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COVID-19 Original Article Inequitable distribution of excess mortality during the COVID-19 pandemic in Korea, 2020
Jin-Hwan Kim1orcid , Saerom Kim1,2orcid , Eunhye Park1orcid , Chang-yup Kim1orcid
Epidemiol Health 2022;44e2022081-0
DOI: https://doi.org/10.4178/epih.e2022081
Published online: September 26, 2022
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1Department of Public Health, Graduate School of Public Health, Seoul National University, Seoul, Korea
2People’s Health Institute, Seoul, Korea
Corresponding author:  Chang-yup Kim,
Email: cykim@snu.ac.kr
Received: 15 June 2022   • Accepted: 26 September 2022

This study analyzed inequities in excess mortality according to region and socioeconomic position to explain the distribution of excess mortality in Korea in 2020.
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.
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.
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.

Epidemiol Health : Epidemiology and Health