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Brief Communications
Timely access to secondary pediatric services in Korea: a key to reducing child and adolescent mortality
Minku Kang, Young June Choe, Hye Sook Min, Saerom Kim, Seung-Ah Choe
Epidemiol Health. 2024;46:e2024059.   Published online July 5, 2024
DOI: https://doi.org/10.4178/epih.e2024059
  • 2,032 View
  • 85 Download
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Geographic disparities in access to secondary pediatric care remain a significant issue in countries with universal health coverage, including Korea. This study investigated the link between geographic access to secondary pediatric care and mortality rates in children and adolescents (0-19 years) in 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).
RESULTS
The AVI ranged from 0% to 100% across the districts for the study period. The confidence interval (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. We found 8% rise in mortality rates among individuals aged 0-19 years for every 10% increase in AVI (95% CI, 1.06 to 1.10).
CONCLUSIONS
The study highlights disparities in pediatric care access and their impact on child survival, emphasizing the need for improved access to achieve true universal health coverage.
Summary
Korean summary
본 연구는 한국에서 소아 의료 서비스에 대한 지리적 접근성과 아동 사망률 사이의 연관성을 조사하여, 특히 COVID-19 대유행 기간 동안 접근성 제한이 높은 사망률과 관련이 있음을 발견하였다. 이 연구는 아동 및 청소년의 예방 가능한 사망률에 대한 지역 격차를 줄이기 위해 시기적절한 치료 접근성을 개선해야 할 필요성을 강조하였다.
Key Message
The study investigated the link between geographic access to pediatric services and child mortality in South Korea, finding that limited access, particularly during the COVID-19 pandemic, was associated with higher mortality. The research highlights the need for improved access to timely care to reduce regional disparities in preventable deaths among children and adolescents.
Assessing the impact and implications of the revised Act on the Aggravated Punishment of Specific Crimes in preventing child traffic injuries in school zones in Korea: an interrupted time series analysis
Hong Jin Ku, Jin-Hwan Kim, Young June Choe, Seung Ah Choe, Mark R. Zonfrillo
Epidemiol Health. 2024;46:e2024032.   Published online February 21, 2024
DOI: https://doi.org/10.4178/epih.e2024032
  • 6,565 View
  • 115 Download
AbstractAbstract AbstractSummary PDF
Abstract
In 2019, a child’s death in Korea led to legislation that imposed stricter penalties for school zone traffic violations. We assessed the impact of that legislation using 2017-2022 Traffic Accident Analysis System data. Adjusted analyses revealed a significant decline in severe injuries in school zones, decreasing from 11 cases to 8 cases per month (p=0.017). The legislation correlated with a reduced risk of all child traffic injuries (risk ratio, 0.987; 95% confidence interval, 0.977 to 0.997; p=0.002), indicating its efficacy in curbing accidents.
Summary
Korean summary
2019년 민식이법 도입 후 소아 교통사고에 미치는 영향을 평가하고자 하였다. 2017-2022 교통사고 분석 시스템 데이터를 통해 그 효과를 평가했고, 학군지역에서 심각한 부상이 월 평균 11건에서 8건으로 감소했다(p=0.017). 또한, 모든 어린이 교통사고 위험 비율도 감소했고(risk ratio, 0.987, 95% CI, 0.977-0.997; p=0.002), 사고 예방에 효과적임을 입증했다. 이 연구는 학군지역 어린이 안전에 법 조치의 긍정적 영향을 강조하며, 지속적인 도로 안전 강화의 중요성을 강조한다.
Key Message
Revised legislation in Korea, following a child’s tragic death, enforced stricter penalties for school zone traffic violations. Analysis of 2017-2022 data showed a significant decrease in severe injuries from 11 to 8 cases monthly (p=0.017). The legislation also reduced the risk of all child traffic injuries (risk ratio, 0.987; 95% CI, 0.977 to 0.997; p=0.002), demonstrating its effectiveness in preventing accidents. This study underscores the legislation’s positive impact on child safety in school zones, emphasizing the importance of ongoing enforcement efforts for road safety.
Original Articles
Outbreak of carbapenem-resistant Enterobacterales at a long-term care facility in Seoul, Korea: surveillance and intervention mitigation strategies
Yoojin Park, Euncheol Son, Young June Choe, Cho Ryok Kang, Sangmi Roh, Young Ok Hwang, Sung-il Cho, Jihwan Bang
Epidemiol Health. 2023;45:e2023057.   Published online June 9, 2023
DOI: https://doi.org/10.4178/epih.e2023057
  • 6,797 View
  • 313 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Because effective decolonization options are not available, and treatment options are limited, carbapenem-resistant Enterobacterales (CRE) constitute increasingly threatening nosocomial pathogens. To prevent CRE-associated transmission and ensure patient safety, healthcare personnel and everyone in contact with CRE-infected patients must implement stringent infection control practices. This report describes a CRE outbreak, possibly related to a caregiver at a long-term care facility (LTCF), and presents a new surveillance model to improve the infection control of CRE in Seoul, Korea.
METHODS
The Seoul Metropolitan Government surveillance system identified an outbreak of CRE in an LTCF in 2022. We obtained data on the demographic characteristics and contact histories of the inpatients, medical staff, and caregivers. To isolate the inpatients and employees exposed to CRE, we used rectal swab samples and environmental sampling during the study period (May-December 2022).
RESULTS
We identified 18 cluster cases (1 caregiver and 17 inpatients) and 12 sporadic cases with CRE, and conducted a complete 197-day follow-up of all cases in the LTCF’s isolation wards.
CONCLUSIONS
This investigation demonstrated that our surveillance model and targeted intervention, based on the cooperation of the municipal government, public health center, and infection control advisory committee, effectively contained the epidemic at the LTCF. Measures to improve the compliance of all employees in LTCFs with infection control guidelines should also be adopted.
Summary
Korean summary
서울시 CRE 감시체계를 통해 2022년 한 요양병원의 집단발생을 인지하였다. 현장역학조사를 실시하여 18명의 집단발생 사례(1명 간병인, 17명 입원환자)와 12명의 산발적인 사례를 확인하였고 감염관리 컨설팅을 통해 유행을 확산을 방지하는 중재를 시행하였다.
Key Message
The Seoul Metropolitan Government surveillance system identified an outbreak of carbapenem-resistant Enterobacterales (CRE) in a long-term care facility (LTCF) in 2022. We identified 18 cluster cases (1 caregiver and 17 inpatients) and 12 sporadic cases with CRE. In the current study, we could demonstrate that our surveillance model and targeted intervention, based on the cooperation of the municipal government, public health center, and infection control advisory committee, effectively contained the epidemic at the LTCF. Measures to improve the compliance of all employees in LTCFs with infection control guidelines should also be adopted.

Citations

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  • Combating Antimicrobial Resistance Through a Data-Driven Approach to Optimize Antibiotic Use and Improve Patient Outcomes: Protocol for a Mixed Methods Study
    Jonathan Mayito, Conrad Tumwine, Ronald Galiwango, Elly Nuwamanya, Suzan Nakasendwa, Mackline Hope, Reuben Kiggundu, Dathan M Byonanebye, Flavia Dhikusooka, Vivian Twemanye, Andrew Kambugu, Francis Kakooza
    JMIR Research Protocols.2024; 13: e58116.     CrossRef
  • Role of Probiotics in Preventing Carbapenem-Resistant Enterobacteriaceae Colonization in the Intensive Care Unit: Risk Factors and Microbiome Analysis Study
    Jung-Hwan Lee, Jongbeom Shin, Soo-Hyun Park, Boram Cha, Ji-Taek Hong, Don-Haeng Lee, Kye Sook Kwon
    Microorganisms.2023; 11(12): 2970.     CrossRef
Barriers to COVID-19 vaccine surveillance: the issue of under-reporting adverse events
Yunha Noh, Hwa Yeon Ko, Ju Hwan Kim, Dongwon Yoon, Young June Choe, Seung-Ah Choe, Jaehun Jung, Ju-Young Shin
Epidemiol Health. 2023;45:e2023054.   Published online June 7, 2023
DOI: https://doi.org/10.4178/epih.e2023054
  • 6,334 View
  • 147 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study investigated the reporting rates of adverse events following immunization (AEFIs) to the spontaneous reporting system (SRS) and its predictors among individuals with AEFIs after coronavirus disease 2019 (COVID-19) vaccination.
METHODS
A cross-sectional, web-based survey was conducted from December 2, 2021 to December 20, 2021, recruiting participants >14 days after completion of a primary COVID-19 vaccination series. Reporting rates were calculated by dividing the number of participants who reported AEFIs to the SRS by the total number of participants who experienced AEFIs. We estimated adjusted odds ratios (aORs) using multivariate logistic regression to determine factors associated with spontaneous AEFIs reporting.
RESULTS
Among 2,993 participants, 90.9% and 88.7% experienced AEFIs after the first and second vaccine doses, respectively (reporting rates, 11.6 and 12.7%). Furthermore, 3.3% and 4.2% suffered moderate to severe AEFIs, respectively (reporting rates, 50.5 and 50.0%). Spontaneous reporting was more prevalent in female (aOR, 1.54; 95% confidence interval [CI], 1.31 to 1.81); those with moderate to severe AEFIs (aOR, 5.47; 95% CI, 4.45 to 6.73), comorbidities (aOR, 1.31; 95% CI, 1.09 to 1.57), a history of severe allergic reactions (aOR, 2.02; 95% CI, 1.47 to 2.77); and those who had received mRNA-1273 (aOR, 1.25; 95% CI, 1.05 to 1.49) or ChAdOx1 (aOR, 1.62; 95% CI, 1.15 to 2.30) vaccines versus BNT162b2. Reporting was less likely in older individuals (aOR, 0.98; 95% CI, 0.98 to 0.99 per 1-year age increment).
CONCLUSIONS
Spontaneous reporting of AEFIs after COVID-19 vaccination was associated with younger age, female sex, moderate to severe AEFIs, comorbidities, history of allergic reactions, and vaccine type. AEFIs under-reporting should be considered when delivering information to the community and in public health decision-making.
Summary
Korean summary
본 연구는 국내 19-49세 성인을 대상으로, 코로나19 예방 백신 접종 후 이상반응 경험에 대한 자발적 보고율을 조사하고, 자발적 보고와 관련된 요인을 파악하고자 하였다. 2021년 12월 2일부터 20일까지 온라인 설문조사를 통하여 자료를 수집하였으며, 연구대상자는 코로나19 예방 백신의 기초접종을 완료한 후 2주 경과한 19-49세 성인으로, 전국 대표성을 확보하기 위해 성별, 연령, 지역별로 층화하여 모집하였다. 이상반응 자발적 보고율은 1차 접종과 2차 접종 후 각각 약 11.6%, 12.7%로 나타났으며, 중등도에서 중증의 이상반응에 대한 자발적 보고율은 약 50.5%, 50.0%로 나타났다. 이상반응 자발적 보고율 관련 영향요인으로는 젊은 연령층, 여성, 이상반응의 중증도, 동반질환, 알러지 반응 이력, 기초접종 백신 종류가 포함되었다.
Key Message
Spontaneous reporting rates of adverse events following immunization (AEFIs) against coronavirus disease 2019 (COVID-19) were low, at around 12 % of any AEFIs and 50 % of moderate-to-severe AEFIs. Younger age, female sex, severe AEFIs, comorbidities, history of allergic reactions, and the type of COVID-19 vaccine were associated with the AEFIs reporting.

Citations

Citations to this article as recorded by  
  • The effect of covid vaccination on menstruation and attitude to the vaccine among Indian women – Results of a prospective survey
    Anbukkani Subbian, Jeevithan Shanmugam, Uma Ram
    Indian Journal of Obstetrics and Gynecology Research.2024; 11(1): 70.     CrossRef
Parental concerns about COVID-19 vaccine safety and hesitancy in Korea: implications for vaccine communication
Hye-Kyung Cho, Hyunju Lee, Young June Choe, Shinkyeong Kim, Sujin Seo, Jiwon Moon, Eun Hwa Choi, Geun-Yong Kwon, Jee Yeon Shin, Sang-Yoon Choi, Mi Jin Jeong, Myoungsoon You
Epidemiol Health. 2023;45:e2023004.   Published online December 13, 2022
DOI: https://doi.org/10.4178/epih.e2023004
  • 7,646 View
  • 164 Download
  • 7 Web of Science
  • 7 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Vaccination is one of the most important strategies to contain the spread of coronavirus disease 2019 (COVID-19). Vaccination in children is dependent on their parents, making it important to understand parents’ awareness and attitudes toward vaccines in order to devise strategies to raise vaccination rates in children.
METHODS
A web-based nationwide survey was conducted among Korean parents of 7-year-old to 18-year-old children in August 2021 to estimate parents’ intention to vaccinate their children against COVID-19 and identify key factors affecting parental acceptance and hesitancy through regression analysis.
RESULTS
Approximately 56.4% (575/1,019) were willing to vaccinate their children against COVID-19. Contributing factors to COVID-19 vaccine hesitancy were being a mother (adjusted odds ratio [aOR], 0.36; 95% confidence interval [CI], 0.25 to 0.52), a lower education level (aOR, 0.83; 95% CI, 0.70 to 0.97), hesitancy to other childhood vaccines (aOR, 0.78; 95% CI, 0.64 to 0.96), and refusal to vaccinate themselves (aOR, 0.08; 95% CI, 0.02 to 0.20). Having older children (aOR, 1.20; 95% CI, 1.13 to 1.28), trusting the child’s doctor (aOR, 1.19; 95% CI, 1.07 to 1.32), positive perceptions of the COVID-19 vaccine’s effectiveness (aOR, 2.60; 95% CI, 1.90 to 3.57) and perceiving the COVID-19 vaccine as low-risk (aOR, 1.68; 95% CI, 1.27 to 2.24) were associated with COVID-19 vaccine acceptance. Concerns about adverse reactions were the most common cause of hesitancy.
CONCLUSIONS
Providing parents with accurate and reliable information on vaccine effectiveness and safety is important to increase COVID-19 vaccine uptake in children. Differential or targeted approaches to parents according to gender, age, and their children’s age are necessary for effective communication about vaccination in children.
Summary
Korean summary
부모에게 백신 효과와 안전성에 대한 정확하고 믿을만한 정보를 제공하는 것이 소아 코로나19 백신 접종률을 높이는데 중요하다. 자녀의 백신 접종에 대한 의사소통을 효율적으로 하기 위해서는 부모의 성별과 연령, 자녀의 연령을 고려한 차별적인 접근 방법이 필요하다.
Key Message
To improve COVID-19 vaccine uptake in children, it's crucial to provide parents with reliable and precise information about vaccine safety and effectiveness. Targeted communication strategies that consider factors such as the age of the parents and their children, as well as gender, may be necessary to effectively convey this information.

Citations

Citations to this article as recorded by  
  • Safety of BNT162b2 mRNA COVID-19 vaccine in children with chronic kidney disease: a national population study from South Korea
    Young June Choe, Yo-Han Ahn, Eunsun Gwak, Eunseo Jo, Jinseob Kim, Seung-Ah Choe
    Pediatric Nephrology.2024; 39(2): 625.     CrossRef
  • Assessing the determinants of influenza and COVID-19 vaccine co-administration decisions in the elderly
    Seunghyun Lewis Kwon, So-Yeon Kim, Minju Song, Hyung-Min Lee, Seon-Hwa Ban, Mi-Soon Lee, Hyesun Jeong
    Human Vaccines & Immunotherapeutics.2024;[Epub]     CrossRef
  • Descriptive cross-sectional study to evaluate perception, attitude, and practice of parents regarding COVID-19 vaccination in children 10–12 years of age—A step toward prevention of future COVID-19 outbreaks in India
    Vivek Mehta, Deep Inder, Pawan Kumar, Anupma Raheja
    Journal of Family Medicine and Primary Care.2024; 13(5): 2104.     CrossRef
  • Comparative safety of monovalent and bivalent mRNA COVID-19 booster vaccines in adolescents aged 12 to 17 years in the Republic of Korea
    Mijeong Ko, Seontae Kim, Seok-Kyoung Choi, Seung Hwan Shin, Yeon-Kyeng Lee, Yunhyung Kwon
    Osong Public Health and Research Perspectives.2024; 15(4): 364.     CrossRef
  • Pediatric asthma and COVID-19 vaccination: unveiling patterns of hesitancy and acceptance
    Marzieh Tavakol, Saber Gharagozlou, Mohammad Abbasi, Zahra Zamani, Mohammad Gharagozlou
    Therapeutic Advances in Vaccines and Immunotherapy.2024;[Epub]     CrossRef
  • Willingness and hesitancy of parents to vaccinate against COVID-19 their children ages 6 months to 4 years with frail conditions in Italy
    Grazia Miraglia del Giudice, Giorgia Della Polla, Mario Postiglione, Italo Francesco Angelillo
    Frontiers in Public Health.2023;[Epub]     CrossRef
  • Associations between Socio-Demographic Characteristics and Maternal Attitudes towards Childhood Vaccination in Cyprus—A Cross-Sectional Survey
    Maria Kyprianidou, Georgia Fakonti, Eleana Tzira, Magdalini Pylli, Konstantinos Giannakou
    COVID.2023; 3(7): 1042.     CrossRef
Predictors of COVID-19 booster vaccine hesitancy among fully vaccinated adults in Korea: a nationwide cross-sectional survey
Yunha Noh, Ju Hwan Kim, Dongwon Yoon, Young June Choe, Seung-Ah Choe, Jaehun Jung, Sang-Won Lee, Ju-Young Shin
Epidemiol Health. 2022;44:e2022061.   Published online July 22, 2022
DOI: https://doi.org/10.4178/epih.e2022061
  • 11,071 View
  • 375 Download
  • 14 Web of Science
  • 14 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study explored predictors of coronavirus disease 2019 (COVID-19) booster hesitancy among fully vaccinated young adults and parental COVID-19 vaccine hesitancy for their children.
METHODS
This cross-sectional study administered an online survey from December 2 to December 20, 2021. We enrolled participants aged 18-49 years, for whom ≥2 weeks had passed after their initial COVID-19 vaccination. We estimated odds ratios (ORs) with 95% confidence intervals (CIs) using multivariate logistic regression to evaluate factors associated with booster/vaccine hesitancy.
RESULTS
Among the 2,993 participants, 48.8% showed hesitancy (wait and see: 40.2%; definitely not: 8.7%). Booster hesitancy was more common among women (OR, 1.25; 95% CI, 1.05 to 1.50), younger people (OR, 1.44; 95% CI, 1.17 to 1.77), those with a lower education level (OR, 2.05; 95% CI, 1.10 to 3.82), those who received the mRNA-1273 vaccine type (OR, 2.01; 95% CI, 1.65 to 2.45), and those who experienced serious adverse events following previous COVID-19 vaccination (OR, 2.03; 95% CI, 1.47 to 2.80). The main reasons for booster hesitancy were concerns about safety (54.1%) and doubts about efficacy (29.8%). Among the 1,020 respondents with children aged <18 years, 65.8% were hesitant to vaccinate their children against COVID-19; hesitancy was associated with younger parental age, education level, the type of vaccine the parent received, and a history of COVID-19 infection.
CONCLUSIONS
Concerns about the efficacy and safety of COVID-19 vaccines were the major barrier to booster acceptance. The initial COVID-19 vaccine type (mRNA-1273), young age, gender (women), a low education level, and adverse events after the first COVID-19 vaccine were key predictors of booster hesitancy.
Summary
Korean summary
본 연구는 국내 19-49세 성인을 대상으로, 코로나19 3차접종 의향과 그들의 18세 미만 자녀에 대한 코로나19 기초접종 의향을 조사하고, 코로나19 백신접종 기피와 관련된 요인을 파악하고자 하였다. 2021년 12월 2일부터 20일까지 온라인 설문조사를 통하여 자료를 수집하였으며, 연구대상자는 코로나19 기초접종을 완료한 후 2주 경과한 19-49세 성인으로, 전국 대표성을 확보하기 위해 성별, 연령, 지역별로 층화하여 모집하였다. 코로나19 3차접종 기피율은 약 48.8%로 나타났으며, 접종 기피 관련 영향요인으로는 젊은 연령층, 여성, 낮은 교육수준, 기초접종 백신 종류, 기초접종 후 중증 이상반응 경험이 포함되었으며, 18세 미만 자녀에 대한 코로나19 기초접종 기피율은 65.8%로, 관련 영향요인으로는 젊은 부모 연령, 교육수준, 부모의 기초접종 백신 종류, 코로나19 감염 과거력이 포함되었다.
Key Message
Concerns about the safety and efficacy of COVID-19 vaccines were the major barrier to booster acceptance; the initial COVID-19 vaccine type (mRNA-1273), younger age, gender (women), a low education level, and adverse events after the first COVID-19 vaccine were key predictors of booster hesitancy.

Citations

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  • Factors influencing Thai university students’ decisions to take COVID-19 vaccine booster doses: a cross-sectional survey
    Weerakorn Thichumpa, Naphat Yimthin, Anawat Ratchatorn, Satoko Izumi, Wirichada Pan-ngum
    Tropical Medicine and Health.2024;[Epub]     CrossRef
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    Sami Abdeen, Muna Abed Alah, Manal Al-Zaidan, Mohamed Izham Mohamed Ibrahim, Jazeel Abdulmajeed, Asma Ali Al-Nuaimi, Mohamed Ghaith Al-Kuwari
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    Rodrigo Camacho-Neciosup, Ericka N. Balcazar-Huaman, Margarita L. Alvarez-Vilchez, Janith P. De la Cruz-Galán, Yubely Gálvez-Guadalupe, Edwin D. Garcia-Muñoz, Greysi Cerron-Daga, Virgilio E. Failoc-Rojas, Mario J. Valladares-Garrido
    PeerJ.2024; 12: e16727.     CrossRef
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    Jing-Shan Deng, Chun-Lian Huang, Qiong-Ying Hu, Lei Shi, Xiao-Ying Chen, Xu Luo, Tao-Hsin Tung, Jian-Sheng Zhu
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    Nobuyuki Tetsuka, Keiko Suzuki, Kodai Suzuki, Takuma Ishihara, Takao Miwa, Satoko Tajirika, Miho Adachi, Ryo Horita, Taku Fukao, Mayumi Yamamoto
    Vaccine: X.2024; 19: 100516.     CrossRef
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    Fabián R. Chacón-Labrador, María G. Passantino, Augusto Moncada-Ortega, Atahualpa A. Ávila, Andrea A. Moreno, Nicolle A. Kuffaty-Akkou, Luisana M. Pedroza, Natasha A. Camejo-Ávila, Daniela L. Mendoza-Millán, Carlis M. Rodriguez-Saavedra, María V. Marcano-
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    Yam B. Limbu, Bruce A. Huhmann
    Tropical Medicine and Infectious Disease.2023; 8(3): 159.     CrossRef
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    Kai Wei Lee, Sook Fan Yap, Hooi Tin Ong, Myo Oo, Kye Mon Min Swe
    Vaccines.2023; 11(3): 638.     CrossRef
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    Theresia Santi, Badriul Hegar, Zakiudin Munasir, Ari Prayitno, Retno Asti Werdhani, Ivo Novita Sah Bandar, Juandy Jo, Ruswati Uswa, Ratna Widia, Yvan Vandenplas
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Clinical outcomes of COVID-19 following the use of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers among patients with hypertension in Korea: a nationwide study
Ju Hwan Kim, Yeon-Hee Baek, Hyesung Lee, Young June Choe, Hyun Joon Shin, Ju-Young Shin
Epidemiol Health. 2021;43:e2021004.   Published online December 29, 2020
DOI: https://doi.org/10.4178/epih.e2021004
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Recent evidence has shown no harm associated with the use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs) in patients with coronavirus disease 2019 (COVID-19). We sought to further clarify the possible association between ACEI/ARB use and the risk of poor clinical outcomes of COVID-19.
METHODS
From the completely enumerated COVID-19 cohort in Korea, we identified 1,290 patients with hypertension, of whom 682 had and 603 did not have records of ACEI/ARB use during the 30-day period before their COVID-19 diagnosis. Our primary endpoint comprised clinical outcomes, including all-cause mortality, use of mechanical ventilation, intensive care unit admission, and sepsis. We used inverse probability of treatment weighting (IPTW) to mitigate selection bias, and a Poisson regression model to estimate the relative risks (RRs) and 95% confidence intervals (CIs) for comparing outcomes between ACEI/ARB users and non-users.
RESULTS
Compared to non-use, ACEI/ARB use was associated with lower clinical outcomes (IPTW-adjusted RR, 0.60; 95% CI, 0.42 to 0.85; p=0.005). For individual outcomes, ACEI/ARB use was not associated with all-cause mortality (IPTW-adjusted RR, 0.62; 95% CI, 0.35 to 1.09; p=0.097) or respiratory events (IPTW-adjusted RR, 0.99; 95% CI, 0.84 to 1.17; p=0.904). Subgroup analysis showed a trend toward a protective role of ACEIs and ARBs against overall outcomes in men (IPTW-adjusted RR, 0.84; 95% CI, 0.69 to 1.03; p<sub>interaction</sub>=0.008) and patients with pre-existing respiratory disease (IPTW-adjusted RR, 0.74; 95% CI, 0.60 to 0.92; p<sub>interaction</sub>=0.002).
CONCLUSIONS
We present clinical evidence to support continuing ACE/ARB use in COVID-19 patients with hypertension based on the completely enumerated Korean cohort.
Summary
Korean summary
– 코로나-19 검사를 받은 69,793명 중에 코로나-19 양성이며 고혈압이 있는 1,290명을 연구대상자로 선정했으며, 이중 코로나-19 진단일로부터 30일이내에 ACEI 또는 ARB를 사용한 환자는 682명이었음. – ACEI 또는 ARB 사용은 비사용 대비 사망 또는 폐 관련 질환의 위험과의 관련성이 없었음. – 하위그룹 분석에서 남성 또는 기저 폐질환 보유 환자에서 ACEI 또는 ARB 사용이 코로나-19 예후 악화를 예방하는 트렌드를 보였음.
Key Message
– Among 69,793 individuals screened for COVID-19, we identified 1,290 patients with hypertension who tested positive, of whom 682 had records of using ACEIs or ARBs in the 30 days before their COVID-19 diagnosis. – ACEI/ARB use (compared with non-use) was not associated with all-cause mortality or respiratory events. – A subgroup analysis showed a trend toward a protective role of ACEIs and ARBs against the overall composite endpoint of poor outcomes in men and those with pre-existing respiratory disease.

Citations

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