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COVID-19: Original Article
Socioeconomic disparities in Korea by health insurance type during the COVID-19 pandemic: a nationwide study
Han Eol Jeong, Jongseong Lee, Hyun Joon Shin, Ju-Young Shin
Epidemiol Health. 2021;43:e2021007.   Published online January 13, 2021
DOI: https://doi.org/10.4178/epih.e2021007
  • 13,188 View
  • 426 Download
  • 14 Web of Science
  • 13 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study explored socioeconomic disparities in Korea using health insurance type as a proxy during the ongoing coronavirus disease 2019 (COVID-19) pandemic.
METHODS
We conducted a retrospective cohort study using Korea’s nationwide healthcare database, which contained all individuals who received a diagnostic test for COVID-19 (n=232,390) as of May 15, 2020. We classified our cohort by health insurance type into beneficiaries of the National Health Insurance (NHI) or Medicaid programs. Our study outcomes were infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and COVID-19-related outcomes, a composite of all-cause death, intensive care unit admission, and mechanical ventilation use. We estimated age-, sex-, and Charlson comorbidity index score–adjusted odds ratios (aORs) with 95% confidence intervals (CIs) using a multivariable logistic regression analysis.
RESULTS
Of the 218,070 NHI and 14,320 Medicaid beneficiaries who received COVID-19 tests, 7,777 and 738 tested positive, respectively. The Medicaid beneficiaries were older (mean age, 57.5 vs. 47.8 years), more likely to be males (47.2 vs. 40.2%), and had a higher comorbidity burden (mean CCI, 2.0 vs. 1.7) than NHI beneficiaries. Compared to NHI beneficiaries, Medicaid beneficiaries had a 22% increased risk of SARS-CoV-2 infection (aOR, 1.22; 95% CI, 1.09 to 1.38), but had no significantly elevated risk of COVID-19-related outcomes (aOR 1.10, 95% CI 0.77 to 1.57); the individual events of the composite outcome yielded similar findings.
CONCLUSIONS
As socioeconomic factors, with health insurance as a proxy, could serve as determinants during the current pandemic, pre-emptive support is needed for high-risk groups to slow its spread.
Summary
Korean summary
사회경제적 수준과 코로나19 발생률 및 예후 간 연관성 등 코로나19로 인한 건강 불평등 현상은 아직 확인된 바가 없다. 건강보험 가입자 대비 의료급여 수급권자에서 SARS-CoV-2의 감염 위험이 더 높게 나타났다. 코로나19의 확산을 늦추기 위해서는, 의료급여 수급권자를 비롯한 취약계층 대상의 선제적 지원이 제공되어야 한다.
Key Message
Socioeconomic status, with health insurance as a proxy, could explain health inequalities in clinical outcomes, diverse disease incidence and prognosis, during the COVID-19 pandemic.

Citations

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    Ilsu Park, Kyounga Lee, Eunshil Yim
    Healthcare.2023; 11(13): 1811.     CrossRef
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    Sungmin Lee, Jungha Park, Jae-ryun Lee, Jin Yong Lee, Byung sung Kim, Chang Won Won, Hyejin Lee, Sunyoung Kim
    Annals of Geriatric Medicine and Research.2023; 27(3): 241.     CrossRef
  • The road to recovery: impact of COVID-19 on healthcare utilization in South Korea in 2016–2022 using an interrupted time-series analysis
    Katelyn Jison Yoo, Yoonkyoung Lee, Seulbi Lee, Rocco Friebel, Soon-ae Shin, Taejin Lee, David Bishai
    The Lancet Regional Health - Western Pacific.2023; 41: 100904.     CrossRef
  • Unequal burdens of COVID-19 infection: a nationwide cohort study of COVID-19-related health inequalities in Korea
    Jeangeun Jeon, Jieun Park, Min-Hyeok Choi, Hongjo Choi, Myoung-Hee Kim
    Epidemiology and Health.2023; 45: e2023068.     CrossRef
  • Increased Healthcare Delays in Tuberculosis Patients During the First Wave of COVID-19 Pandemic in Korea: A Nationwide Cross-Sectional Study
    Jinsoo Min, Yousang Ko, Hyung Woo Kim, Hyeon-Kyoung Koo, Jee Youn Oh, Yun-Jeong Jeong, Hyeon Hui Kang, Kwang Joo Park, Yong Il Hwang, Jin Woo Kim, Joong Hyun Ahn, Yangjin Jegal, Ji Young Kang, Sung-Soon Lee, Jae Seuk Park, Ju Sang Kim
    Journal of Korean Medical Science.2022;[Epub]     CrossRef
  • Socioeconomic Inequalities in COVID-19 Incidence During Different Epidemic Phases in South Korea
    Dae-sung Yoo, Minji Hwang, Byung Chul Chun, Su Jin Kim, Mia Son, Nam-Kyu Seo, Myung Ki
    Frontiers in Medicine.2022;[Epub]     CrossRef
  • Neighbourhood socio-economic vulnerability and access to COVID-19 healthcare during the first two waves of the pandemic in Geneva, Switzerland: A gender perspective
    Denis Mongin, Stéphane Cullati, Michelle Kelly-Irving, Maevane Rosselet, Simon Regard, Delphine S. Courvoisier
    eClinicalMedicine.2022; 46: 101352.     CrossRef
  • Analysis of the Relationship between Socioeconomic Status and Incidence of Hysterectomy Using Data of the Korean Genome and Epidemiology Study (KoGES)
    Yung-Taek Ouh, Kyung-Jin Min, Sanghoon Lee, Jin-Hwa Hong, Jae Yun Song, Jae-Kwan Lee, Nak Woo Lee
    Healthcare.2022; 10(6): 997.     CrossRef
  • Effect of socioeconomic disparities on the risk of COVID-19 in 8 metropolitan cities in the Korea: a community-based study
    Myung-Jae Hwang, Shin Young Park, Tae-Ho Yoon, Jinhwa Jang, Seon-Young Lee, Myeongsu Yoo, Yoo-Yeon Kim, Hae-Kwan Cheong, Donghyok Kwon, Jong-Hun Kim
    Epidemiology and Health.2022; 44: e2022107.     CrossRef
  • The determinants of caregiver use and its costs for elderly inpatients in Korea: a study applying Andersen’s behavioral model of health care utilization and replacement cost method
    Jennifer Ivy Kim, Sukil Kim
    BMC Health Services Research.2021;[Epub]     CrossRef
  • Dissection of non-pharmaceutical interventions implemented by Iran, South Korea, and Turkey in the fight against COVID-19 pandemic
    Mohammad Keykhaei, Sogol Koolaji, Esmaeil Mohammadi, Reyhaneh Kalantar, Sahar Saeedi Moghaddam, Arya Aminorroaya, Shaghayegh Zokaei, Sina Azadnajafabad, Negar Rezaei, Erfan Ghasemi, Nazila Rezaei, Rosa Haghshenas, Yosef Farzi, Sina Rashedi, Bagher Larijan
    Journal of Diabetes & Metabolic Disorders.2021; 20(2): 1919.     CrossRef
  • The associations of previous influenza/upper respiratory infection with COVID-19 susceptibility/morbidity/mortality: a nationwide cohort study in South Korea
    So Young Kim, Joo-Hee Kim, Miyoung Kim, Jee Hye Wee, Younghee Jung, Chanyang Min, Dae Myoung Yoo, Songyong Sim, Hyo Geun Choi
    Scientific Reports.2021;[Epub]     CrossRef
COVID-19: Original Article
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
  • 28,681 View
  • 450 Download
  • 8 Web of Science
  • 8 Crossref
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

Citations to this article as recorded by  
  • Systematic review and meta-analysis of the clinical outcomes of ACEI/ARB in East-Asian patients with COVID-19
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    PLOS ONE.2023; 18(1): e0280280.     CrossRef
  • Mortality and Severity in COVID-19 Patients on ACEIs and ARBs—A Systematic Review, Meta-Analysis, and Meta-Regression Analysis
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    Frontiers in Medicine.2022;[Epub]     CrossRef
  • Renin‐Angiotensin Aldosterone System Inhibitors and COVID‐19: A Systematic Review and Meta‐Analysis Revealing Critical Bias Across a Body of Observational Research
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    Journal of the American Heart Association.2022;[Epub]     CrossRef
  • Drugs acting on the renin–angiotensin–aldosterone system (RAAS) and deaths of COVID-19 patients: a systematic review and meta-analysis of observational studies
    Ruchika Sharma, Anoop Kumar, Jaseela Majeed, Ajit K. Thakur, Geeta Aggarwal
    The Egyptian Heart Journal.2022;[Epub]     CrossRef
  • Acute motor-sensory axonal polyneuropathy variant of Guillain–Barre syndrome complicating the recovery phase of coronavirus disease 2019 infection: a case report
    Ahmed Maseh Haidary, Sarah Noor, Esmatullah Hamed, Tawab Baryali, Soma Rahmani, Maryam Ahmad, Farahnaz Erfani, Hashmatullah Azimi, Habib Ul Rahman Habib, Gul Ahmad Tahiri, Ramin Saadaat, Abdul Sami Ibrahimkhil, Esmatullah Esmat, Haider Ali Malakzai
    Journal of Medical Case Reports.2021;[Epub]     CrossRef
  • Renin‐Angiotensin Aldosterone System Inhibitors in Primary Prevention and COVID‐19
    Jordan Loader, Erik Lampa, Stefan Gustafsson, Thomas Cars, Johan Sundström
    Journal of the American Heart Association.2021;[Epub]     CrossRef
  • Role of Hypertension on the Severity of COVID-19: A Review
    Mei Peng, Jia He, Ying Xue, Xue Yang, Shao Liu, Zhicheng Gong
    Journal of Cardiovascular Pharmacology.2021; 78(5): e648.     CrossRef
  • COVID-19, the Pandemic of the Century and Its Impact on Cardiovascular Diseases
    Yuanyuan Zhang, Mingjie Wang, Xian Zhang, Tianxiao Liu, Peter Libby, Guo-Ping Shi
    Cardiology Discovery.2021; 1(4): 233.     CrossRef
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