The impact of the COVID-19 pandemic on life expectancy by the level of area deprivation in South Korea.

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Comparative evidence suggests that the impact of COVID-19 on life expectancy has been relatively milder in South Korea. This study aims to examine whether the pandemic has universal or unequal impacts on life expectancy across 250 districts with varying levels of deprivation. Using mortality data from 2012 to 2021 obtained from the Microdata Integrated Service of Statistics Korea, we calculated life expectancy at birth and age 65 for both sexes, by deprivation quintiles, before and during the pandemic. We summarized life expectancy gaps using the slope of the inequality index (SII) and further decomposed the gaps by the contribution of age and cause of death using Arriaga's method. Both men and women experienced consistent improvements in life expectancy from 2012 to 2019, but the trend was disrupted during 2020 and 2021, primarily driven by older people. While men in more deprived areas were initially hit harder by the pandemic, the life expectancy gap across deprivation quintiles remained relatively constant and persistent across the study period [SII: -2.48 (CI: -2.70 from -2.27) for 2019 and - 2.84 (CI: -3.06 from -2.63) for 2020]. Middle-aged men from the most deprived areas were the most significant contributors to the life expectancy gap, with liver disease, liver cancer, transport accidents, and intentional injuries being the leading causes, both in the pre and during the pandemic. While these contributors remained largely similar before and during the pandemic, the contribution of transport accidents and liver cancer to the male life expectancy gap slightly decreased during the pandemic, while that of ischemic heart disease and pneumonia slightly increased. A similar increase was also observed for the female life expectancy gap. This study found no clear evidence of an increased life expectancy gap during the pandemic in South Korea, unlike in other countries, although access to emergency healthcare services may have been slightly more disturbed in deprived areas. This achievement can provide lessons for other countries. However, the persistent regional gaps in life expectancy observed over the past decade indicate the need for more targeted public health policies to address this issue.