Health-adjusted Life Expectancy Research Articles

Diminishing marginal returns and sufficiency in health-care resource use: an exploratory analysis of outcomes, expenditure, and emissions

Increasing health expenditure in low-income countries is associated with rapid gains in health status. Less attention has been paid to the possibility of diminishing marginal returns to health expenditure at high levels of spending, or to the relationship between health-care greenhouse gas emissions and outcomes. Our study aimed to investigate the existence, scale, and implications of diminishing marginal returns to health-care expenditure and emissions. Segmented (piecewise) regression analysis was used to explore the relationship between two measures of health outcome from the Global Burden of Disease project (mortality amenable to health care [MAH] and health-adjusted life expectancy [HALE]), four aggregates of health expenditure per capita from the WHO Global Health Expenditure Database, and health-care sector greenhouse gas emissions per capita derived from a 2020 study by Lenzen and colleagues. Turning point knots-points at which the elasticity or velocity of increasing returns to expenditure and emissions changed substantially-were estimated and countries in the vicinity of these knots identified. Rapidly increasing returns (improvements in population health as measured by MAH and HALE) to health expenditure were estimated in low-income and lower-middle-income countries; at levels of spending above approximately US$500 per capita, these returns start to slow. At levels of spending above those seen in high-income countries such as Italy (approximately US$3400), there is little or no evidence of further health returns to additional spending or to increasing health-care greenhouse gas emissions. Dramatic improvements in population health outcomes could be achieved by additional investment in health expenditure in low-income countries. Conversely, continuing growth in health expenditure in high-income countries will, by itself, be unlikely to yield rapid improvements in health outcomes. Our findings inform the emerging debate on the importance of sufficiency within planetary boundaries-low-income countries need rapid growth in health expenditure, whereas high-income countries could potentially achieve better health outcomes at substantially lower levels of resource use. None.

Trends and Distribution of Life Expectancy and Health-Adjusted Life Expectancy - Asia-Pacific Region, 1990-2021.

The Asia-Pacific region is the most populous and diverse globally, encompassing nations with both the longest and shortest life expectancies (LE). However, less is known about the health-adjusted life expectancy (HALE) situation in this region. This study found diversity in the levels and trends of HALE among countries in the Asia-Pacific region, with HALE in 2021 ranging from 49.87 years in Afghanistan to 74.96 years in Singapore. The largest HALE increase from 1990 to 2021 was observed in the Lao People's Democratic Republic and the smallest in Fiji. HALE continually increased as SDI increased, but different patterns of HALE across countries varied by SDI level. The diversity among these countries provides a prerequisite and scientific basis for promoting the achievement of health goals in the Asia-Pacific region through multilateral and bilateral cooperation.

Differential Impact of Fertility on Health-Adjusted Life Expectancy of Older Adults Across Countries of Various Levels of Socio-Demographic Index - Worldwide, 1995-2019.

Health-adjusted life expectancy (HALE) is a crucial indicator of global health, which is strongly correlated with the socio-demographic index (SDI) and population dynamics. This study revealed that the correlation between total fertility rate (TFR) and HALE of older adults varies across countries with different SDI levels, offering valuable insights for the development of more targeted health promotion programs and interventions. Different health interventions should be tailored to countries with different levels of SDI. In countries with both low fertility rates and low SDI, advanced measures are needed to address the challenge of an aging population that may live longer but face poorer health in the future.

Longer healthy life, but for how many? A stochastic analysis of healthy lifespan inequality

AbstractOver the past 150 years, life expectancy doubled and healthy life expectancy increased. Expectations reveal nothing about variability, so we present a stochastic analysis to investigate changes over time, age and gender of variation, among individuals, in healthy lifespan, for different levels of country income. To complement health-adjusted life expectancy (HALE) data from the Global Burden of Disease Study, we use a stochastic model to compute the standard deviation of healthy life (SDHL). The model is a finite-state absorbing Markov chain with rewards. It includes stochastic survival, mortality, and loss of good health status. An individual surviving from one age to the next gains, as a "reward," a year of good health. This method provides all the moments of healthy longevity. The mean healthy longevity is exactly the HALE. As a measure of variation, here we focus on the standard deviation of healthy longevity. From 1990 to 2019, HALE increased, with greater increases at younger ages. At the same time, SDHL at younger ages decreased and at older ages increased. The most significant changes at birth occurred in low- and lower-middle-income countries. High- and upper-middle-income countries saw notable increases at old ages. Women generally have longer HALE and higher SDHL, but the overall HALE increase was greater for men. The reduction in SDHL over time suggests that more individuals benefit from increased longevity, particularly in low-income countries closing the gap with high-income countries. However, improvements in healthy survival at older ages appear unevenly distributed among individuals in high-income countries.

Which freedoms benefit the poor? A two‐horse race between economic and political freedoms on health‐adjusted life expectancy and child mortality, 1990–2020

AbstractWe examine theoretically and empirically whether democratic rights might be superior to economic rights in a two‐horse race, utilizing indicators of poverty reduction, such as health‐adjusted life expectancy (HALE) and child mortality as outcomes. The results show robustly that economic freedoms associate positively with HALE and negatively with child mortality, while the effect of democracy is more mixed. Studies reporting a negative effect of political freedoms on child mortality without accounting for economic freedoms, thus, are potentially mis‐specified. These results are robust to a barrage of tests, alternative data, estimating method and formal tests of omitted variables bias.

Construction and evaluation of a practical model for measuring health-adjusted life expectancy (HALE) in China

BackgroundHALE is now a regular strategic planning indicator for all levels of the Chinese government. However, HALE measurements necessitate comprehensive data collection and intricate technology. Therefore, effectively converting numerous diseases into the years lived with disability (YLD) rate is a significant challenge for HALE measurements. Our study aimed to construct a simple YLD rate measurement model with high applicability based on the current situation of actual data resources within China to address challenges in measuring HALE target values during planning.MethodsFirst, based on the Chinese YLD rate in the Global Burden of Disease (GBD) 2019, Pearson correlation analysis, the global optimum method, etc., was utilized to screen the best predictor variables from the current Chinese data resources. Missing data for predictor variables were filled in via spline interpolation. Then, multiple linear regression models were fitted to construct the YLD rate measurement model. The Sullivan method was used to measure HALE. The Monte Carlo method was employed to generate 95% uncertainty intervals. Finally, model performances were assessed using the mean absolute error (MAE) and mean absolute percentage error (MAPE).ResultsA three-input-parameter model was constructed to measure the age-specific YLD rates by sex in China, directly using the incidence of infectious diseases, the incidence of chronic diseases among persons aged 15 and older, and the addition of an under-five mortality rate covariate. The total MAE and MAPE for the combined YLD rate were 0.0007 and 0.5949%, respectively. The MAE and MAPE of the combined HALE in the 0-year-old group were 0.0341 and 0.0526%, respectively. There were slightly fewer males (0.0197, 0.0311%) than females (0.0501, 0.0755%).ConclusionWe constructed a high-accuracy model to measure the YLD rate in China by using three monitoring indicators from the Chinese national routine as predictor variables. The model provides a realistic and feasible solution for measuring HALE at the national and especially regional levels, considering limited data.

Living longer but in poor health: healthcare system responses to ageing populations in industrialised countries based on the Findings from the Global Burden of Disease Study 2019

ObjectivesThis study aimed to examine changes in life expectancy (LE), health-adjusted life expectancy (HALE), unhealthy years of life, and disease burden of older people in industrialised countries and associations with health systems.MethodsWe used estimates of LE and HALE, unhealthy years of life, years of life loss (YLL), years lived with disability (YLD) for individuals aged 70 years and over in 33 industrialised countries from 1990 to 2019 from the Global Burden of Disease Study 2019. A linear regression analysis was conducted to examine the association of health outcomes with the Healthcare Access and Quality (HAQ) index.ResultsLE and HALE increased with improved HAQ index from 1990 to 2019. However, the number of unhealthy years of life increased. An increased HAQ index was associated with decreases in YLL. However, changes in YLD were relatively small and were not correlated with HAQ index.ConclusionsThe healthcare system needs to more address the increased morbidity burden among older people. It should be designed to handle to healthcare needs of the ageing population.

Trends of Gaps Between Health-Adjusted Life Expectancy and Life Expectancy at the Regional Level in Korea Using a Group-Based Multi-Trajectory Modeling Approach (2008-2019).

Health-adjusted life expectancy (HALE) is an indicator of the average lifespan in good health. Through this study, we aimed to identify regional disparities in the gap between HALE and life expectancy, considering the trends that have changed over time in Korea. We employed a group-based multi-trajectory modeling approach to capture trends in the gap between HALE and life expectancy at the regional level from 2008 to 2019. HALE was calculated using incidence-based "years lived with disability." This methodology was also employed in the Korean National Burden of Disease Study. Based on five different information criteria, the most fitted number of trajectory groups was seven, with at least 11 regions in each group. Among the seven groups, one had an exceptionally large gap between HALE and life expectancy compared to that of the others. This group was assigned to 17 regions, of which six were metropolitan cities. Based on the results of this study, we identified regions in which health levels have deteriorated over time, particularly within specific areas of metropolitan cities. These findings can be used to design comprehensive policy interventions for community health promotion and urban regeneration projects in the future.

Gender-Specific Health-Adjusted Life Expectancy of Type 2 Diabetes Mellitus Among the Rural Elderly Population.

Objectives: This study aimed to estimate the life expectancy (LE) and health-adjusted life expectancy (HALE) of type 2 diabetes mellitus (T2DM) among the rural elderly population. Methods: A total of 10,318 participants aged 65 to 79 were derived from the Henan Rural Cohort. The LE and HALE were calculated via the Sullivan method and multistate life table. Results: Among 10,318 subjects, 1,325 suffered from T2DM at the baseline, and 394 participants had newly-developed T2DM. The results from the Sullivan method showed that the LE, HALE, and HALE/LE were 17.98, 16.18years, and 89.95% for men aged 65 to 69, and the corresponding estimates for women were 21.81, 18.73years, and 85.86%, respectively. The LE, HALE and HALE/LE calculated via multistate life table were 19.86, 17.53years, and 88.29% for men at aged 65, and the corresponding values for women were 25.01, 20.87years, and 83.44%, respectively. Conclusion: Rural elderly women have a longer LE and HALE of T2DM, but they have lower quality of life than men. More attention should be paid to T2DM among rural elderly people, especially in women. Clinical Trial Registration: The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). Date of registration: 06 July 2015. http://www.chictr.org.cn/showproj.aspx?proj=11375.

Distributionally sensitive measurement and valuation of population health

We introduce a measure of population health that is sensitive to inequality in both age-specific health and lifespan and can be calculated from a health-extended period life table. By allowing for inequality aversion, the measure generalises health-adjusted life expectancy without requiring more data. A transformation of change in the (life-years) measure gives a distributionally sensitive monetary valuation of change in population health and disease burden. Application to Sub-Saharan Africa between 1990 and 2019 reveals that the change in population health is sensitive to allowing for lifespan inequality but is less sensitive to age-specific health inequality. Allowing for distributional sensitivity changes relative burdens of diseases, reduces convergence between the burdens of communicable and non-communicable diseases, and so could influence disease prioritisation. It increases the value of health improvements relative to GDP.

Divergences and gaps in life expectancy and health-adjusted life expectancy in Mexico: Contribution analysis of the Global Burden of Disease Study 2019

Introduction Life expectancy (LE) and Health-adjusted life expectancy (HALE) are summary indicators that reflect a population’s general life conditions and measure inequities in health outcomes. The objective of this study was to identify the differences in LE and HALE by sex, age group, and state in Mexico from 1990 to 2019. Also, to evaluate whether the changes in HALE are related to sociodemographic indicators and indicators of access to and quality of health services. Methods A secondary analysis was performed based on the Global Burden of Disease, Injuries, and Risk Factors Study (GBD). Data were obtained for LE (by sex and state) and HALE (by sex, age group, and state) for the years 1990, 2010, and 2019. The correlations between HALE with the Socio-Demographic Index (SDI) and with the Healthcare Access and Quality (HAQ) Index were estimated for 1990 and 2019 (by total population and sex). Results LE and HALE had an absolute increase of 6.7% and 6.4% from 1990 to 2019, mainly among women, although they spent more years in poor health (11.8 years) than men. The patterns of LE and HALE were heterogeneous and divergent by state. In 2019, the difference in HALE (for both sex) between the states with the highest (Hidalgo) and the lowest (Chiapas) value was 4.6 years. Conclusions Progress in LE and HALE has slowed in recent years; HALE has even had setbacks in some states. Gaps between men and women, as well as between states, are persistent. Public and population policymaking should seek to lengthen LE and focus on ensuring that such years are spent in good health and with good quality of life.

The estimated health impact of alcohol interventions in New Zealand: A modelling study.

To estimate the health impacts of key modelled alcohol interventions among Māori (indigenous peoples) and non-Māori in New Zealand (NZ). Multi-stage life-table intervention modelling study. We modelled two scenarios: (1) business-as-usual (BAU); and (2) an intervention package scenario that included a 50% alcohol tax increase, outlet density reduction from 63 to five outlets per 100 000 people, outlet hours reduction from 112 to 50 per week and a complete ban on all forms of alcohol marketing. The model's population replicates the 2018 NZ population by ethnicity (Māori/non-Māori), age and sex. Alcohol consumption was estimated using nationally representative survey data combined with sales data and corrected for tourist and unrecorded consumption. Disease incidence, prevalence and mortality were calculated using Ministry of Health data. We used dose-response relationships between alcohol and illness from the 2016 Global Burden of Disease study and calculated disability rates for each illness. Changes in consumption were based on the following effect sizes: total intervention package [-30.3%, standard deviation (SD) = 0.02); tax (-7.60%, SD = 0.01); outlet density (-8.64%, SD = 0.01); outlet hours (-9.24%, SD = 0.01); and marketing (-8.98%, SD = 0.02). We measured health gain using health-adjusted life years (HALYs) and life expectancy. Compared with the BAU scenario, the total alcohol intervention package resulted in 726 000 [95% uncertainty interval (UI) = 492 000-913 000] HALYs gained during the life-time of the modelled population. Māori experienced greater HALY gains compared with non-Māori (0.21, 95% UI = 0.14-0.26 and 0.16, 95% UI = 0.11-0.20, respectively). When modelled individually, each alcohol intervention within the intervention package produced similar health gains (~200 000 HALYs per intervention) owing to the similar effect sizes. Modelled interventions for increased alcohol tax, reduced availability of alcohol and a ban on alcohol marketing among Māori and non-Māori in New Zealand (NZ) suggest substantial population-wide health gains and reduced health inequities between Māori and non-Māori.

The socioeconomic distribution of life expectancy and healthy life expectancy in Chile

BackgroundLife expectancy (LE) has usually been used as a metric to monitor population health. In the last few years, metrics such as Quality-Adjusted-Life-Expectancy (QALE) and Health-Adjusted-Life- Expectancy (HALE) have gained popularity in health research, given their capacity to capture health related quality of life, providing a more comprehensive approach to the health concept. We aimed to estimate the distribution of the LE, QALEs and HALEs across Socioeconomic Status in the Chilean population.MethodsBased on life tables constructed using Chiang II´s method, we estimated the LE of the population in Chile by age strata. Probabilities of dying were estimated from mortality data obtained from national registries. Then, life tables were stratified into five socioeconomic quintiles, based on age-adjusted years of education (pre-school, early years to year 1, primary level, secondary level, technical or university). Quality weights (utilities) were estimated for age strata and SES, using the National Health Survey (ENS 2017). Utilities were calculated using the EQ-5D data of the ENS 2017 and the validated value set for Chile. We applied Sullivan´s method to adjust years lived and convert them into QALEs and HALEs.ResultsLE at birth for Chile was estimated in 80.4 years, which is consistent with demographic national data. QALE and HALE at birth were 69.8 and 62.4 respectively. Men are expected to live 6.1% less than women. However, this trend is reversed when looking at QALEs and HALEs, indicating the concentration of higher morbidity in women compared to men. The distribution of all these metrics across SES showed a clear gradient in favour of a better-off population-based on education quintiles. The absolute and relative gaps between the lowest and highest quintile were 15.24 years and 1.21 for LE; 18.57 HALYs and 1.38 for HALEs; and 21.92 QALYs and 1.41 for QALEs. More pronounced gradients and higher gaps were observed at younger age intervals.ConclusionThe distribution of LE, QALE and HALEs in Chile shows a clear gradient favouring better-off populations that decreases over people´s lives. Differences in LE favouring women contrast with differences in HALEs and QALEs which favour men, suggesting the need of implementing gender-focused policies to address the case-mix complexity. The magnitude of inequalities is greater than in other high-income countries and can be explained by structural social inequalities and inequalities in access to healthcare.

Distributional impact of infectious disease interventions in the Ethiopian Essential Health Service Package: a modelling study

ObjectivesReducing inequalities in health and financial risk are key goals on the path toward universal health coverage, particularly in low-income and middle-income countries. The design of the health benefit package...

The Trend of Healthcare Needs among Elders and Its Association with Healthcare Access and Quality in Low-Income Countries: An Exploration of the Global Burden of Disease Study 2019.

To investigate the trend of healthcare needs among elders in low-income countries (LICs) and how changes in healthcare access and quality (HAQ) have correlated with these changes from 1990 to 2019, this study used estimates from the global burden of disease (GBD) 2019 study, including prevalence, years of life lost (YLLs), years lived with disability (YLDs), life expectancy (LE), health-adjusted life expectancy (HALE) and the HAQ index for years 1990 and 2019. We found increases in numbers of YLLs, YLDs, and prevalent cases due to NCDs, and the rate of increase was higher for all indicators of non-communicable diseases (NCDs) when compared with communicable, maternal, neonatal and nutritional diseases among elders. We also observed increases in LE and HALE among all countries. However, this was also challenged by increases in unhealthy life years (ULYs) and their constant percentage of LE. The HAQ index of LICs was also found to be low, although it had increased during the period. A reduction in the burden of acute diseases explains the increase in LE, but increases in ULYs and the NCD burden were also observed. LICs need to improve their HAQ to counter the growing threat of longer but less healthy lives.

Estimation of the population, death, and quality of life in Shaanxi Province, western China: a cross-sectional study.

Measuring the health of the population is of great significance to the development of a region. We aimed to estimate the population, probability of death, and quality of life in western China. We calculated the age-specific mortality rate and prevalence rate of diseases and injuries using the Full Population Database and the Home Page of Inpatient Medical Record. We used multiple interpolation methods to insert missing information from the death data and the model of Kannisto to adjust the mortality rate for elderly individuals. The age-specific prevalence rate of diseases and injuries was adjusted according to the standard ratio of age and methods of equal proportional allocation. Life expectancy was calculated by a life table, and the quality of life was estimated using the Sullivan method. The total population continued to increase in 2015 to 2019 in the Shaanxi Province, China. The mortality rate of children under five has improved, and the mortality rate of people over 65 is decreasing year by year. Life expectancy increased from 74.66 years in 2015 to 77.19 years in 2019. Even with the total risk of disease and injury, the health-adjusted life expectancy increased by 1.90 years within 5 years, and the number of unhealthy years significantly improved. Health-adjusted life expectancy increased by 1.75 years when only considered the ten major disease systems (tumors; endocrinology, nutrition and metabolism; mental and behavioral disorders; nervous system; sensory diseases; circulatory system; respiratory system; digestive system; genitourinary system; musculoskeletal system and connective tissue), and the number of unhealthy years increased slightly. In the past five years, Shaanxi Province has made progress in improving life expectancy and controlling the development of chronic diseases. It is necessary to take specific preventive measures and improve the quality of basic public health services.

Socioeconomic Determinants of Life Expectancy: Southeastern European Countries

This paper analyses the socioeconomic determinants of life expectancy in Southeastern Europe countries highlighting the most important factors that can affect life expectancy in this part of Europe. 
 Two Panel Data Regression with fixed–effects model was applied for 20 years from 2000 to 2019. Eight socioeconomic and environmental explanatory variables were used to verify their influence on life expectancy.
 The analysis highlights the important influence of factors such as urbanization; GDP per capita; fertility rate; education; marital status; CO2 emission and the non-significant influence of other factors, such as health expenditure or health care out-of-pocket healthcare expenditure. This study points out that healthcare spending (public and/or household out-of-pocket spending) is not a significant factor in improving life expectancy in SEE countries. Results illustrate that GDP per capita; urbanization, CO2 emissions, and fertility rate are the most influential and significant explanatory factors. A surprising result concerns marital status, which in this study affects life expectancy inversely in one of the panel regressions.
 Life expectancy is a very important and expressive outcome indicator for public health. Each country is committed to spending public money to improve people's quality of life, which translates into a longer life (Life expectancy), or even better, a longer and healthier life (Health Adjusted Life Expectancy). The results of this study, considering the demographic development of the SEE countries (low fertility rate and aged people), show that policymakers need to consider public healthcare organization and reassess the effectiveness of public health expenditure. On the other hand, the balanced urbanization process with a clean ecosystem (less CO2 emissions) conducts a better life quality (consequently an improved life expectancy).
 Keywords: Panel data analysis; Life Expectancy; Public Health; SEE Countries
 Jel Classification: C33; H51; I15

Potential Gains in Health-Adjusted Life Expectancy by Reducing Burden of Noncommunicable Diseases in 188 Countries: A Population-Based Study

ObjectivesThis article quantifies the potential gains in health-adjusted life expectancy for people aged 30 to 70 years (HALE[30-70]) by examining the reductions in disability in addition to premature mortality from noncommunicable diseases (NCDs). MethodsWe extracted data from the Global Burden of Disease Study 2019 for 4 major NCDs (cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes mellitus) in 188 countries from 2010 to 2019. Estimates of the potential gains in HALE[30-70] were based on a counterfactual analysis involving 3 alternative future scenarios: (1) achieve Sustainable Development Goals target 3.4 but do not make any progress on disability reduction, (2) achieve Sustainable Development Goals target 3.4 and eliminate NCD-related disability, and (3) eliminate all NCD-related mortality and disability. ResultsIn all scenarios, the high-income group has the greatest potential gains in HALE[30-70], above the global average. For all specific causes, potential gains in HALE[30-70] decrease as income levels fall. Across these 3 scenarios, the potential gains in HALE[30-70] globally of reducing premature mortality for 4 major NCDs are 3.13 years, 4.53 years, and 7.32 years, respectively. In scenario A, all income groups have the greatest potential gains in HALE[30-70] from diabetes and chronic respiratory diseases. In scenarios B and C, the high-income group has the greatest potential gains in HALE[30-70] from cancer intervention, and the other income groups have the greatest potential gains in HALE[30-70] from cardiovascular diseases intervention. ConclusionReducing premature death and disability from 4 major NCDs at once and attaching equal importance to each lead to a sizable improvement in HALE[30-70].

Health-adjusted life expectancy according to lifestyle classified by the Yonsei Lifestyle Profile-BREF.

This study aimed to investigate health-adjusted life expectancy (HALE) by demographic characteristics (sex, educational achievement, and residential area) according to the lifestyle classifications of the Yonsei Lifestyle Profile-BREF (YLP-BREF). This study included 569 participants aged 55 years or older living in Korea. The YLP-BREF domains were physical activity, activity participation, and nutrition. Females had a longer HALE (mean±standard deviation, 8.90±5.06 years) in the physical activity domain, while males had a longer HALE in the nutrition domain (9.44±5.91 years). People living in rural areas had longer HALE in physical activity (12.02±5.60 years), activity participation (8.58±4.21 years), and nutrition (11.33±6.43 years). There were no significant differences according to sex or residential area. High school graduates showed the longest HALE (physical activity: 10.38± 6.89; activity participation: 7.64±4.29; nutrition: 9.59±6.40 years). There was a significant difference in educational achievement. As people age, the demand for a healthy lifestyle increases. This study attempted to calculate HALE by demographic characteristics according to lifestyle. The results of this study will help inform future research directions for providing a healthy lifestyle.

The gaps in health-adjusted life Expectancy (HALE) by income and region in Korea

Abstract This study aims to calculate the health-adjusted life expectancy (HALE) by using years lived with disability (YLD) from the national claims data, as well as to identify the differences and inequalities in sex, income level and region. The study was carried out on total population receiving national health insurance and medical benefits. We calculated incidence-based YLD for 260 disease groups, and used it as the number of healthy years lost to calculate HALE. We adopted the insurance premium to calculate the income as a proxy indicator. For the region classification, we chose 250 Korean municipal-level administrative districts. The primary outcome was HALE in the Korean population. The second outcome was the HALE’s gap in terms of sex, income, and region. Our results revealed that HALE increased from 2008 (68.89 years) to 2019 (70.58 years). HALE in males increased faster than that in females. HALE was higher in higher income levels. In 2019, the gap in HALE between Q1 and Q2, the lower income group, was about 5.70 years. The gap in females by income level was smaller than that in males. Moreover, the gap in HALE by region was found to increase. Results suggest that there is an inequality in YLD in terms of income level in Korea. Therefore, we need intensive management for the low-income group to increase HALE at the national level. Key messages • Males’ health level may be more sensitive to the socioeconomic level than females’ health level. • In the 5th National Health Plan (HP2030), it was decided to set a target value for the overall goals based on this result.