This study presents HALE based on YLD calculated from 2008 to 2016 using national claims data. We computed the gap in HALE by gender and income level to measure the equity of HALE. HALE increased from 2008 to 2016, and results by gender suggest that HALE in males increase faster than in females. Results by income level reveal that HALE is higher in higher income level. The gap in HALE between Q1 and Q2, the lower income group, was about 5.10 years in 2016. The gap by income level in females was smaller than in males, which can be because males have greater inequality in terms of HALE according to income level. The gap in HALE between regions widened over time.
The gap in life expectancy by gender decreased from 6.55 years in 2008 to 6.10 years in 2016 . The gap in life expectancy by income level also decreased from 6.9 years in 2008 to 6.59 years in 2016. According to the results, the gap in gender has been on the decline from 4.53 in 2006 to 4.16 in 2016, and the gap based on income levels has decreased from 7.94 in 2008 to 6.72 in 2012, thereafter increasing to 7.58 years in 2016. Especially, the lowest income level group has lower HALE compared to other quintiles. Several studies show that smoking, alcohol usage, and other health behaviors of the low-income bracket are worse than other brackets [19-21]. We need intensive management for the low-income group to promote HALE at the national level. Research is needed on how to set goals for managing health hazards by calculating PAF (population attributable fractions), a fraction that major health hazards such as smoking, drinking, and obesity contributed to YLD, and improving HALE by preventing certain diseases.
This study suggests that the regional gap in HALE keeps increasing. South Korea has the lowest birthrate and the fastest aging population rate in the world, and the income gap between regions is also deepening. The gap in QALE by regions is correlated with socioeconomic characteristics, smoking, and health infrastructure related indicators . Therefore, there is a need for further research to identify the origin of regional HALE gap. Moreover, we need research that reveals the association with the distribution of infrastructure on HALE. Through the research revealing this association, we can develop evidence of medical resources allocation for HALE promotion in areas with low HALE.
We calculated lived in poor health from the difference between life expectancy in Korea suggested from the study of Khang et al. (2019) and HALE from this study . In terms of the ‘years of lived on poor health’, we found an increase of 1.25 years from 11.15 years in 2008 to 12.40 years in 2016. For males, 1.30 years increased from 10.04 years in 2008 to 11.34 years in 2016. For females, there was an increase of 1.22 years from 12.06 years in 2008 to 13.28 years in 2016. The difference in life expectancy is 6.10 years in 2016, but the difference in HALE is smaller as 4.16 years in the same period. That is, females relatively have more ‘years of lived on poor health period’ than males. In 2016, Q1 spent 13.26 years, while Q5 spent 12.26 years in terms of time spent in an unhealthy state; and the difference between the two groups was 0.99 years. The results suggest that there is an inequality in ‘year of lived on poor health’ in terms of income level in Korea.
South Korea’s HALE from GBD 2016 in 2016 was 68.49 years for males and 72.97 years for females, and ‘year of lived on poor health’ for males was 11.25 years and for females was 9.18 years . The facts that females have a higher HALE and higher ‘year of lived on poor health’ than males matched the results of this study. Moreover, derived HALE in this study (70.56 years) is similar to the HALE from GBD 2016 (70.76 years). However, South Korea’s HALE in 2016 from GBD 2017 is 71.57 years (69.59 years for males, 73.37 years for females), and it increased by about 0.81 years from GBD 2016 . This difference between the GBD Study and this study is caused by the adoption of the procedure of input variable estimation by WHO and IHME.
The WHO also calculates HALE based on YLD from GBD Study. The WHO currently presents South Korea’s HALE in 2016 as 73.0 years (70.7 years for males, 75.1 years for females). In 2015, the WHO’s HALE for South Korea was 72.7 years (70.3 years for males, 74.8 years for females) [23, 24]. It was updated based on World Health Statistics 2018 on April 6, 2018, but South Korea’s HALE in 2015 was presented as 73.2 years using World Health Statistics 2016 . Limitations mentioned above make it difficult for individual countries to develop and evaluate the health goal using HALE as a national indicator. Therefore, when establishing and evaluating Korea’s policy, data-driven YLD is more compatible than model-driven YLD, which the WHO and IHME have adopted. Additionally, HALE from the WHO and IHME can be used as a powerful indicator for a comparative study between countries, but it is not being produced in terms of equity, such as income in individual countries or regional differences in HALE.