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Unequal burdens of COVID-19 infection: a nationwide cohort study of COVID-19-related health inequalities in Korea
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Jeangeun Jeon, Jieun Park, Min-Hyeok Choi, Hongjo Choi, Myoung-Hee Kim
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Epidemiol Health. 2023;45:e2023068. Published online July 31, 2023
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DOI: https://doi.org/10.4178/epih.e2023068
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Abstract
OBJECTIVES
While the Korean government’s response to the coronavirus disease 2019 (COVID-19) pandemic is considered effective given the relatively low mortality rate, issues of inequality have been insufficiently addressed. This study explored COVID-19-related health inequalities in Korea.
METHODS Age standardization for various health inequality indices was derived using data from the Korean National Health Insurance Service, the Korea Disease Control and Prevention Agency, and the Microdata Integrated Service of Statistics Korea. The slope index of inequality (SII) and relative index of inequality (RII) were calculated for socioeconomic variables, while absolute difference (AD) and relative difference (RD) were used for gender and disability inequalities.
RESULTS We observed a number of COVID-19-related health outcome inequalities. Gender inequality was particularly noticeable in infection rates, with the rate of women 1.16 times higher than that of men. In contrast, socioeconomic inequality was evident in vaccination rates, with a 4.5-fold (SII, -4.519; 95% confidence interval, -7.403 to -1.634) difference between the highest and lowest household income groups. Regarding clinical progression post-infection, consistent findings indicated higher risk for men (RD for hospitalization, 0.90; severe cases, 0.54; and fatality, 0.65), individuals with disabilities (RD for hospitalization, 2.27; severe cases, 2.29; and fatality, 2.37), and those from lower socioeconomic groups (SII for hospitalization, 1.778; severe cases, 0.089; and fatality, 0.451).
CONCLUSIONS While the infection risk was nearly ubiquitous, not everyone faced the same level of risk post-infection. To prevent further health inequalities, it is crucial to develop a thoughtful policy acknowledging individual health conditions and resources.
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Summary
Korean summary
2020년 10월-2022년 4월까지의 국내 코로나-19 확진자 데이터와 건강보험 빅데이터, 사망등록통계를 연계하여 건강결과의 불평등 지표를 산출한 결과, 감염율, 백신접종율, 입원율, 중증화율, 치명률에서 소득수준(건강보험료 소득분위 기준), 성별, 장애유무에 따른 건강결과의 불평등이 확인되었다. 감염율은 여성이 남성보다 높았고, 백신접종율은 장애인과 의료급여 수급권자의 비율이 낮게 나타났고, 코로나-19로 인한 입원율과 중증화율, 치명율에서는 남성, 의료급여 수급권자, 장애인의 취약성이 두드러졌다. 본 연구의 분석결과는 국내 방역정책이 기존의 사회불평등을 충분하게 고려하지 못했을 가능성이 크며, 미래 감염병 관리 시 이를 고려하여 불평등을 완화시킬 수 있는 방향의 정책적 전략이 필요하다는 점을 시사한다.
Key Message
This study sought to investigate COVID-19-related health inequalities in Korea by linking COVID-19 registry data to the KNHIS big data and the cause of death data for the period October 2020 - April 2022. COVID-19-related health outcome inequalities were observed in infection, vaccination, hospitalization, clinical progress, and fatality by household income, gender, and disability. The infection rate was higher in women, the vaccination proportion was lower in the disabled and medical-aid beneficiaries, and men, the disabled and medical-aid beneficiaries were vulnerable in clinical progression post-infection which implies that a policy necessarily should consider existing socioeconomic inequalities for future pandemics.
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Effects of particulate air pollution on tuberculosis development in seven major cities of Korea from 2010 to 2016: methodological considerations involving long-term exposure and time lag
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Honghyok Kim, Sarah Yu, Hongjo Choi
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Epidemiol Health. 2020;42:e2020012. Published online March 12, 2020
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DOI: https://doi.org/10.4178/epih.e2020012
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11,342
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Abstract
OBJECTIVES
Epidemiological evidence of associations between ambient particulate matter (PM) and tuberculosis (TB) risk is accumulating. Two previous studies in Korea found associations between air pollution—especially sulfur dioxide (SO<sub>2</sub>)—and TB. In this study, we conducted an annual time-series cross-sectional study to assess the effect of PM with an aerodynamic diameter less than 10 μm (PM<sub>10</sub>) on TB risk in seven major cities of Korea from 2010 to 2016, taking into account time lag and long-term cumulative exposure.
METHODS Age-standardized TB notification rates were derived using the Korea National TB Surveillance System. Annual average PM<sub>10</sub> concentrations were obtained from annual Korean air quality reports. We applied a generalized linear mixed model with unconstrained distributed lags of exposure to PM<sub>10</sub>. We adjusted for potential confounders such as age, health behaviors, and area-level characteristics.
RESULTS Both average annual PM<sub>10</sub> concentrations and age-standardized TB notification rates decreased over time. The association between cumulative exposure to PM<sub>10</sub> and TB incidence became stronger as a longer exposure duration was considered. An increase of one standard deviation (5.63 μg/m<sup>3</sup>) in PM<sub>10</sub> exposure for six years was associated with a 1.20 (95% confidence interval, 1.17 to 1.22) times higher TB notification rate. The marginal association of exposure duration with the TB notification rate was highest at four and five years prior to TB notification. This association remained consistent even after adjusting it for exposure to SO<sub>2</sub>.
CONCLUSIONS The findings of this study suggest that cumulative exposure to PM<sub>10</sub> may affect TB risk, with a potential lag effect.
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Summary
Korean summary
국외 연구에서 미세먼지와 결핵발생의 관련성이 종종 보고되지만, 기존의 국내 연구에서는 관련성이 없는 것으로 알려져 있다. 본 연구는 미세먼지 노출의 누적효과와 결핵발생과의 시차에 주목하여 수행했다. 연구결과 미세먼지의 누적 노출 효과가 시간적 격차는 결핵발생률과 관련이 확인되었으며, 향후 연구에서도 이와 같은 방법론적 고려가 필요하겠다
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Citations
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