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Original Articles
Socioeconomic and Regional Disparities in Under-five Mortality in Indonesia: Insights From Indonesia’s 2020 Census
Asep Hermawan
J Prev Med Public Health. 2026;59(3):258-266.   Published online March 20, 2026
DOI: https://doi.org/10.3961/jpmph.25.763
  • 2,101 View
  • 129 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
This study examined district-level and municipality-level socioeconomic determinants of the under-five mortality rate (U5MR) to inform equitable policies aimed at achieving Sustainable Development Goal (SDG) 3.2.
Methods
An ecological cross-sectional study was conducted using data from 514 districts and municipalities in Indonesia. U5MR estimates were obtained from Statistics Indonesia and calculated using the indirect Trussell method based on the 2020 Population Census Long Form. Poverty rate, mean years of schooling, gross regional domestic product per capita, and total fertility rate (TFR) were analyzed using bivariate and multivariable ordinary least squares regression with robust standard errors. To account for spatial dependence, a spatial autoregressive (SAR) model was additionally applied. Spatial mapping was used to illustrate geographic variation.
Results
U5MR ranged from 10.7 to 75.8 deaths per 1000 live births across districts and municipalities. Higher TFR (β=13.21, p<0.001) and higher poverty rates (β=0.61, p<0.001) were associated with higher U5MR, whereas higher educational attainment was associated with lower U5MR (β=−0.79, p=0.001). The association between poverty and mortality was stronger in rural districts than in municipalities (interaction β=−0.30, p=0.06). The SAR model identified significant spatial dependence and demonstrated improved model fit. Spatial clustering revealed an east-west divide, with the highest mortality observed in Papua and East Nusa Tenggara.
Conclusions
Fertility, poverty, and educational attainment are key predictors of child survival in Indonesia, with districts in eastern regions bearing disproportionate burdens. Policy efforts should prioritize family planning, maternal education, and targeted support for socioeconomically disadvantaged districts to accelerate progress toward achieving SDG 3.2 by 2030.
Summary
Key Message
Socioeconomic inequalities remain important determinants of under-five mortality in Indonesia at the district and municipality levels. Higher poverty and fertility rates were associated with increased mortality, whereas higher educational attainment was associated with lower mortality. Equity-oriented and geographically targeted interventions, particularly in disadvantaged eastern districts, are essential to accelerate progress toward Sustainable Development Goal 3.2.
Healthcare Utilization and Discrepancies by Income Level Among Patients With Newly Diagnosed Type 2 Diabetes in Korea: An Analysis of National Health Insurance Sample Cohort Data
Eun Jee Park, Nam Ju Ji, Chang Hoon You, Weon Young Lee
J Prev Med Public Health. 2024;57(5):471-479.   Published online August 20, 2024
DOI: https://doi.org/10.3961/jpmph.24.165
  • 8,762 View
  • 261 Download
  • 5 Web of Science
  • 6 Crossref
AbstractAbstract AbstractSummary PDF
Objectives
The use of qualitative healthcare services or its discrepancy between different income levels of the type 2 diabetes (T2D) patients has seldom been studied concurrently. The present study is unique that regarding T2D patients of early stages of diagnosis. Aimed to assess the utilization of qualitative healthcare services and influence of income levels on the inequality of care among newly diagnosed patients with T2D.
Methods
A retrospective cohort study of 7590 patients was conducted by the National Health Insurance Service National Sample Cohort 2.0 from 2002 to 2015. Insured employee in 2013 with no history of T2D between 2002 and 2012 were included. The standard of diabetes care includes hemoglobin A1c (HbAlc; 4 times/y), eyes (once/y) and lipid abnormalities (once/y). Multivariate logistic regression analysis was performed to examine the difference between income levels and inequality of care.
Results
From years 1 to 3, rates of appropriate screening fell from 16.9% to 14.1% (HbA1c), 15.8% to 14.5% (eye), and 59.2% to 33.2% (lipid abnormalities). Relative to income class 5 (the highest-income group), HbA1 screening was significantly less common in class 2 (year 2: odds ratio [OR], 0.78; 95% confidence interval [CI], 0.61 to 0.99; year 3: OR, 0.79; 95% CI, 0.69 to 0.91). In year 1, lipid screening was less common in class 1 (OR, 0.84; 95% CI, 0.73 to 0.98) than in class 5, a trend that continued in year 2. Eye screening rates were consistently lower in class 1 than in class 5 (year 1: OR, 0.73; 95% CI, 0.60 to 0.89; year 2: OR, 0.63; 95% CI, 0.50 to 0.78; year 3: OR, 0.81; 95% CI, 0.67 to 0.99).
Conclusions
Newly diagnosed T2D patients have shown low rate of HbA1c and screening for diabetic-related complications and experienced inequality in relation to receiving qualitative diabetes care by income levels.
Summary
Korean summary
의료서비스 이용의 강도와 질을 측정하는 당뇨 관련 합병증 검진율은 저소득층에서 특히 낮았습니다. 보편적 건강 보장이 있는 국가에서도 신환환자 특히 낮은 경제적 계층의 치료 불균형을 해소 하기 위해서는 재정적 부담은 절감하고, 건강 문해력 증진시키고, 일차의료 기관의 기능을 최적화 하여 책임을 강화하는 것이 필요합니다.
Key Message
Diabetic-related complications screening rates that measure the intensity and quality of medical care service usage were statistically lower in low-income groups. Reducing financial burden, promoting health literacy and optimizing the function of primary care physician and reinforcing the health care provider’s accountability are necessary to address the discrepancy of care for those with low socioeconomic status people in early stage of disease, even in nations with universal health coverage.

Citations

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    Journal of the Korean Society for Research on Nicotine and Tobacco.2026; 17(2): 54.     CrossRef
  • Income level and the risk of incident dementia among adults aged ≥50 with newly diagnosed type 2 diabetes: a population-based cohort study using the NHIS-Senior database in South Korea
    Su-Min Park, Ah Jung Ko, Jae Hyeok Lim, Eun-Cheol Park
    BMJ Open.2026; 16(7): e112641.     CrossRef
  • Utilization of glycated hemoglobin testing in the Korean health check-up population from local clinics and hospitals and its impact on diabetes and prediabetes classification
    Rihwa Choi, Mi-Jung Park, Sang Gon Lee
    BMC Endocrine Disorders.2026;[Epub]     CrossRef
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    Sangjun Lee, Soyeoun Kim
    Cancer Epidemiology, Biomarkers & Prevention.2026; 35(8): 1329.     CrossRef
  • Older Adults with Diabetes in Korea: Latest Clinical and Epidemiologic Trends
    Kyuho Kim, Bongseong Kim, Kyuna Lee, Yu-Bae Ahn, Seung-Hyun Ko, Sung Hee Choi, Kyungdo Han, Jae-Seung Yun
    Diabetes & Metabolism Journal.2025; 49(2): 183.     CrossRef
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    Hyun-Jin Kim, Byung Sik Kim, Hasung Kim, Jungkuk Lee, Ha Hye Jo, Dong Wook Kim, Jeong-Hun Shin, Ki-Chul Sung
    The Korean Journal of Internal Medicine.2025; 40(6): 975.     CrossRef
Identifying, Measuring, and Ranking Social Determinants of Health for Health Promotion Interventions Targeting Informal Settlement Residents
Farhad Nosrati Nejad, Mohammad Reza Ghamari, Seyed Hossein Mohaqeqi Kamal, Seyed Saeed Tabatabaee
J Prev Med Public Health. 2023;56(4):327-337.   Published online June 26, 2023
DOI: https://doi.org/10.3961/jpmph.23.059
  • 7,262 View
  • 208 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDF
Objectives
Considering the importance of social determinants of health (SDHs) in promoting the health of residents of informal settlements and their diversity, abundance, and breadth, this study aimed to identify, measure, and rank SDHs for health promotion interventions targeting informal settlement residents in a metropolitan area in Iran.
Methods
Using a hybrid method, this study was conducted in 3 phases from 2019 to 2020. SDHs were identified by reviewing studies and using the Delphi method. To examine the SDHs among informal settlement residents, a cross-sectional analysis was conducted using researcher-made questionnaires. Multilayer perceptron analysis using an artificial neural network was used to rank the SDHs by priority.
Results
Of the 96 determinants identified in the first phase of the study, 43 were examined, and 15 were identified as high-priority SDHs for use in health-promotion interventions for informal settlement residents in the study area. They included individual health literacy, nutrition, occupational factors, housing-related factors, and access to public resources.
Conclusions
Since identifying and addressing SDHs could improve health justice and mitigate the poor health status of settlement residents, ranking these determinants by priority using artificial intelligence will enable policymakers to improve the health of settlement residents through interventions targeting the most important SDHs.
Summary

Citations

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  • The data scientist as a mainstay of the tumor board: global implications and opportunities for the global south
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    Frontiers in Digital Health.2025;[Epub]     CrossRef
Scoping Review
The Most Important Social Determinants of Slum Dwellers’ Health: A Scoping Review
Farhad Nosrati Nejad, Mohammad Reza Ghamari, Seyed Hossein Mohaqeqi Kamal, Seyed Saeed Tabatabaee, Raheleh Ganjali
J Prev Med Public Health. 2021;54(4):265-274.   Published online July 8, 2021
DOI: https://doi.org/10.3961/jpmph.21.073
  • 12,992 View
  • 297 Download
  • 16 Web of Science
  • 17 Crossref
AbstractAbstract PDF
Objectives
Given the importance of social determinants of health in promoting the health of slum residents, this study was conducted with the aim of identifying the main dimensions and components of these determinants.
Methods
This scoping review study was conducted according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). A comprehensive search was performed of PubMed, ProQuest, Scopus, and Web of Science for articles conducted from 2010 to the end of 2019. Studies were selected based on inclusion criteria, with a special focus on studies dealing with the social determinants of physical and mental health or illness.
Results
Thirty-three articles were selected to extract information on the social determinants of health. After reviewing the articles, 7 main dimensions (housing, socioeconomic status of the family, nutrition, neighborhood characteristics, social support and social capital, occupational factors, and health behaviors) and 87 components were extracted as social determinants of health among slum dwellers.
Conclusions
This framework could be used by planners, managers, and policy-makers when making decisions affecting the health of these settlements’ residents due to the common characteristics of slums around the world, especially in developing countries.
Summary

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    JMIR mHealth and uHealth.2026; 14: e81123.     CrossRef
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    Cogent Mental Health.2025;[Epub]     CrossRef
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    Current Pediatric Reviews.2025; 21(3): 245.     CrossRef
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  • Identifying, Measuring, and Ranking Social Determinants of Health for Health Promotion Interventions Targeting Informal Settlement Residents
    Farhad Nosrati Nejad, Mohammad Reza Ghamari, Seyed Hossein Mohaqeqi Kamal, Seyed Saeed Tabatabaee
    Journal of Preventive Medicine and Public Health.2023; 56(4): 327.     CrossRef
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Evaluation Studies
The Effect of Catastrophic Health Expenditure on the Transition to Poverty and the Persistence of Poverty in South Korea.
Eun Cheol Song, Young Jeon Shin
J Prev Med Public Health. 2010;43(5):423-435.
DOI: https://doi.org/10.3961/jpmph.2010.43.5.423
  • 8,747 View
  • 142 Download
  • 19 Crossref
AbstractAbstract PDF
OBJECTIVES
The low benefit coverage rate of South Korea's health security system has been continually pointed out. A low benefit coverage rate inevitably causes catastrophic health expenditure, which can be the cause of the transition to poverty and the persistence of poverty. This study was conducted to ascertain the effect of catastrophic health expenditure on the transition to poverty and the persistence of poverty in South Korea. METHODS: To determine the degree of social mobility, this study was conducted among the 6311 households that participated in the South Korea Welfare Panel Study in both 2006 and 2008. The effect of catastrophic health expenditure on the transition to poverty and the persistence of poverty in South Korea was assessed via multiple logistic regression analysis. RESULTS: The poverty rate in South Korea was 21.6% in 2006 and 20.0% in 2008. 25.1 - 7.3% of the households are facing catastrophic health expenditure. Catastrophic health expenditure was found to affect the transition to poverty even after adjusting for the characteristics of the household and the head of the household, at the threshold of 28% or above. CONCLUSIONS: 25.1% of the households in this study were found to be currently facing catastrophic health expenditure, and it was determined that catastrophic health expenditure is a cause of transition to poverty. This result shows that South Korea's health security system is not an effective social safety net. As such, to prevent catastrophic health expenditure and transition to poverty, the benefit coverage of South Korea's health security system needs to the strengthened.
Summary

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JPMPH : Journal of Preventive Medicine and Public Health
© Korean Society for Preventive Medicine.
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