium with difference between LE and cancer-free LE in 3,396 eups/myeons/dongs for (a) total population, (b) males and (c) females; solid lines represent fitted regression lines.LE = life expectancy.

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