Mortality transition in Korea: 1960-1980

Abstract

Historical mortality declines in developed areas of the world resulted primarily from economic growth leading to improvements in living standards, while the importation of modern medical technologies has been largely responsible for the more recent mortality reductions in the developing countries. Since the Korean mortality transition began around 1900, it was, at first, comparable with the experience in the developing countries, mainly resulting from a limited control of some infectious diseases and reduction in incidence of major food shortages, and later, since about 1960, it has continued, in the wake of socioeconomic development. As a result, mortality has reached a moderately low level: 61.3 years of expectation of life at birth for males and 67.5 years for females in 1976-80. The main objectives of the present study were to ascertain clearly the present situation of Korean mortality and to investigate the changing determinants of Korean mortality transition. Additionally, on the basis of the Korean mortality transition, we have shown a general pattern of changing determinants in mortality decline with the progress of socioeconomic development. This study adopted death registration data in the period 1970-81 for adult mortality and in 1980-81 for cause-of-death analysis; and the 1974 Korean National Fertility Survey data in the period 1955-73 for the study of infant and childhood (ages 1-4 years) mortality. While the age-specific death rates declined remarkably at all ages between 1971-75 and 1976-80, the mortality trend of the late childhood and young adult ages (5-34 years of age) stood out because of the relatively large decline; the declines in female mortality were in all age groups faster than those for males; as a consequence, the difference in expectation of life at birth between males and females, favouring females, widened from 5.0 years in 1971-75 to 6.8 in 1976-80. The age-sex mortality pattern in Korea conformed to the 'Far Eastern pattern', characterized by higher male death rates among the older than expected on the basis of mortality levels at the younger ages in model life tables, and very high sex ratios of death rates at the older ages. The differentials in adult mortality by socioeconomic variables were clear and in the expected direction: mortality levels among urban residents, higher educated groups, and non-agricultural workers were lower than among the other sub-groups. The net effects of each of the four socioeconomic variables, which were place of residence, educational level, marital status and occupation, on adult mortality were statistically significant. Among them, educational level was the most important factor for the determination of the adult mortality level; the differences in mortality by occupation were brought out mainly by the difference in educational level among occupational categories. In both urban and rural areas, in Korea, mother's education is the most important determinant of infant mortality; on the other hand, maternal age and number of rooms used are the main determinants of child mortality. Previous birth interval and previous birth's survival also significantly affect infant mortality; previous birth interval affects child mortality, in both urban and rural areas. In general, demographic factors are relatively more important for infant mortality in rural areas and for child mortality in urban areas; in contrast, socioeconomic factors are dominant determinants of infant mortality in urban areas and of child mortality in rural areas. The mortality transition accompanied by socioeconomic development in Korea changed the pattern of mortality differentials between urban and rural areas: the mortality differences between the two areas widened until the late 1970s and then narrowed gradually. Also, the increasing proportion of the population with higher education, especially in the younger age groups, has pressed down the mortality level in the 9-year period between 1970-72 and 1979-81. On the basis of the analysis of Korean data, the changing patterns of demographic and socioeconomic determinants of infant and child mortality are generalized. The pattern for infant mortality is: (I) in a traditional society demographic factors affect infant mortality more than socioeconomic factors; (II) at the early stage of development, demographic factors are replaced by socioeconomic factors as the main determinants of infant mortality; (III) when the difference in living standards between social classes narrows, the socioeconomic differentials in mortality also diminish; and (IV) at the stage of high development the effects of demographic factors (endogenous causes) are left although the absolute differences are very small. The pattern of changing determinants of child mortality is nearly the reverse of that of infant mortality.