• Dohee Lim, Jinwook Bahk, Minsu Ock, Ikhan Kim, Hee-Yeon Kang, Yeon-Yong Kim, Jong Heon Park, and Young-Ho Khang.
• Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, South Korea.
• Health Qual Life Out. 2020 Feb 27; 18 (1): 45.

BackgroundThe aim of this study was to measure differences in quality-adjusted life expectancy (QALE) by income in Korea at the national and district levels.MethodsMortality rates and EuroQol-5D (EQ-5D) scores were obtained from the National Health Information Database of the National Health Insurance Service and the Korea Community Health Survey, respectively. QALE and differences in QALE among income quintiles were calculated using combined 2008-2014 data for 245 districts in Korea. Correlation analyses were conducted to investigate the associations of neighborhood characteristics with QALE and income gaps therein.ResultsQALE showed a graded pattern of inequality according to income, and increased over time for all levels of income and in both sexes, except for low-income quintiles among women, resulting in a widened inequality in QALE among women. In all 245 districts, pro-rich inequalities in QALE were found in both men and women. Districts with higher QALE and smaller income gaps in QALE were concentrated in metropolitan areas, while districts with lower QALE and larger income gaps in QALE were found in rural areas. QALE and differences in QALE by income showed relatively close correlations with socioeconomic characteristics, but relatively weak correlations with health behaviors, except for smoking and indicators related to medical resources.ConclusionsThis study provides evidence of income-based inequalities in health measured by QALE in all subnational areas in Korea. Furthermore, QALE and differences in QALE by income were closely associated with neighborhood-level socioeconomic characteristics.

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