Cancer-free Life Expectancy in Small Administrative Areas in Korea and Its Associations with Regional Health Insurance Premiums.

Background: To determine the priorities and resource allocation of community cancer-related health policies, it is necessary to measure cancer-related health indicators and the burden of cancer by region. This study calculated the cancer-free life expectancy at the level (small administrative units in South Korea) for the first time, and analyzed its association with regional health insurance premiums.

Methods: We used aggregate data from the 2008-2017 National Health Information Database provided by the National Health Insurance Service. Cancer-free life expectancy was calculated by applying Sullivan's method to mortality and cancer prevalence by age group and sex for the 10-year period in 3,396 . Correlation analyses were performed to analyze the relationship between cancer-free life expectancy and regional health insurance premiums.

Results: Cancer-free life expectancy in of metropolitan areas tended to be higher than in non-metropolitan areas. However, some of non-metropolitan areas showed quite a high cancer-free life expectancy, especially for females. The median values of differences between cancer-free life expectancy and life expectancy at the level (total: 1.6 years, male: 1.8 years, female: 1.4 years) indicated that a person's healthy life can be shortened by a number of years due to cancer. The association of cancer-free life expectancy by with the regional health insurance premium was statistically significant (β = 1.0, < 0.001) and more prominent for males (β = 1.3, < 0.001) than for females (β = 0.5, < 0.001). The relationship between the regional health insurance premium and the burden of cancer (life expectancy minus cancer-free life expectancy) was also statistically significant (β = 0.2 for the total population, β = 0.2 for males, and β = 0.1 for females, all values < 0.001).

Conclusion: This study showed a significant regional gap with regard to cancer-free life expectancy and the burden of cancer at the level. This work makes a meaningful contribution by presenting new and firsthand summary measures of cancer-related health across small areas in Korea. The results will also help the authorities to evaluate the effectiveness of local cancer management projects in small administrative areas and determine regional priorities for implementing cancer control policies.