Rural Remote Health. 2026 Mar;26(1):10113. doi: 10.22605/RRH10113. Epub 2026 Mar 2.
ABSTRACT
INTRODUCTION: End-stage kidney disease (ESKD) imposes a significant financial burden due to its long-term treatment and represents a growing health issue worldwide. Health inequalities arising from urban and rural geographic disparities remain pressing global issues. South Korea operates a universal and inclusive healthcare system aimed at achieving health equity, with catastrophic health expenditure (CHE) widely recognised as a key indicator for measuring the financial burden associated with diseases. This study aims to assess health equity between urban and rural individuals with ESKD by identifying health status, healthcare accessibility, household finances, financial burden, and CHE factors.
METHODS: This study utilised longitudinal data comprising 421 observations of ESKD from 105 individuals in the 7-year dataset of the Korea Health Panel (2012-2018). Non-parametric statistics were used for cross-sectional analyses to determine subject characteristics at baseline, and mixed-effects panel logistic regression and linear regression for longitudinal studies accounting for time-varying effects. Additionally, population-weighted analyses were conducted to address potential sampling bias in the panel data.
RESULTS: Among those with ESKD, 34.3% resided in rural areas. Over a 7-year period, the cumulative prevalence of CHE was 24.6% in urban areas, 30.6% in rural areas, and 26.7% overall. Over the 7-year panel data, no significant differences in health status or household financial indicators were identified between urban and rural areas. However, regarding healthcare accessibility, the adjusted odds ratio (AOR) for inpatient utilisation in rural compared to urban areas was 2.72 (95%CI 1.41-5.25). Conversely, the AOR for outpatient use was 0.14 (95%CI 0.02-0.80). After population weighting, the prevalence of CHE (AOR 1.40, 95%CI 1.39-1.42) and the prevalence of impoverishment (AOR 1.56, 95%CI 1.54-1.57) were significantly elevated in rural compared to urban areas. Factors associated with higher CHE prevalence included being female (AOR 1.83, 95%CI 1.02-3.16), lowest household income (AOR 6.55, 95%CI 1.67-25.72), inpatient utilisation (AOR 5.36, 95%CI 2.86-10.03), and being aged 65 years or older (AOR 1.71, 95%CI 0.88-3.31). In the population-weighted analysis, CHE was higher in rural areas than in urban areas (AOR 1.22, 95%CI 1.20-1.23).
CONCLUSION: Health status and household financial equity between urban and rural individuals with ESKD in South Korea demonstrate positive outcomes of a universal and inclusive healthcare coverage system. Nevertheless, regarding healthcare accessibility, living rurally exhibited lower outpatient and emergency room visits alongside higher inpatient utilisation, indicating greater challenges in CHE. Tailored adjustments to the healthcare system are needed to address the vulnerabilities of rural place.
PMID:41766405 | DOI:10.22605/RRH10113
