Skip to main content

Widening social disparities in alcohol-attributable deaths among Korean men aged 40–59 years during the transitional period of the economic crisis (1995–2005)



This study examined socioeconomic disparities in alcohol-related mortality among Korean men aged 40–59 years during the period before and after the economic crisis in the late 1990s.


We used Korean Census data (1995, 2005) and data from the National Death Files (1994–1996, 2004–2006) on education and employment status as indicators of socioeconomic position. Based on the age-standardized rates of alcohol-attributable deaths, relative discrepancies across socioeconomic positions were estimated.


Socially disadvantaged men were substantially disadvantaged in terms of alcohol-attributable mortality in both years. The disadvantage of men with the lowest level of education relative to the highest was worse in 2005 than in 1995. The relative disadvantage in alcohol-attributable deaths seemed to narrow over time based on the rate ratios. However, the relative index of inequality was higher in 2005 compared to 1995 for both education and occupation.


The results showed that alcohol-attributable mortality in Korea became socioeconomically polarized during the economic crisis. The serious impact of economic polarization following the economic crisis might have been transmitted to alcohol-attributable mortality.

This is a preview of subscription content, access via your institution.


  • Bessudnov A, McKee M, Stuckler D (2012) Inequalities in male mortality by occupational class, perceived status and education in Russia, 1994–2006. Eur J Public Health 22(3):332–337

    Article  PubMed  Google Scholar 

  • Billingsley S (2009) Downward mobility, unemployment, and mortality. MPIDR Working Papers 2009-015, Max Planck Institute for Demographic Research, Germany

  • Catalano R, Dooley D, Wilson G, Hough R (1993a) Job loss and alcohol abuse: a test using data from the Epidemiologic Catchment Area project. J Health Soc Behav 34(3):215–225

    Article  PubMed  CAS  Google Scholar 

  • Catalano R, Dooley D, Novaco RW, Wilson G (1993b) Using ECA survey data to examine the effect of job layoffs on violent behavior. Hosp Community Psychiatry 44(9):874–879

    PubMed  CAS  Google Scholar 

  • Cheng NR, Han PZ, Gansky SA (2008) Methods and software for estimating health disparities: the case of children’s oral health. Am J Epidemiol 168(8):906–914

    Article  PubMed  Google Scholar 

  • Easterly W (2005) What did structural adjustment adjust? The association of policies and growth with repeated IMF and World Bank adjustment loans. J Dev Econ 76(1):1–22

    Google Scholar 

  • Emslie C, Mitchell R (2009) Are there gender differences in the geography of alcohol-related mortality in Scotland? An ecological study. BMC Public Health 9(1):58–66

    Article  PubMed  Google Scholar 

  • Han TS (2000) Moderate drinking in terms of socio-cultural aspect. J Korean Public Health Assoc 26(4):383–392

    Google Scholar 

  • Hemstrom O (2002) Alcohol related deaths contribute to socioeconomic differentials in mortality in Sweden. Eur J Public Health 12(4):254–262

    Article  PubMed  Google Scholar 

  • Herttua K, Makela P, Martikainen P (2007) Differential trends in alcohol-related mortality: a register-based follow-up study in Finland in 1987–2003. Alcohol 42(5):456–464

    Google Scholar 

  • Herttua K, Makela P, Martikainen P (2008) Changes in alcohol-related mortality and its socioeconomic differences after a large reduction in alcohol prices: a natural experiment based on register data. Am J Epidemiol 168(10):1110–1118

    Article  PubMed  Google Scholar 

  • Khang YH, Yun SC, Hwang IA, Lee MS, Lee SI, Jo MW, Lee MJ (2005a) Changes in mortality inequality in relation to the South Korean economic crisis: use of area-based socioeconomic position. J Prev Med Pub Health 38(3):359–365

    Google Scholar 

  • Khang YH, Lynch JW, Kaplan GA (2005b) Impact of economic crisis on cause-specific mortality in South Korea. Int J Epidemiol 34(6):1291–1301

    Article  PubMed  Google Scholar 

  • Kim HR (2002) Prevalence of alcohol consumption by socio-demographic factors in the Seoul metropolitan area. J Korean Alcohol Sci 3(1):87–101

    Google Scholar 

  • Kim YM, Kim MH (2007) Health inequalities in Korea: current conditions and implications. J Prev Med Pub Health 40(6):431–438

    Article  Google Scholar 

  • KCDC and KIHASA (Korea Centers for Disease Control and Prevention and Korea Institute for Health and Social Affairs (2007) In-depth analyses of the Third National Health and Nutrition Examination Survey: The Health Interview and Health Behavior Survey Part, pp 269–282

  • Korean Statistical Information Service (2011) Household survey data.

  • Kovács K (2008) Suicide and alcohol-related mortality in Hungary in the last two decades. Int J Public Health 53(5):252–259

    Article  PubMed  Google Scholar 

  • Leinsalu M, Vagero D, Kunst AE (2003) Estonia 1989–2000: enormous increase in mortality differences by education. Int J Epidemiol 32(6):1081–1087

    Article  PubMed  Google Scholar 

  • Leinsalu M, Stirbu I, Vågerö D, Kalėdienė R, Kovács K, Wojtyniak B, Wróblewska W, Mackenbach JP, Kunst AE (2009) Educational inequalities in mortality in four Eastern European countries: divergence in trends during the post-communist transition from 1990 to 2000. Int J Epidemiol 38(2):512–525

    Article  PubMed  Google Scholar 

  • Makela P (1999a) Alcohol-related mortality as a function of socio-economic status. Addiction 94(6):867–886

    Article  PubMed  CAS  Google Scholar 

  • Makela P (1999b) Alcohol-related mortality during an economic boom and recession. Contemp Drug Probs 26:369–390

    Google Scholar 

  • Makela P, Valkonen T, Martelin T (1997) Contribution of deaths related to alcohol use to socioeconomic variation in mortality: register based follow up study. BMJ 315(7102):211–225

    Article  PubMed  CAS  Google Scholar 

  • Morris JA, Gardner MJ (1988) Calculating confidence intervals for relative risks (odds ratios) and standardised ratios and rates. BMJ 296:1313–1316

    Article  PubMed  CAS  Google Scholar 

  • Najman JM, Williams GM, Room R (2007) Increasing socioeconomic inequalities in male cirrhosis of the liver mortality: Australia 1981–2002. Drug Alcohol Rev 26(3):273–278

    Article  PubMed  Google Scholar 

  • National Center for Health Statistics (2009) National vital statistics reports 57(14)

  • Pamuk ER (1985) Social class inequality in mortality from 1921 to 1972 in England and Wales. Popul Stud 39:17–31

    Article  CAS  Google Scholar 

  • Pärna K, Rahu K (2010) Dramatic increase in alcoholic liver cirrhosis mortality in Estonia in 1992–2008. Alcohol 45(6):548–551

    Google Scholar 

  • Pridemore WA, Tomkins S, Eckhardt K, Kiryanov N, Saburova L (2010) A case–control analysis of socio-economic and marital status differentials in alcohol- and non-alcohol-related mortality among working-age Russian males. Eur J Public Health 20(5):569–575

    Article  PubMed  Google Scholar 

  • Rahu K, Parna K, Palo E, Rahu M (2009) Contrasts in alcohol-related mortality in Estonia: education and ethnicity. Alcohol 44(5):517–522

    Google Scholar 

  • Riva M, Bambra C, Easton S, Curtis S (2011) Hard times or good time? Inequalities in the health effects of economic change. Int J Public Health 56:3–5

    Article  PubMed  Google Scholar 

  • Shin KY, Lee SK (2000) Class and unemployment in the ‘IMF’ economic crisis. J Korean Labor Econ Assoc 23(S):155–172

    Google Scholar 

  • Shkolnikov VM, Leon DA, Adamets S, Andreev E, Deev A (1998) Educational level and adult mortality in Russia: an analysis of routine data 1979 to 1994. Soc Sci Med 47(3):357–369

    Article  PubMed  CAS  Google Scholar 

  • Shkolnikov VM, Jasilionis D, Andreev EM, Jdanov DA, Stankuniene V, Ambrozaitiene D (2007) Linked versus unlinked estimates of mortality and length of life by education and marital status: evidence from the first record linkage study in Lithuania. Soc Sci Med 64(7):1392–1406

    Article  PubMed  Google Scholar 

  • Sorlie PD, Johnson NJ (1996) Validity of education information on the death certificate. Epidemiology 7:437–439

    Article  PubMed  CAS  Google Scholar 

  • Statistics Korea (2006) Annual report on the cause of death statistics. Statistics Korea, Korea

  • Sterling TD, Weinkam JJ (1986) Extent, persistence, and constancy of the healthy worker or healthy person effect by all and selected causes of death. J Occup Environ Med 28(5):348–353

    CAS  Google Scholar 

  • The Korean Public Health Association (2011) Alcohol statistics system.

  • Valkonen T, Martikainen P, Jalovaara M, Koskinen S, Martelin T, Makela P (2000) Changes in socioeconomic inequalities in mortality during an economic boom and recession among middle-aged men and women in Finland. Eur J Public Health 10(4):274–280

    Article  Google Scholar 

Download references


This work was supported by the National Research Foundation of Korea Grant funded by the Korean Government (NRF-2010-330-B00141).

Author information

Authors and Affiliations


Corresponding author

Correspondence to Youngtae Cho.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Shim, E., Cho, Y. Widening social disparities in alcohol-attributable deaths among Korean men aged 40–59 years during the transitional period of the economic crisis (1995–2005). Int J Public Health 58, 521–527 (2013).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: