PHWR Public Health Weekly Report

In 2023, chronic diseases such as malignant neoplasms (cancer), heart disease, cerebrovascular disease, Alzheimer’s disease, diabetes, and hypertensive diseases accounted for approximately 78.1% of all deaths in the Republic of Korea (ROK) and ranked sixth among the top causes of death. The prevalence of chronic diseases has increased with the aging population, leading to escalating medical expenditures. Medical expenditures for chronic diseases (KRW 90 trillion) accounted for 84.5% of all medical expenditures [1]. According to the Statistics Korea in 2023 [2], Gyeongsangnam-do ranked first among 17 cities and provinces (si and do) nationwide in terms of mortality from cancer, cerebrovascular disease, Alzheimer’s disease, and diabetes. On the other hand, Ulsan ranked first in ROK for brain and heart disease, indicating a high mortality rate due to chronic diseases (Figure 1) [2]. Furthermore, data from the Ministry of the Interior and Safety in 2024 indicate that the elderly population aged ≥65 years in the Gyeongnam region (Busan, Ulsan, and Gyeongsangnam-do) constituted 21.7% of the total population, which is higher than the national rate of 19.7% [3]. This underscores the need for effective health management strategies, particularly in addressing chronic diseases and health risks, among the elderly population in the region. The prevention and management of chronic diseases necessitate the early recognition, control, and management of precursor diseases, in addition to the improvement of health risk factors, requiring both individual efforts and integrated linkages at the community and national levels. Therefore, it is necessary to identify the health behaviors and chronic disease management status in the region and promote effective prevention and management interventions tailored to the region. Since 2008, the Korea Disease Control and Prevention Agency has been conducting the Korea Community Health Survey (KCHS) annually to produce health statistics on the health behaviors, chronic disease morbidity, and management levels of local residents. Local governments use the results of the KCHS as evidence for local healthcare planning and evaluation. This study aims to investigate health behaviors, chronic disease morbidity, and management in the Gyeongnam region (Busan, Ulsan, and Gyeongsangnam-do) using the statistical results of the “Local Health Statistics at a Glance” published based on the 2024 KCHS data and to identify trends in the gaps between cities, counties, and districts (si, gun, and gu) in the Gyeongnam region to provide the basic data for the development of chronic disease prevention and management intervention projects.

Figure 1. Age-standardized mortality rates by major causes of death in 2023 highest lowest regions
Reused from Statistics Korea (https://kostat.go.kr/board.es?mid=a10301060200&bid=218&act=view&list_no=433106) [2].

In order to identify the health behavior, chronic disease morbidity, and management status of local residents in the Gyeongnam region, the “2024 Local Health Statistics at a Glance” report and statistics were published by the KDCA [4].

For analysis, 10 indicators related to health behaviors and 6 indicators related to morbidity were selected (Table 1). Out of the 16 indicators, 10 were finally selected as they were deemed to be the most salient for local governments to utilize in the execution of health projects. The results for each health indicator were sex- and age-standardized, and the representative value was calculated as the median of 41 cities, counties, and districts in the Gyeongnam region. The trend of the highest (%p) and lowest (%p) values for each of the 3 cities and provinces and 41 cities, counties, and districts in the Gyeongnam region over the last 10 years (2014–2024) was presented in a graph by year, as well as the year-on-year increase (city) and decrease (province) and regional gap (city, county, and district). Furthermore, the Golden Diamond method was employed to prioritize regional health projects by comparing the national indicator value (2024) with the indicator value of the Gyeongnam region for the last 3 years (2021–2023) [5], which was then presented for each region (Busan, Ulsan, and Gyeongsangnam-do).

Table 1 Status of health indicators in the Gyeongnam region (2014, 2023, 2024)

Category	Indicators	Busan			Increase/decrease (2024–2023)	Ulsan			Increase/decrease (2024–2023)	Gyeongsangnam-do			Increase/decrease (2024–2023)	Gyeongnam region			Increase/decrease (2024–2023)	Nationwidea)			Increase/decrease (2024–2023)
		2014	2023	2024		2014	2023	2024		2014	2023	2024		2014	2023	2024		2014	2023	2024
Health behavior	Current smoking rate	23.4	18.8	16.8	▼	22.5	19.7	19.2	▼	24.1	19.1	17.7	▼	23.7	19.3	17.7	▼b) (–1.6)	24.0	20.3	18.9	▼
	Current smoking rate of male	44.3	33.8	30.2	▼	42.6	35.5	35.4	▼	45.5	35.6	32.5	▼	45.2	35.6	32.3	▼ (–3.3)	45.2	36.1	34.0	▼
	Monthly drinking rate	64.1	59.6	61.4	▲	43.3	61.0	62.4	▲	64.1	57.8	60.0	▲	62.6	57.9	60.3	▲b) (2.4)	60.9	58.0	58.3	▲
	High-risk drinking rate	15.1	12.6	12.3	▼	14.6	13.6	13.8	▲	16.78	13.9	13.8	▼	14.8	13.6	13.0	▼ (–0.6)	14.6	13.2	12.6	▼
	Walking practice rate	43.7	53.2	60.3	▲	40.7	52.5	54.5	▲	31.2	43.3	48.0	▲	36.1	48.5	52.6	▲ (4.1)	37.5	47.9	49.7	▲
	Moderate-to-vigorous physical activity rate	21.7	24.4	25.8	▲	21.5	27.1	29.2	▲	23.2	25.9	31.8	▲	20.9	23.9	27.6	▲ (3.7)	21.7	25.1	26.6	▲
	Obesity rate (self-reported)	24.5	32.1	33.2	▲	23.5	33.2	34.7	▲	24.0	32.4	33.5	▲	24.3	33.1	34.0	▲ (0.9)	25.4	33.7	34.4	▲
	Annual weight control attempt rate	61.1	69.3	64.3	▼	58.0	70.1	68.3	▼	54.3	65.4	66.6	▲	56.2	67.5	64.5	▼ (–3.0)	57.0	66.9	65.0	▼
	Depression experience rate	5.8	7.7	6.3	▼	5.3	8.6	7.2	▼	4.2	7.6	5.6	▼	5.1	6.6	6.6	- (-)	6.4	7.3	6.2	▼
	Stress awareness rate	26.9	23.9	22.6	▼	25.2	25.8	22.2	▼	25.6	24.5	20.5	▼	26.7	23.9	21.7	▼ (–2.2)	28.0	25.7	23.7	▼
Disease and medical use	Hypertension diagnosis experience rate (≥30 yr)	17.8	19.0	19.5	▲	18.2	18.7	19.3	▲	16.8	18.5	18.7	▲	17.1	19.0	19.5	▲ (0.5)	19.1	20.6	21.1	▲
	Treatment rate for people diagnosed with hypertension (≥30 yr)	87.5	92.9	93.0	▲	87.0	92.8	93.7	▲	88.8	95.0	94.5	▼	87.9	93.9	93.6	▼ (–0.3)	88.1	93.6	93.5	▼
	Diabetes diagnosis experience rate (≥30 yr)	7.1	8.7	9.0	▲	8.1	7.3	8.4	▲	6.7	8.2	8.2	-	7.1	8.3	9.0	▲ (0.7)	7.7	9.1	9.4	▲
	Treatment rate for people diagnosed with diabetes (≥30 yr)	84.8	92.5	94.6	▲	79.5	91.1	93.9	▲	85.9	95.8	95.6	▼	85.4	93.9	94.7	▲ (0.8)	84.5	92.8	93.4	▲
	Awareness early symptoms of myocardial infarction	-	56.3	55.1	▼	-	47.4	45.7	▼	-	55.2	50.9	▼	-	56.5	52.6	▼ (–3.9)	-	52.9	49.7	▼
	Awareness early symptoms of stroke	-	63.7	61.5	▼	-	60.0	55.5	▼	-	63.5	58.8	▼	-	64.9	61.7	▼ (–3.2)	-	62.0	59.2	▼

^a)Median among 258 cities, counties, and district. ^b)▼=decrease; ▲=increase..

An analysis of 10 key health indicators within the Gyeongnam region (Busan, Ulsan, and Gyeongsangnam-do) revealed that the current smoking rate and the current smoking rate for male in 2024 stood at 17.7% and 32.3%, respectively. This decline represented a 1.6%p decrease and a 3.3%p decrease, respectively, compared to the previous year. The monthly alcohol consumption rate was 60.3%, walking practice rate was 52.6%, moderate physical activity practice rate was 27.6%, and obesity rate was 34.0%, which increased by 2.4%p, 4.1%p, 3.7%p, and 0.9%p, respectively, from the previous year. The hypertension diagnosis rate was 19.5%, and the diabetes diagnosis rate was 9.0%, which increased by 0.5%p and 0.7%p, respectively, from the previous year. In particular, the gap between the local governments in the Gyeongnam region was 47.6%p for the walking practice rate, which represents the largest gap among health indicators in the region (Figure 2E).

Figure 2. Trend of health indicators in the Gyeongnam region (2014–2024)
(A) Current smoking rate, (B) current smoking rate of males, (C) monthly drinking rate, (D) obesity rate (self-reported), (E) walking practice rate, (F) stress awareness rate, (G) hypertension diagnosis experience rate (≥30 years), (H) diabetes diagnosis experience rate (≥30 years), (I) awareness early symptoms of stroke, (J) awareness early symptoms of myocardial infarction. Indicators I and J have been included since 2017.

1. Smoking Rate

Table 1 presents a summary of the key health indicators by city and province (Busan, Ulsan, and Gyeongsangnam-do) in the Gyeongnam region. The current smoking rate has been decreasing since 2014, and it has decreased from 18.8% to 16.8% in Busan, from 19.7% to 19.2% in Ulsan, and from 19.1% to 17.7% in Gyeongsangnam-do from 2023 to 2024 (a gap of 2.4%p among cities and provinces in the Gyeongnam region). Compared to the national rate (18.9%), it was 2.1%p and 1.2%p lower in Busan and Gyeongsangnam-do, respectively.

The current smoking rate for male has been decreasing since 2014, and it has decreased from 33.8% to 30.2% in Busan, from 35.5% to 35.4% in Ulsan, and from 35.6% to 32.5% in Gyeongsangnam-do from 2023 to 2024 (a gap of 5.2%p among cities and provinces in the Gyeongnam region). Compared to the national rate (34.0%), it was 3.8%p and 1.5%p lower in Busan and Gyeongsangnam-do, respectively.

In 2024, the current smoking rate and current smoking rate for male in each of the 41 cities, counties, and districts in the Gyeongnam region were the highest in Goseong-gun, Gyeongsangnam-do, at 23.9% and 43.6%, respectively, and the lowest in Hamyang-gun, Gyeongsangnam-do, at 12.3% and 21.5%, respectively (a gap of 22.1%p among cities, counties, and districts in the Gyeongnam region; Figure 3A, B).

Figure 3. Highest lowest si/gun/gu in the Gyeongnam by health indicators over the past 10 years (2014–2024)
(A) Current smoking rate, (B) current smoking rate of males, (C) monthly drinking rate, (D) obesity rate (self-reported), (E) walking practice rate, (F) stress awareness rate, (G) hypertension diagnosis experience rate (≥30 years), (H) diabetes diagnosis experience rate (≥30 years), (I) awareness early symptoms of stroke, (J) awareness early symptoms of myocardial infarction. Indicators I and J have been included since 2017.

2. Alcohol Consumption Rate

The alcohol consumption rate by city and province (Busan, Ulsan, Gyeongsangnam-do) has been decreasing to some extent since 2014. It has increased from 59.6% to 61.4% in Busan, from 61.0% to 62.4% in Ulsan, and from 57.8% to 60.0% in Gyeongsangnam-do from 2023 to 2024 (a gap of 2.4%p among cities and provinces in the Gyeongnam region). Compared to the national rate (58.3%), it was 3.1%p, 4.1%p, and 1.7%p lower in Busan, Ulsan, and Gyeongsangnam-do, respectively. In 2024, the monthly alcohol consumption rate for male, in each of the 41 cities, counties, and districts in the Gyeongnam region was the highest in Nam-gu, Ulsan, at 66.9%, and the lowest in Jinju, Gyeongsangnam-do, at 44.1% (a gap of 22.8%p among cities, counties, and districts in the Gyeongnam region; Figure 3C).

3. Obesity Rate

The obesity rate by city and province (Busan, Ulsan, and Gyeongsangnam-do) has been increasing since 2014. It increased from 32.1% to 33.2% in Busan, from 33.2% to 34.7% in Ulsan, and from 32.4% to 33.5% in Gyeongsangnam-do from 2023 to 2024, resulting in a 1.5%p gap among cities and provinces in the Gyeongnam region. Compared to the national rate (34.4%), it was lower in Busan and Gyeongsangnam-do, and 0.3%p higher in Ulsan (Figure 2D). In 2024, the obesity rate (self-report) in each of the 41 cities, counties, and districts in the Gyeongnam region was the highest in Uiryeong-gun, Gyeongsangnam-do, at 40.0%, and the lowest in Changwon-si, Gyeongsangnam-do, at 29.3% (a gap of 10.7%p among cities, counties, and districts in the Gyeongnam region; Figure 3D).

4. Physical Activity

The walking practice rate by city and province (Busan, Ulsan, and Gyeongsangnam-do) has been increasing since 2014. It has increased from 53.2% to 60.3% in Busan, from 52.5% to 54.5% in Ulsan, and from 43.3% to 48.0% in Gyeongsangnam-do from 2023 to 2024 (a gap of 12.3%p among cities and provinces in the Gyeongnam region). Compared to the national rate (49.7%), it was 10.6%p and 4.8%p higher in Busan and Ulsan, respectively, and 1.7%p lower in Gyeongsangnam-do (Figure 2E). In 2024, the walking practice rate in each of the 41 cities, counties, and districts in the Gyeongnam region was the highest in Jin-gu, Busan, at 71.7%, and the lowest in Hapcheon-gun, Gyeongsangnam-do, at 24.1%, showing the highest gap among local governments in the Gyeongnam region (a gap of 47.6%p among cities, counties, and districts in the Gyeongnam region; Figure 3E).

5. Mental Health

The perceived stress rate by city and province (Busan, Ulsan, and Gyeongsangnam-do) has been decreasing to a certain extent since 2014. It has decreased from 23.9% to 22.6% in Busan, from 25.8% to 22.2% in Ulsan, and from 24.5% to 20.5% in Gyeongsangnam-do from 2023 to 2024 (a gap of 2.1%p among cities and provinces in the Gyeongnam region). Compared to the national rate (25.7%), it was 1.1%p, 1.5%p, and 3.2%p higher in Busan, Ulsan, and Gyeongsangnam-do, respectively (Figure 2F). In 2024, the perceived stress rate in each of the 41 cities, counties, and districts in the Gyeongnam region was the highest in Geochang-gun, Gyeongsangnam-do, at 26.8%, and the lowest in Geoje-si, Gyeongsangnam-do, at 13.3% (a gap of 13.5%p among cities, counties, and districts in the Gyeongnam region; Figure 3F).

6. Morbidity

The hypertension diagnosis rate by city and province (Busan, Ulsan, and Gyeongsangnam-do) has been increasing in some measure since 2014. It has increased from 19.0% to 19.5% in Busan, from 18.7% to 19.3% in Ulsan, and from 18.5% to 18.7% in Gyeongsangnam-do from 2023 to 2024 (a gap of 0.8%p among the cities and provinces in the Gyeongnam region). Compared to the national rate (21.1%), it was lower in the Gyeongnam region (by 1.6%p in Busan, 1.8%p in Ulsan, and 2.4%p in Gyeongsangnam-do; Figure 2G). In 2024, the hypertension diagnosis rate (among those aged ≥30 years) in each of the 41 cities, counties, and districts in the Gyeongnam region was the highest in Sahagu, Busan, at 23.0%, and the lowest in Masan, Gyeongnam region at 16.5% (a gap of 6.5%p among the cities, counties, and districts in the Gyeongnam region; Figure 3G).

The diabetes diagnosis rate by city and province (Busan, Ulsan, and Gyeongsangnam-do) has been increasing to some extent since 2014. It has changed from 8.7% to 9.0% in Busan, from 7.3% to 8.4% in Ulsan, and from 8.2% to 8.2% in Gyeongsangnam-do from 2023 to 2024, increasing except in Gyeongsangnam-do (a gap of 0.8%p among cities and provinces in the Gyeongnam region). Compared to the national rate (9.4%), it was lower in the Gyeongnam region (by 0.4%p in Busan, 1.0%p in Ulsan, and 1.2%p in Gyeongsangnam-do; Figure 2H). In 2024, the diabetes diagnosis rate (among those aged ≥30 years) in each of the 41 cities, counties, and districts in the Gyeongnam region was the highest in Sasang-gu, Busan, at 12.3%, and the lowest in Changwon-si, Gyeongsangnam-do, at 6.2% (a gap of 6.1%p among cities, counties, and districts in the Gyeongnam region; Figure 3H).

7. Health Knowledge

The recognition rate for the early symptoms of myocardial infarction by city and province (Busan, Ulsan, and Gyeongsangnam-do) has been decreasing to a certain extent since 2014. It has decreased from 56.3% to 55.1% in Busan, from 47.4% to 45.7% in Ulsan, and from 55.2% to 50.9% in Gyeongsangnam-do from 2023 to 2024 (a gap of 9.4%p among cities and provinces in the Gyeongnam region). Compared to the national rate (49.7%), it decreased in Ulsan by 4.0%p (Figure 2I). In 2024, the recognition rate for the early symptoms of myocardial infarction in each of the 41 cities, counties, and districts in the Gyeongnam region was the highest in Changnyeong-gun, Gyeongsangnam-do, at 81.4%, and the lowest in Buk-gu, Ulsan, at 34.0%, showing the highest gap among local governments in the Gyeongnam region after the walking practice rate (a gap of 47.4%p among cities, counties, and districts in the Gyeongnam region; Figure 3I). The recognition rate for early symptoms of stroke (cerebrovascular accident; CVA) has decreased from 63.7% to 61.5% in Busan, from 60.0% to 55.5% in Ulsan, and from 63.5% to 58.8% in Gyeongsangnam-do from 2023 to 2024 (a gap of 2.7%p among cities and provinces in the Gyeongnam region). Compared to the national rate (59.2%), it was lower in Ulsan and Gyeongsangnam-do by 3.7%p and 0.4%p, respectively (Figure 2J).

In 2024, the recognition rate for the early symptoms of stroke (CVA) in each of the 41 cities, counties, and districts in the Changnyeong-gun, Gyeongsangnam-do, was at 83.5%, and the lowest rate was in Sancheong-gun, Gyeongsangnam-do, at 43.0% (a gap of 40.5%p among the cities, counties, and districts in the Gyeongnam region; Figure 3J).

An examination of the community health level in the Gyeongnam region, as indicated by the 2024 KCHS data, revealed year-on-year improvements in several key indicators, such as the current smoking rate, current smoking rate for male, high-risk alcohol consumption rate, walking practice rate, moderate physical activity rate, and perceived stress rate. However, indicators, such as obesity rate, hypertension diagnosis rate, diabetes diagnosis rate, and recognition rates of myocardial infarction and stroke have deteriorated, suggesting the need for local health projects, education, and outreach efforts.

Furthermore, the indicators with the largest health gap among local governments in the Gyeongnam region were the walking practice rate (47.6%p in 2024), recognition rate for myocardial infarction (47.4%p in 2024), and recognition rate for stroke (40.5%p in 2024), requiring improvement due to the large regional gap among local governments. In particular, an analysis using the key indicators of KCHS and the Golden Diamond method for the last 4 years (from 2021 to 2024) showed that the monthly alcohol consumption rate and blood pressure recognition rate were identified as the indicators requiring improvement in Busan, along with the monthly alcohol consumption rate, high-risk alcohol consumption rate, and breakfast consumption rate in Ulsan, and the high-risk alcohol consumption rate, breakfast consumption rate, monthly alcohol consumption rate, and obesity rate in Gyeongsangnam-do. Such findings may help inform the selection of priority tasks for local health projects (Supplementary Figure 1; available online).

The analysis indicates that intensive local management is necessary to enhance the health vulnerability indicators of the local governments (e.g., obesity rate, hypertension diagnosis rate, diabetes diagnosis rate, and recognition rates for myocardial infarction and stroke). In particular, Gyeongsangnam-do, with the highest levels of cancer, heart disease, cerebrovascular disease, Alzheimer’s disease, and diabetes, and Ulsan with the highest levels of brain and heart disease compared to other regions [2], may require the promotion of chronic disease prevention and management intervention projects centered on areas with high smoking, drinking, and obesity rates, which are major risks for chronic diseases. The proportion of the elderly population aged ≥65 years is higher in Busan and Gyeongsangnam-do (21.7% and 21.5%, respectively) than the national average (18.7%); additionally, the key indicators related to health behaviors, such as alcohol consumption and obesity are high, suggesting the need to actively implement tailored health education and lifestyle improvement campaigns to prevent obesity and hypertension in the elderly and high-risk groups. The establishment of health policies tailored to the region and continuous monitoring and implementation of health projects to reduce the health gap among cities and provinces, as well as cities, counties, and districts in the Gyeongnam region, is expected to contribute to the improvement in the quality of life of local residents. In the future, the Gyeongnam Regional Center for Disease Control and Prevention will further strengthen the regional cooperation system between local governments, improve local health vulnerability indicators, and support the establishment of health policies tailored to regional characteristics through continuous surveys and analyses.

Ethics Statement: Not applicable.

Funding Source: None.

Acknowledgments: None.

Conflict of Interest: The authors have no conflicts of interest to declare.

Author Contributions: Conceptualization: YWK. Data curation: YWK. Project administration: YWK. Resource: YWK. Writing – original draft: YWK. Writing – review & editing: YWK. SJP.

Supplementary data are available online.