Inequitable distribution of excess mortality during the COVID-19 pandemic in Korea, 2020
0
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
OBJECTIVES: This study analyzed inequities in excess mortality according to region and socioeconomic position to explain the distribution of excess mortality in Korea in 2020. METHODS: We acquired weekly all-cause mortality data from January 2015 to December 2020 from (1) the National Health Insurance Database and (2) Vital Statistics. Excess mortality for 2020 was calculated by comparing the weekly observed and expected deaths from the same period (2015-2019) using quasi-Poisson regression. RESULTS: An inequitable distribution of excess mortality was identified. The estimated excess mortality in Korea was -29,112 (95% confidence interval, -29,832 to -28,391), corresponding to -55 per 100,000, and the ratio of observed deaths to expected deaths was 0.91. Negative excess mortality was observed except for females in the 0-14 age group. Male Medical Aid beneficiaries showed positive excess mortality, while non-disabled and disabled groups showed similar negative values. When the standardized mortality ratio was calculated for the top 10 causes of death, deaths from Alzheimer’s disease and septicemia increased, whereas those from diabetes mellitus and cerebrovascular disease decreased. The decrease in mortality was primarily concentrated in older adults, while the mortality of young females increased due to increased intentional self-harm. CONCLUSIONS: This study adds essential evidence regarding the overall performance of Korea. The observed inequalities according to various socioeconomic variables indicate that the results of strict measures to control coronavirus disease 2019 were not distributed equitably. Efforts should be made to properly evaluate the current and future problems related to the pandemic.
Abstract
OBJECTIVES: This study analyzed inequities in excess mortality according to region and socioeconomic position to explain the distribution of excess mortality in Korea in 2020. METHODS: We acquired weekly all-cause mortality data from January 2015 to December 2020 from (1) the National Health Insurance Database and (2) Vital Statistics. Excess mortality for 2020 was calculated by comparing the weekly observed and expected deaths from the same period (2015-2019) using quasi-Poisson regression. RESULTS: An inequitable distribution of excess mortality was identified. The estimated excess mortality in Korea was -29,112 (95% confidence interval, -29,832 to -28,391), corresponding to -55 per 100,000, and the ratio of observed deaths to expected deaths was 0.91. Negative excess mortality was observed except for females in the 0-14 age group. Male Medical Aid beneficiaries showed positive excess mortality, while non-disabled and disabled groups showed similar negative values. When the standardized mortality ratio was calculated for the top 10 causes of death, deaths from Alzheimer’s disease and septicemia increased, whereas those from diabetes mellitus and cerebrovascular disease decreased. The decrease in mortality was primarily concentrated in older adults, while the mortality of young females increased due to increased intentional self-harm. CONCLUSIONS: This study adds essential evidence regarding the overall performance of Korea. The observed inequalities according to various socioeconomic variables indicate that the results of strict measures to control coronavirus disease 2019 were not distributed equitably. Efforts should be made to properly evaluate the current and future problems related to the pandemic.
참고문헌 (43)
- Douglas M, "Mitigating the wider health effects of covid-19 pandemic response", BMJ, 369, pp.m1557~ (2020)
- Ashraf BN, "Economic impact of government interventions dur-ing the COVID-19 pandemic : international evidence from financial markets", J Behav Exp Finance, 27, pp.100371~ (2020)
- Michelozzi P, "Temporal dynamics in total excess mortality and COVID-19 deaths in Italian cities", BMC Public Health, 20, pp.1238~ (2020)
- Stang A, "Excess mortality due to COVID-19 in Germany", J Infect, 81, pp.797~801 (2020)
- Stokes AC, "COVID-19 and excess mortality in the United States : a countylevel analysis", PLoS Med, 18, pp.e1003571~ (2021)
- Banerjee A, "Estimating excess 1-year mortality associated with the COVID-19 pandemic according to underlying conditions and age : a population-based cohort study", Lancet, 395, pp.1715~1725 (2020)
- Oliu-Barton M, "SARS-CoV-2 elimination, not mitigation, creates best outcomes for health, the economy, and civil liberties", Lancet, 397, pp.2234~2236 (2021)
- Kiang MV, "Every Body counts : measuring mortality from the COVID-19 pandemic", Ann Intern Med, 173, pp.1004~1007 (2020)
- Leon DA, "COVID-19 : a need for real-time monitoring of weekly excess deaths", Lancet, 395, pp.e81~ (2020)
- Islam N, "Excess deaths associated with covid-19 pandemic in 2020 : age and sex disaggregated time series analysis in 29 high income countries", BMJ, 373, pp.n1137~ (2021)
- Kontis V, "Lessons learned and lessons missed : impact of the coronavirus disease 2019(COVID-19)pandemic on all-cause mortality in 40 industrialised countries and US states prior to mass vaccination", Wellcome Open Res, 6, pp.279~ (2022)
- "COVID-19 dashboard" (2022)[URL]
- Shin Min Sun, "Estimation of Excess All-cause Mortality during COVID-19 Pandemic in Korea", Journal of Korean Medical Science, 36(39), pp.1~10 (2021), 대한의학회[DOI]
- Han C, "Changes in mortality rate of the general population during the COVID-19 pandemic : an interrupted time series study in Korea", Int J Epidemiol, 51, pp.1396~1407 (2022)
- Park H, "Excess deaths on suicide during COVID-19 in South Korea", Korean J Public Health, 58, pp.1~12 (2021)
- Bottan N, "The unequal impact of the coronavirus pandemic : evidence from seventeen developing countries", PLoS One, 15, pp.e0239797~ (2020)
- Bambra C, "The unequal pandemic:COVID-19 and health inequalities", pp.101~ (2021), Bristol University Press
- Gibson B, "The impact of inequality on mental health outcomes during the COVID-19 pandemic : a systematic review", Can Psychol, 62, pp.101~126 (2021)
- Dang HH, "Gender inequality during the COVID19 pandemic : Income, expenditure, savings, and job loss", World Dev, 140, pp.105296~ (2021)
- Seong SC, "Data resource profile : the National Health Information Database of the National Health Insurance Service in South Korea", Int J Epidemiol, 46, pp.799~800 (2017)
- 박진욱, "Using the National Health Information Database of the National Health Insurance Service in Korea for Monitoring Mortality and Life Expectancy at National and Local Levels", Journal of Korean Medical Science, 32(11), pp.1764~1770 (2017), 대한의학회
- Kim T, "Stagnation of life expectancy in Korea in 2018 : a cause-specific decomposition analysis", PLoS One, 15, pp.e0244380~ (2020)
- Harper S, "Implicit value judgments in the measurement of health inequalities", Milbank Q, 88, pp.4~29 (2010)
- Asada Y, "On the choice of absolute or relative inequality measures", Milbank Q, 88, pp.616~622 (2010)
- Andreev EM, "Algorithm for decomposition of differences between aggregate demographic measures and its application to life expectancies, healthy life expectancies, parity-progression ratios and total fertility rates", Demogr Res, 7, pp.499~522 (2002)
- Gregory G, "Learning from the pandemic : mortality trends and seasonality of deaths in Australia in 2020", Int J Epidemiol, 51, pp.718~726 (2022)
- Onozuka D, "Reduced mortality during the COVID-19 outbreak in Japan, 2020 : a two-stage interrupted time-series design", Int J Epidemiol, 51, pp.75~84 (2022)
- Newall AT, "Delay-adjusted age-and sex-specific case fatality rates for COVID-19 in South Korea : evolution in the estimated risk of mortality throughout the epidemic", Int J Infect Dis, 101, pp.306~311 (2020)
- Ben-Zur H, "Gender differences in coping reactions under community crisis and daily routine conditions", Pers Individ Dif, 20, pp.331~340 (1996)
- Krase K, "Exploring the impact of gender on challenges and coping during the COVID-19 pandemic", Int J Sociol Soc Policy, 42, pp.1001~1012 (2022)
- "’21 Plan for the prevention of lonely death" (2021)[URL]
- Case A, "Mortality and morbidity in the 21st century", Brookings Pap Econ Act, 2017, pp.397~476 (2017)
- "Updated report on South Korea with new data on COV-ID-19 deaths linked to care homes" (2020)[URL]
- Al-Quteimat OM, "The impact of the COVID-19 pandemic on cancer patients", Am J Clin Oncol, 43, pp.452~455 (2020)
- Riera R, "Delays and disruptions in cancer health care due to COVID-19 pandemic : systematic review", JCO Glob Oncol, 7, pp.311~323 (2021)
- Koh GC, "The impact of diabetes on the pathogenesis of sepsis", Eur J Clin Microbiol Infect Dis, 31, pp.379~388 (2012)
- "Suicide rates among young Korean women on the rise" (2020)[URL]
- Kim H, "Changes in mortality after the recent economic crisis in South Korea", Ann Epidemiol, 14, pp.442~446 (2004)
- Karlinsky A, "Tracking excess mortality across countries during the COVID-19 pandemic with the World Mortality Dataset", Elife, 10, pp.e69336~ (2021)
- Kwon S, "Thirty years of national health insurance in South Korea : lessons for achieving universal health care coverage", Health Policy Plan, 24, pp.63~71 (2009)
- Scortichini M, "Excess mortality during the COVID-19 outbreak in Italy : a two-stage interrupted time-series analysis", Int J Epidemiol, 49, pp.1909~1917 (2021)
- Fouillet A, "Excess mortality related to the August 2003 heat wave in France", Int Arch Occup Environ Health, 80, pp.16~24 (2006)
- Rooney C, "Excess mortality in England and Wales, and in Greater London, during the 1995 heatwave", J Epidemiol Community Health, 52, pp.482~486 (1998)