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Original article Worsening of health disparities across COVID-19 pandemic stages in Korea
Hyejin Lee1,2orcid , Hyunwoo Nam3orcid , Jae-ryun Lee1orcid , Hyemin Jung4orcid , Jin Yong Lee5,6orcid
Epidemiol Health 2024;e2024038
DOI: https://doi.org/10.4178/epih.e2024038 [Accepted]
Published online: March 13, 2024
1Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
2Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
3Seoul National University College of Medicine, Seoul, Korea
4Department of Education and Human Resource Development, Seoul National University Hospital, Seoul, Korea
5Seoul National University Hospital, Seoul, Korea
6HIRA Research Institute, Health Insurance Review & Assessment Service, Wonju, Korea
7Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
8Institute of Health Policy and Management, Seoul National University Medical Research Center,, Seoul, Korea
Corresponding author:  Jin Yong Lee,
Email: jylee2000@gmail.com
Received: 10 August 2023   • Revised: 9 January 2024   • Accepted: 21 February 2024
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Abstract

OBJECTIVES
With the end of the coronavirus disease 2019 (COVID-19) pandemic, the health outcomes of this disease in Korea must be examined. We aimed to investigate health outcomes and disparities linked to socioeconomic status during the COVID-19 pandemic in Korea and to identify risk factors for hospitalization and mortality.
METHODS
This nationwide retrospective study incorporated an analysis of individuals with and without COVID-19 in Korea between January 1, 2020, and December 31, 2022. The study period was divided into 4 stages. Prevalence, hospitalization, mortality, and case-fatality rates were calculated per 100,000 population. Multivariate logistic regression was performed to identify risk factors for COVID-19 hospitalization and mortality.
RESULTS
Overall, the incidence rate was 40,601 per 100,000 population, the mortality rate was 105 per 100,000 population, and the case-fatality rate was 259 per 100,000 cases. A total of 12,577,367 new cases (24.5%) were recorded in stage 3 and 8,979,635 cases (17.5%) in stage 4. Medical Aid recipients displayed the lowest 3-year cumulative incidence rate (32,737 per 100,000) but the highest hospitalization (5,663 cases per 100,000), mortality (498 per 100,000), and case-fatality (1521 per 100,000) rates. Male sex, older age, lower economic status, non-metropolitan area of residence, high Charlson comorbidity index, and disability were associated with higher risk of hospitalization and death. Vaccination was found to reduce mortality risk.
CONCLUSIONS
As the pandemic progressed, surges were observed in incidence, hospitalization, and mortality, exacerbating disparities associated with economic status and disability. Nevertheless, Korea has maintained a low case-fatality rate across all economic groups.

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