Inequality in mortality according to regional deprivation during the COVID-19 pandemic

OBJECTIVES: Vulnerability to coronavirus disease 2019 (COVID-19) is significantly greater in regions with lower socioeconomic status (SES). However, detailed analyses of regional socioeconomic disparities have rarely been conducted in Korea. This study aimed to identify and compare mortality inequalities associated with regional SES across different areas of Korea during the COVID-19 pandemic. METHODS: Using cause-of-death statistics from 2020 to 2022, we calculated age-standardized mortality rates (ASMRs) for total mortality, COVID-19 mortality, and pneumonia mortality. The SES of each region was assessed using the regional deprivation index. Additionally, we calculated the rate difference, rate ratio, slope index of inequality (SII), and relative index of inequality (RII) for each socioeconomic level to examine the extent of mortality inequality and its temporal changes. These analyses were stratified by gender and urban-rural classification. RESULTS: The total mortality rate, as well as COVID-19-specific and pneumonia-specific mortality rates, increased during the COVID-19 pandemic. The ASMR for COVID-19 was higher in rural areas (ASMR, 27.79), which have lower healthcare accessibility, compared to urban areas (ASMR, 26.63). However, mortality inequality indicators for COVID-19 were more pronounced in urban areas compared to rural areas (SII: urban, 2.72; rural, -0.05, RII: urban, 0.10; rural, 0.00). Notably, significant inequalities were observed among men residing in urban areas. CONCLUSIONS: In disaster situations such as the COVID-19 pandemic, it is essential to implement strategies aimed at reducing overall mortality rates and addressing regional socioeconomic inequalities.