Age-Period-Cohort Analysis of Trends in Infectious Disease Mortality in South Korea from 1983 to 2017.

Sang Jun Eun,Hee Sook Kim

doi:10.3390/ijerph18030906

Abstract

We aimed to describe the infectious disease (ID) mortality trends and evaluate age–period–cohort (APC) effects on ID mortality in Korea. Using cause-of-death and census population estimates data from 1983–2017, age-standardized ID mortality trends were investigated by joinpoint regression analysis. The APC effects on ID mortality were estimated using intrinsic estimator models. The age effect showed a J-shaped concave upward curve. Old age, especially ≥70 years, was a critical factor for ID deaths. Similar to the W-shaped period curve, ID mortality rapidly decreased due to economic development and the expansion of health coverage in the 1980s, decelerated with increasing inequality, surged due to the 1997 economic crisis, and has gradually increased since the mid-2000s. The cohort effect showed an inverted U-shape. The increasing cohort effect due to the deterioration of living standards led to a decreasing trend after the independence of Korea. Notwithstanding the slowdown during the 1950–1953 Korean War, educational expansion, economic growth, fertility reduction, and the improvement of ID-related policies might have led to a continued decline among the cohorts born since the 1960s. Diverse socioeconomic events may have influenced ID mortality trends in Korea via period and cohort effects. Policies to reduce the growing burden of ID deaths should be further improved.

Highlights

Infectious disease (ID) is a leading cause of death and premature death worldwide, despite a decreasing trend [1]
In South Korea, ID mortality was on a decline until the mid-1990s; it has been continuously increasing since the mid-2000s after a temporary increase during the 1997 economic crisis [2]
An increase in mortality due to pneumonia and sepsis has led to a recent unfavorable trend [2,4]

Summary

Introduction

Infectious disease (ID) is a leading cause of death and premature death worldwide, despite a decreasing trend [1]. In 2017, nearly 9 million people died and more than 420 thousand years of life were lost due to IDs, accounting for 15% of all deaths and 25%. Of years of life lost, respectively [1]. In 2018, pneumonia was the third leading cause of death, while sepsis was the 9th and 10th leading cause of death in women and men, respectively [4]. These diseases, along with tuberculosis, continue to contribute to the socioeconomic gap in mortality and life expectancy [2,5]

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