COVID-19 팬데믹 전후 지역 간 건강수명 불평등의 시계열적 구조 분해*
Temporal Decomposition of Regional Inequalities in Health Adjusted Life Expectancy Before and After the COVID-19 Pandemic in South Korea
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= Abstract = Objectives: This study investigates the structural characteristics and temporal dynamics of regional inequality in healthy life expectancy (HALE) across Korea’s 250 administrative districts from 2018 to 2021. Methods: Using officially published data on life expectancy and HALE, we computed inequality metrics including the Gini coefficient, coefficient of variation (CV), and Theil index. The Theil index, reported to five decimal places due to its scale, was decomposed to estimate the percentage contributions of inequality between and within provinces. Results: Life expectancy showed stable inequality levels, with a Gini coefficient of 0.004 throughout the study period. HALE declined in average value during the COVID-19 pandemic, yet its Gini coefficient decreased from 0.014 to 0.010, suggesting relatively even national-level impacts. However, CV and Theil index analyses revealed substantial regional disparities. Seoul maintained the highest HALE and lowest internal inequality, whereas Daejeon and Busan experienced widening intra-regional gaps despite gains in average HALE. In contrast, Ulsan and Gwangju achieved improvements in both HALE and equity. Several rural provinces showed narrowing HALE gaps, possibly due to temporary reductions in healthcare access disparities. Theil decomposition indicated that intra-provincial inequality, particularly within metropolitan areas, accounted for the largest share of total disparity and increased over time. Conclusions: National averages may obscure substantial subregional disparities in health. Equity-oriented interventions tailored to local conditions are essential to address uneven spatial health outcomes and promote balanced health improvements nationwide.
Abstract
= Abstract = Objectives: This study investigates the structural characteristics and temporal dynamics of regional inequality in healthy life expectancy (HALE) across Korea’s 250 administrative districts from 2018 to 2021. Methods: Using officially published data on life expectancy and HALE, we computed inequality metrics including the Gini coefficient, coefficient of variation (CV), and Theil index. The Theil index, reported to five decimal places due to its scale, was decomposed to estimate the percentage contributions of inequality between and within provinces. Results: Life expectancy showed stable inequality levels, with a Gini coefficient of 0.004 throughout the study period. HALE declined in average value during the COVID-19 pandemic, yet its Gini coefficient decreased from 0.014 to 0.010, suggesting relatively even national-level impacts. However, CV and Theil index analyses revealed substantial regional disparities. Seoul maintained the highest HALE and lowest internal inequality, whereas Daejeon and Busan experienced widening intra-regional gaps despite gains in average HALE. In contrast, Ulsan and Gwangju achieved improvements in both HALE and equity. Several rural provinces showed narrowing HALE gaps, possibly due to temporary reductions in healthcare access disparities. Theil decomposition indicated that intra-provincial inequality, particularly within metropolitan areas, accounted for the largest share of total disparity and increased over time. Conclusions: National averages may obscure substantial subregional disparities in health. Equity-oriented interventions tailored to local conditions are essential to address uneven spatial health outcomes and promote balanced health improvements nationwide.