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Timely access to secondary pediatric services: a key to reducing child and adolescent mortality
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Miniku Kang, Young June Choe, Hye Sook Min, Saerom Kim, Seung-Ah Choe
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Epidemiol Health. 2024;e2024059. Published online July 5, 2024
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DOI: https://doi.org/10.4178/epih.e2024059
[Accepted]
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Abstract
OBJECTIVES
Geographic disparities in access to secondary pediatric care remain a significant issue in countries with universal health coverage, including South Korea. Our study investigated the relationship between the geographic availability of secondary pediatric care services and mortality rates among children and adolescents in South Korea.
METHODS We analyzed district-level data to assess the percentage of those aged 0-19 years residing outside of a 60-minute travel radius from the nearest secondary pediatric care provider (Accessibility Vulnerability Index, AVI). This analysis was conducted in conjunction with national mortality statistics for the same age group spanning the years 2017 to 2021. The concentration index was used to evaluate socioeconomic disparities in the AVI among districts. Using generalized estimating equation models, we calculated the relative risk (RR) of annual mortality per 10% increase in the AVI for secondary pediatric care.
RESULTS The AVI ranged from 0% to 100% across the districts for the study period. The CI was -0.30 (95% CI, -0.41 to -0.19) in 2017 and -0.41 (95% CI, -0.52 to -0.30) in 2021, indicating that the proportion of those who could not access care within 60 minutes was disproportionately higher in districts with lower socioeconomic status. Our findings revealed an 8% rise in mortality rates among individuals aged 0-19 years for every 10% increase in AVI (95% CI, 1.06-1.10). The association between AVI and mortality was more pronounced during the COVID-19 pandemic (RR, 1.11; 95% CI, 1.08-1.14) than in the pre-pandemic period (RR< 1.07; 95% CI, 1.05-1.09; p for heterogeneity = 0.016).
CONCLUSIONS Significant disparities were found in geographic access to pediatric care, which were relevant for child survival. Achieving true universal health coverage requires an emphasis on timely access to care for all pediatric populations.
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Inequitable distribution of excess mortality during the COVID-19 pandemic in Korea, 2020
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Jin-Hwan Kim, Saerom Kim, Eunhye Park, Chang-yup Kim
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Epidemiol Health. 2022;44:e2022081. Published online September 26, 2022
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DOI: https://doi.org/10.4178/epih.e2022081
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Abstract
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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.
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Summary
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Citations
Citations to this article as recorded by  - Did the socioeconomic inequalities in avoidable and unavoidable mortality worsen during the first year of the COVID-19 pandemic in Korea?
Rora Oh, Myoung-Hee Kim, Juyeon Lee, Rangkyoung Ha, Jungwook Kim
Epidemiology and Health.2023; 45: e2023072. CrossRef
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