Associations between socioeconomic development and mortality-a small area panel data analysis in Taiwan, 2000-2015

Aim The socioeconomic status (SES) in Taiwan has been greatly improved after decades of socioeconomic development. However, health inequality still exists. This study aims to explore the trend of socioeconomic development in three counties which were more impoverished compared to others in central Taiwan during 2000-2015 and to analyze the correlation between SES and health for investigating the existence of geographical health inequalities and related mechanisms. Subjects and methods This study examined four independent variables of economic development indicators and three independent variables of social development indicators, as well as the main outcome of standardized mortality rate (SMR) using data from official government publications. Descriptive and panel data analyses were applied and a geographic information system used for visualized presentation of the regional mortality changes. Results The results showed that the all-cause SMRs were statistically significantly different within the three counties (p = 0.002). In 2015, the SMR of Yunlin, Nantou, and Changhua were 5.07 parts per thousand, 5.01 parts per thousand, and 4.46 parts per thousand, respectively. We found that the difference in SMRs among townships was not only significant but also increased year by year. Findings from the panel data analysis also suggested that the higher the degree of socioeconomic development, the lower the SMR regardless of the county or township level, and that education was the most important factor. Conclusion We can say that there is still health inequality in central Taiwan and we advocate the importance of universal education, especially for the disadvantaged, to achieve the goal of health for all.