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Cause-specific mortality in Korea during the first year of the COVID-19 pandemic

Article information

Epidemiol Health. 2022;44.e2022110
Publication date (electronic) : 2022 November 23
doi : https://doi.org/10.4178/epih.e2022110
1Department of Public Health, Keimyung University, Daegu, Korea
2Department of Environmental Medicine, Ewha Womans University College of Medicine, Seoul, Korea
Correspondence: Kyunghee Jung-Choi, Department of Environmental Medicine, Ewha Womans University College of Medicine, 25 Magokdong-ro 2-gil, Gangseo-gu, Seoul 07804, Korea, E-mail: jungchoi@ewha.ac.kr
Received 2022 August 24; Accepted 2022 November 23.

Abstract

OBJECTIVES

This study aimed to examine the trends in total mortality between 1998 and 2020 and to compare the changes in a wide range of detailed causes of death between 2020 (i.e., during the coronavirus disease 2019 [COVID-19] pandemic) and the previous year in Korea.

METHODS

We used registered population and mortality data for the years 1998–2020 obtained from Statistics Korea. The age-standardized all-cause mortality rate and the annual percent change between 1998 and 2020 were determined. The rate ratio and rate difference of the age-standardized mortality rate between 2019 and 2020 were calculated.

RESULTS

The age-standardized all-cause mortality rate in Korea has been on a downward trend since 1998, and the decline continued in 2020. In 2020, 950 people died from COVID-19, accounting for 0.3% of all deaths. Mortality decreased for most causes of death; however, the number of deaths attributed to sepsis and aspiration pneumonia increased between 2019 and 2020 for both men and women. Age-specific mortality rates decreased or remained stable between 2019 and 2020 for all age groups, except women aged 25–29. This increase was mainly attributed to a higher number of suicide deaths.

CONCLUSIONS

This study shed light on the issues of sepsis and aspiration pneumonia despite the successful response to COVID-19 in Korea in 2020. Cases of death from sepsis and aspiration pneumonia should be identified and monitored. In addition, it is necessary to develop a proactive policy to address suicide among young people, especially young women.

GRAPHICAL ABSTRACT

INTRODUCTION

It has been 3 years since coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first spread around the world. On January 30, 2020, the World Health Organization announced an international public health emergency following the initial detection of the disease in Wuhan, China, in December 2019. On February 29, 2020, it increased the global risk to “very high,” and on March 11, 2020, it declared the COVID-19 outbreak a pandemic [1]. As of July 27, 2022, a total of 570,005,017 people have been confirmed as infected, and 6,384,128 people have died [2]. New SARS-CoV-2 mutations have emerged. The COVID-19 pandemic is still going strong despite the development of COVID-19 vaccines and treatments. As of July 27, 2022, there have been 19,535,242 cases of COVID-19 in Korea and 24,957 deaths [3].

Korea’s response to COVID-19 has been successful without a nationwide lockdown [4]. Three infection crises occurred in February, August, and December 2020; however, they were all successfully resolved with a prompt government response, including diagnostic testing, contact tracing, timely treatment, quarantine, and social distancing [4,5]. Citizen cooperation was crucial to the success of the government’s quarantine efforts [6]. Vaccinations began in February 2021 [7]. This successful response has led to a low number of confirmed cases and deaths, and several studies have found that there were no excess deaths in Korea during the COVID-19 pandemic in 2020 [811].

Despite the excellent outcome of Korea’s quarantine measures, there have been reports of increased mortality due to specific causes or delayed treatment during the COVID-19 pandemic [1215]. When mortality rates were analyzed by separating them by deaths in medical facilities and deaths outside of medical facilities, a significant increase in deaths outside of medical facilities was observed in 2020. This indicates potential changes in healthcare-seeking behaviors and the accessibility of emergency medical services during the epidemic [12]. A study conducted in Taiwan, where there were no excess deaths, reported fewer deaths from pneumonia and influenza in 2020 [16]. In contrast, mortality from pneumonia, cardiovascular disease, and diabetes increased between January and March 2020 in Wuhan, a location that reported excess deaths [17]. However, studies have had limitations in analyzing a small number of causes of death or using a broader classification of causes of death. This study aimed to examine the trends in total mortality between 1998 and 2020 and compare the changes in a wide range of detailed causes of death between 2020 during the COVID-19 pandemic and the previous year in Korea.

MATERIALS AND METHODS

Data

We used registered population and mortality data for the years 1998–2020. Both data sets are publicly accessible by visiting a website administered by Statistics Korea. The number of deaths was obtained from death certificate data provided by the MicroData Integrated Service ( https://mdis.kostat.go.kr/) of Statistics Korea [18]. Mortality data included gender, age, and cause of death. Causes of death were coded according to the International Classification of Diseases, 10th revision (ICD-10). The mid-year population data based on information from the resident registration system of the Korean government were obtained from the Korean Statistical Information Service (http://kosis.kr/) of Statistics Korea [19]. The registered population data provide the number of the population according to gender and one-year age groups. Supplementary Material 1 presents the population size and number of deaths during the study period.

We categorized the causes of death into 17 broad classes and 48 specific groups (Supplementary Material 2) based on the categorization of Statistics Korea. Furthermore, sub-specific causes (i.e., alcohol-specific disorders and poisonings, smoking-related causes, and avoidable causes including amenable and preventable causes) were categorized separately. We obtained the list of causes of death associated with smoking from a 2019 United States study [20]. The list of causes of death associated with alcohol-specific disorders and poisonings was obtained from Organization for Economic Cooperation and Development (OECD)/Eurostat lists [21]. OECD/Eurostat lists were also used to categorize the causes of death that were considered amenable and preventable (Supplementary Material 3).

Statistical analysis

The rate of age-standardized all-cause mortality (per 100,000 people) and the annual percent change between 1998 and 2020 were determined. Age-standardized mortality rates and their 95% confidence intervals (CIs) according to the cause of death were calculated using direct standardization. The 2015 Korean population was used as the standard population. The rate ratio (RR) and rate difference (RD) of the age-standardized mortality rate were calculated as relative and absolute measures for differences between 2019 and 2020, respectively. Age-standardized mortality rates, RR, RD, and their 95% CIs were calculated using the PROC STDRATE procedure in SAS based on a normal distribution without bootstrap. We presented the age-standardized mortality rates by specific causes of death using 2015–2019 combined data and compared the age-standardized mortality rate between 2015–2019 and 2020 in Supplementary Materrials 35. All analyses were conducted separately for men and women using SAS version 9.4 (SAS Institute Inc., Cary, NC, USA)

Ethics statement

This study was approved by the Institutional Review Board of the Ewha Womans University College of Medicine, Seoul, Korea (SEUMC 2022-08-044).

RESULTS

In Korea, age-standardized all-cause mortality decreased from 1998–2020 (Figure 1). This trend was sustained in the first year of the COVID-19 pandemic. The age-standardized mortality rate per 100,000 people was 475.6 (95% CI, 473.8 to 477.3) in 2019 and 467.4 (95% CI, 465.7 to 469.1) in 2020. The decrease in mortality was greater among men than among women (Supplementary Material 1).

Figure 1

Trends of total mortality by gender among Korean in 1998–2020. *p<0.05.

Tables 13 show the cause-specific mortality rates and their differences between 2019 and 2020. In 2020, there were 950 (483 men and 467 women) deaths due to COVID-19. COVID-19 deaths accounted for 0.3% of all-cause mortality in 2020. Mortality decreased for most causes of death; however, it increased for sepsis, pneumonitis due to solids and liquids, and senility between 2019 and 2020 (Figure 2A–C). Among them, except for senility, the mortality rates for sepsis and pneumonitis due to solids and liquids were higher than the average mortality rate in 2015–2019 (Supplementary Materials 35). This pattern was observed for both men and women. The number of deaths attributed to sepsis was 1,183 (540 men and 643 women), and the number of deaths attributed to pneumonitis due to solids and liquids was 751 (381 men and 370 women).

Age-standardized mortality rates and differences between 2019 and 2020 by specific causes among Korean men and women

Age-standardized mortality rates and differences between 2019 and 2020 by specific causes among Korean men

Age-standardized mortality rates and differences between 2019 and 2020 by specific causes among Korean women

Figure 2

Trends of six cause-specific mortalities by gender among Korean in 1998–2020; (A) sepsis, (B) pneumonitis due to solids and liquids, (C) senility, (D) pneumonia, (E) chronic lower respiratory disease, and (F) suicide.

Among men, the mortality rate decreased the most for cancer, followed by respiratory disease and external death between 2019 and 2020. Respiratory disease, cardiovascular disease, and cancer showed the highest decrease in the mortality rate among women. Among the detailed causes, pneumonia decreased by 911 cases in 2020 compared to 2019, resulting in an RD of −3.4% (95% CI, −4.0 to −2.7), and chronic lower respiratory disease decreased by 508 people, resulting in an RD of −1.3% (95% CI, −1.6 to −1.0) (Supplementary Material 3). However, pneumonia showed a decreasing trend in 2019 and 2020 compared to 2018, and chronic lower respiratory disease also showed a decreasing pattern after 2002 (Figure 2D and E). Although the number of deaths attributed to smoking among those aged 35 and over increased, the age-standardized mortality rate decreased between 2019 and 2020. Mortality due to alcohol-specific disorders and poisonings increased for both men and women. Avoidable deaths, including those that were amenable and preventable, significantly decreased among men only.

Age-specific mortality rates were decreased or stable between 2019 and 2020 for all age groups, except for women aged 25–29 (Table 4 and Supplementary Material 6). The increase in mortality among women aged 25–29 was attributed to an increase in external causes of deaths; in particular, an increase in suicide deaths. The suicide rate among women aged 25–29 increased by 2.88 from 16.55 (per 100,000) in 2019 to 19.43 in 2020 (Figure 3 and Supplementary Material 7). Since 2017, there has been an increasing trend in the suicide rate for women aged 25–29 (Figure 2F).

Age-specific mortality rates and differences between 2019 and 2020 by specific causes among Koreans

Figure 3

The age-specific mortality rate (per 100,000) among Korean women aged 25–29 according to causes of death in 2019 and 2020. NEC, not elsewhere classified.

DISCUSSION

The age-standardized all-cause mortality in Korea has been on a downward trend since 1998 and this trend continued in 2020, the first year of the COVID-19 pandemic. In 2020, 950 people died from COVID-19, accounting for 0.3% of all deaths. Mortality was decreased for most causes of death; however, the number of deaths attributed to sepsis and pneumonitis due to solids and liquids increased between 2019 and 2020 for both men and women. Age-specific mortality rates decreased or were stable between 2019 and 2020 for all age groups, except for women aged 25–29. The increase in mortality among women aged 25–29 was mainly attributed to a higher number of suicide deaths.

On January 20, 2020, the first case of COVID-19 in Korea was officially confirmed by the Korea Centers for Disease Control and Prevention (hereafter “KCDC,”, the predecessor of the Korea Disease Control and Prevention Agency [KDCA], which was expanded, reorganized, and renamed on September 12, 2020) [5]. Korea had a successful COVID-19 response, including a testing-tracing-treatment (3T) strategy, swift application of focused, social distancing measures in high transmission areas, border control, and risk communication [4,6,22]. The cost of COVID-19 testing, quarantine, and treatment was covered by the Korean government and national health insurance program to reduce the economic burden [22]. Financial support for hospitalized or quarantined people was also provided [23]. These countermeasures led to a relatively low rate of confirmed cases and a low fatality rate, despite three COVID-19 waves in 2020 [2426]. Based on the findings of this study, 950 deaths from COVID-19 were confirmed in 2020 death certificate data, accounting for only 0.3% of the total deaths. Along with the overall decrease in deaths attributed to other causes, the age-adjusted all-cause mortality rate in Korea decreased in 2020. This is in agreement with the findings of other studies analyzing the total mortality rate in Korea, which reported no excess deaths in 2020 [8,12].

However, a significant increase in death from sepsis may suggest the direct or indirect effects of COVID-19. The manifestations of COVID-19 range from asymptomatic to life-threatening sepsis [27], and sepsis findings were reported in all deceased patients in a previous study [28]. If death occurred after a COVID-19 polymerase chain reaction test was negative and the patient was transferred from the isolation ward to the general ward, the cause of death on the death certificate may only list sepsis without any mention of COVID-19 [29]. However, appropriate treatment for sepsis due to other causes may have been delayed or insufficient. The Korean government has prioritized medical resources for COVID-19 treatment to cope with the COVID-19 pandemic [30]. At the end of 2020, the government secured around 6,000 beds in infectious disease hospitals and supported the deployment of medical and paramedical personnel [31], which may have disrupted existing medical care. Delays in the management of patients with acute stroke or acute myocardial infarction during the pandemic were reported [14,15,32]. Additionally, longer or delayed emergency transfer times were noted [33]. In particular, in the case of fever with sepsis, emergency transportation was sometimes refused [34]. Therefore, it is necessary to monitor the occurrence of sepsis and associated death during the COVID-19 pandemic.

Cases of pneumonitis due to solids and liquids (i.e., aspiration pneumonia) also significantly increased. Approximately 5–15% of cases of community-acquired pneumonia may be attributed to aspiration pneumonia [35,36]; compared with other types of community-acquired pneumonia, aspiration pneumonia is associated with higher mortality [35]. The risk factors for aspiration pneumonia include impaired swallowing, degenerative neurologic diseases, impaired consciousness, poor dentition, and old age [35,37]. Aspiration pneumonia is a serious condition for those living in long-term care facilities, as these individuals are more likely to have risk factors [38,39]. Therefore, caregivers play a crucial role in preventing aspiration pneumonia [3941]. As clusters of infections occurred in long-term care facilities among the elderly in the early stages of the COVID-19 pandemic, the government established guidelines for restricting visits (February 24, 2020) and eventually banned all visits (March 13, 2020) [42]. Cohort isolation was implemented when cases were confirmed in long-term care facilities for the elderly, and preventive cohort isolation was practiced in some places [43]. The quality of care for the elderly may have been reduced as the additional quarantine measures increased caregivers’ work burden and prevented family visits [42,43]. Moreover, similar to cases of sepsis, treatment for patients with fever associated with aspiration pneumonia may have been delayed [43]. A more thorough investigation of aspiration pneumonia deaths, taking into account the COVID-19 pandemic in 2021–2022, is required.

In this study, only the mortality rate for women aged 25–29 increased significantly in 2020 compared with 2019, which could be explained by a considerable increase in suicide deaths. However, the increase in the suicide rate of young Korean women is a trend that has continued since 2017 rather than a specific consequence of the 2020 COVID-19 pandemic, and it is not only limited to women aged 25–29 but also common among men and women in their 20s. The suicide rate from 2017 to 2020 in Korea increased from 16.7 (per 100,000) to 19.8 for men aged 20–24 and from 25.3 to 27.5 for men aged 25–29. The suicide rate of women was higher than that of men and increased from 9.5 (per 100,000) to 19.3 for women aged 20–24, and from 13.4 to 19.4 for women aged 25–29 [44]. Unemployment, job insecurity, financial hardships, social exclusion, and social isolation have been suggested as social risk factors for suicide among young adults [45,46]. Specifically, gender inequality and conflict may influence the suicide rate of young women [45]. However, the COVID-19 pandemic could also be related to suicide, as the risk of suicidal thoughts may have increased due to quarantine, exhaustion, social distancing, unemployment, and financial hardships [47]. Therefore, it is necessary to monitor changes in suicide patterns as long as the COVID-19 pandemic persists.

Senility, pneumonia, and chronic lower respiratory disease also showed significant changes in 2020 compared to 2019. However, when all of these diseases were analyzed by extending the period, it was difficult to judge that the change was a specific change from 2019 to 2020. However, since a decrease in pneumonia and chronic lower respiratory disease during the COVID-19 period has been reported in other studies [48], it is necessary to follow up in 2021 and 2022.

The study findings should be interpreted with caution due to certain limitations. First, death certificate data may be inaccurate, which could directly affect the accuracy of the study results. All deaths in Korea must be reported to the National Statistical Office within 1 month. When reporting the cause of death, death certification by a doctor is essential. In Korea, the rate of death registrations accompanied by a doctor’s medical certificate of death has continuously increased over the years, surpassing 90% since 2007, and after 2015—this study’s objective period—it exceeded 99% [49]. However, issues could arise due to the doctors’ lack of training and expertise in death certification [50]. A non-differential misclassification bias caused by the inaccuracies in recording the cause of death may not significantly affect the direction of annual comparison results, but it may have limitations in calculating an accurate mortality rate. Second, the projected mortality rate and the existing mortality rate may be compared to examine excess deaths; however, in this study, 2019 and 2020 were directly compared. For a more rigorous interpretation, we also analyzed whether the absolute death toll was relatively high and whether there were cases where the mortality rate exceeded the average between 2015 and 2019.

Despite its limitations, this study shed light on the issues of sepsis and aspiration pneumonia despite the successful response to COVID-19 in Korea. Cases of deaths from sepsis and aspiration pneumonia should be identified and monitored and preventive measures should be implemented. A proactive policy to address suicide among young people, especially young women, must be developed.

Acknowledgements

None.

Notes

CONFLICT OF INTEREST

The authors have no conflicts of interest to declare for this study.

AUTHOR CONTRIBUTIONS

Both authors contributed equally to conceiving the study, analyzing the data, and writing this paper.

FUNDING

None.

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Article information Continued

Figure 1

Trends of total mortality by gender among Korean in 1998–2020. *p<0.05.

Figure 2

Trends of six cause-specific mortalities by gender among Korean in 1998–2020; (A) sepsis, (B) pneumonitis due to solids and liquids, (C) senility, (D) pneumonia, (E) chronic lower respiratory disease, and (F) suicide.

Figure 3

The age-specific mortality rate (per 100,000) among Korean women aged 25–29 according to causes of death in 2019 and 2020. NEC, not elsewhere classified.

Table 1

Age-standardized mortality rates and differences between 2019 and 2020 by specific causes among Korean men and women

Causes 2019 2020 Between 2019 and 2020



No. of deaths Age-standardized mortality rates (per 100,000) No. of deaths Age-standardized mortality rates (per 100,000) No. of difference RR (95% CI)
Certain infectious and parasitic diseases 8,692 13.7 (13.4–14.0) 10,419 15.5 (15.2–15.8) 1.13 (1.10, 1.16)
 Tuberculosis 1,610 2.5 (2.4–2.7) 1,356 2.0 (1.9–2.1) −254 0.81 (0.75, 0.87)
 Sepsis 4,903 7.6 (7.4–7.8) 6,086 8.9 (8.7–9.1) 1,183 1.17 (1.13, 1.22)
 COVID-19 - - 950 1.4 (1.3–1.5) 950 -

Malignant neoplasms 81,203 134.0 (133.1–134.9) 82,204 130.1 (129.2–131.0) 0.97 (0.96, 0.98)
 Esophageal cancer 1,554 2.6 (2.4–2.7) 1,564 2.5 (2.4–2.6) 10 0.96 (0.90, 1.03)
 Stomach cancer 7,624 12.5 (12.3–12.8) 7,510 11.9 (11.6–12.1) −114 0.95 (0.92, 0.98)
 Colorectal cancer 8,966 14.6 (14.3–14.9) 8,944 13.9 (13.6–14.2) −22 0.95 (0.92, 0.98)
 Liver cancer 10,586 17.8 (17.4–18.1) 10,565 17.0 (16.7–17.3) −21 0.96 (0.93, 0.98)
 Gallbladder cancer 1,906 3.1 (2.9–3.2) 1,890 2.9 (2.8–3.0) −16 0.95 (0.89, 1.01)
 Biliary tract cancer 3,082 5.0 (4.8–5.1) 3,302 5.1 (4.9–5.2) 220 1.02 (0.97, 1.07)
 Pancreatic cancer 6,396 10.5 (10.3–10.8) 6,775 10.7 (10.4–10.9) 379 1.01 (0.98, 1.05)
 Lung cancer 18,574 30.3 (29.8–30.7) 18,673 29.1 (28.7–29.5) 99 0.96 (0.94, 0.98)
 Breast cancer, female 2,622 4.6 (4.5–4.8) 2,725 4.7 (4.5–4.9) 103 1.02 (0.96, 1.07)
 Ovarian cancer 1,234 2.1 (2.0–2.2) 1,369 2.3 (2.2–2.4) 135 1.08 (1.00, 1.16)
 Prostate cancer 2,047 3.2 (3.1–3.4) 2,194 3.3 (3.1–3.4) 147 1.02 (0.96, 1.08)
 Bladder cancer 1,550 2.4 (2.3–2.6) 1,593 2.4 (2.3–2.5) 43 0.98 (0.91, 1.05)
 Non-Hodgkin’s lymphoma 2,015 3.3 (3.2–3.5) 2,069 3.3 (3.2–3.4) 54 0.99 (0.93, 1.05)
 Leukemia 1,911 3.3 (3.1–3.4) 1,825 3.0 (2.9–3.2) −86 0.93 (0.87, 0.99)

Endocrine, nutritional and metabolic diseases 9,502 15.2 (14.9–15.5) 10,052 15.3 (15.0–15.6) 1.01 (0.98, 1.03)
 Diabetes mellitus 8,102 12.9 (12.6–13.2) 8,456 12.8 (12.5–13.1) 354 0.99 (0.96, 1.02)

Mental and behavioral disorders and nervous system diseases 17,575 27.2 (26.8–27.6) 18,138 26.5 (26.1–26.9) 0.97 (0.95, 0.99)
 Dementia 1,0357 15.3 (15.0–15.6) 10,641 14.6 (14.3–14.9) 284 0.95 (0.93, 0.98)
 Alcoholism 916 1.6 (1.5–1.8) 1,089 1.9 (1.8–2.0) 173 1.16 (1.06, 1.26)
 Parkinson’s disease 3,476 5.4 (5.2–5.6) 3,571 5.3 (5.1–5.4) 95 0.98 (0.93, 1.02)

Diseases of the circulatory system 60,252 94.8 (94.0–95.6) 62,196 92.5 (91.8–93.3) 0.98 (0.96, 0.99)
 Hypertensive diseases 5,631 8.5 (8.2–8.7) 6,100 8.6 (8.3–8.8) 469 1.01 (0.98, 1.05)
 Ischemic heart diseases 13,699 21.8 (21.5–22.2) 14,056 21.3 (21.0–21.7) 357 0.98 (0.95, 1.00)
 Heart failure 6,758 10.2 (10.0–10.4) 7,256 10.2 (10.0–10.4) 498 1.00 (0.97, 1.03)
 Cerebrovascular diseases 21,586 34.2 (33.8–34.7) 21,860 32.8 (32.4–33.3) 274 0.96 (0.94, 0.98)
  Hemorrhagic stroke 6,942 11.5 (11.3–11.8) 7,092 11.3 (11.0–11.6) 150 0.98 (0.95, 1.01)
  Ischemic stroke 7,103 10.9 (10.7–11.2) 7,414 10.7 (10.5–11.0) 311 0.98 (0.95, 1.01)
  Other stroke 7,541 11.8 (11.5–12.0) 7,354 10.8 (10.6–11.1) −187 0.92 (0.89, 0.95)

Diseases of the respiratory system 36,655 56.2 (55.6–56.8) 36,368 52.5 (52.0–53.1) 0.94 (0.92, 0.95)
 Pneumonia 23,168 35.3 (34.8–35.7) 22,257 31.9 (31.5–32.4) −911 0.90 (0.89, 0.92)
 Chronic lower respiratory diseases 6,176 9.5 (9.3–9.7) 5,668 8.2 (8.0–8.4) −508 0.86 (0.83, 0.90)
 Pneumonitis due to solids and liquids 2,631 4.0 (3.9–4.2) 3,382 4.9 (4.7–5.0) 751 1.21 (1.15, 1.27)
 Interstitial pulmonary diseases 1,813 2.9 (2.8–3.1) 1,806 2.8 (2.6–2.9) −7 0.95 (0.89, 1.01)

Diseases of the digestive system 11,963 20.0 (19.6–20.4) 12,870 20.7 (20.3–21.0) 1.03 (1.01, 1.06)
 Liver diseases 6,496 11.4 (11.1–11.7) 6,979 11.9 (11.6–12.2) 483 1.05 (1.01, 1.08)
  Alcoholic liver disease 3,658 6.6 (6.4–6.8) 3,941 7.0 (6.8–7.2) 283 1.05 (1.01, 1.10)
  Liver cirrhosis 2,133 3.6 (3.4–3.8) 2,202 3.6 (3.5–3.8) 69 1.00 (0.94, 1.06)

Diseases of the genitourinary system 8,565 13.3 (13.1–13.6) 9,343 13.7 (13.5–14.0) 1.03 (1.00, 1.06)
 Renal failure 6,036 9.5 (9.2–9.7) 6,589 9.8 (9.6–10.0) 553 1.03 (1.00, 1.07)

Symptoms, signs and abnormal clinical and laboratory findings 28,176 43.7 (43.2–44.2) 31,801 46.2 (45.7–46.8) 1.06 (1.04, 1.07)
 Senility 13,522 19.8 (19.5–20.1) 15,823 21.4 (21.0–21.7) 2,301 1.08 (1.06, 1.11)
 Other ill-defined and unspecified causes of mortality 8,549 14.3 (14.0–14.6) 9,143 14.5 (14.2–14.8) 594 1.02 (0.99, 1.05)

External causes of morbidity and mortality 27,282 48.5 (48.0–49.1) 26,442 46.1 (45.5–46.6) 0.95 (0.93, 0.97)
 Transport accidents 4,221 7.4 (7.2–7.7) 3,947 6.8 (6.6–7.0) −274 0.91 (0.87, 0.95)
 Falls 2,665 4.5 (4.3–4.7) 2,663 4.3 (4.1–4.4) −2 0.95 (0.90, 1.00)
 Intentional self-harm 13,799 25.6 (25.2–26.0) 13,195 24.4 (24.0–24.8) −604 0.95 (0.93, 0.98)

Sub-specific causes
 Alcohol-specific disorders and poisonings 4,725 8.5 (8.3–8.8) 5,191 9.2 (8.9–9.4) 466 1.08 (1.03, 1.12)
 Smoking-related causes (+35 yr) 150,707 240.2 (239.0–241.4) 151,728 230.0 (228.8–231.1) 1,021 0.96 (0.95, 0.96)
 Avoidable causes (0–74 yr) 81,553 147.0 (146.0–148.0) 81,373 142.4 (141.4–143.4) −180 0.97 (0.96, 0.98)
  Amenable causes 32,536 58.2 (57.6–58.8) 32,843 56.7 (56.1–57.3) 307 0.97 (0.96, 0.99)
  Preventable causes 65,791 118.6 (117.7–119.5) 65,254 114.4 (113.5–115.3) −537 0.96 (0.95, 0.98)

COVID-19, coronavirus disease 2019; RR, rate ratio; CI, confidence interval.

Table 2

Age-standardized mortality rates and differences between 2019 and 2020 by specific causes among Korean men

Causes 2019 2020 Between 2019 and 2020



No. of deaths Age-standardized mortality rates (per 100,000) No. of deaths Age-standardized mortality rates (per 100,000) No. of difference RR (95% CI)
Certain infectious and parasitic diseases 4,103 17.0 (16.4–17.5) 4,890 19.2 (18.6–19.7) 1.13 (1.08, 1.18)
 Tuberculosis 977 4.1 (3.8–4.3) 842 3.3 (3.1–3.5) −135 0.82 (0.74, 0.90)
 Sepsis 2,013 8.5 (8.1–8.9) 2,553 10.1 (9.8–10.5) 540 1.19 (1.12, 1.26)
 COVID-19 - - 483 1.9 (1.7–2.1) 483 -

Malignant neoplasms 50,281 196.7 (195.0–198.5) 50,817 189.6 (188.0–191.3) 0.96 (0.95, 0.98)
 Esophageal cancer 1,425 5.4 (5.1–5.7) 1,404 5.1 (4.8–5.4) −21 0.94 (0.88, 1.02)
 Stomach cancer 4,956 19.5 (18.9–20.0) 4,807 17.9 (17.4–18.5) −149 0.92 (0.89, 0.96)
 Colorectal cancer 5,065 20.0 (19.4–20.6) 5,060 18.9 (18.4–19.4) −5 0.94 (0.91, 0.98)
 Liver cancer 7,784 29.4 (28.8–30.1) 7,812 28.5 (27.8–29.1) 28 0.97 (0.94, 1.00)
 Gallbladder cancer 805 3.2 (2.9–3.4) 838 3.1 (2.9–3.3) 33 0.99 (0.90, 1.09)
 Biliary tract cancer 1,763 7.0 (6.7–7.3) 1,946 7.3 (7.0–7.6) 183 1.05 (0.98, 1.12)
 Pancreatic cancer 3,424 13.1 (12.7–13.5) 3,452 12.6 (12.2–13.0) 28 0.96 (0.92, 1.01)
 Lung cancer 13,698 53.8 (52.9–54.7) 13,824 51.7 (50.9–52.6) 126 0.96 (0.94, 0.98)
 Prostate cancer 2,047 8.7 (8.3–9.1) 2,194 8.8 (8.4–9.1) 147 1.01 (0.95, 1.07)
 Bladder cancer 1,167 4.9 (4.6–5.2) 1,235 4.8 (4.6–5.1) 68 0.99 (0.92, 1.08)
 Non-Hodgkin’s lymphoma 1,169 4.6 (4.3–4.8) 1,192 4.5 (4.2–4.7) 23 0.98 (0.90, 1.06)
 Leukemia 1,143 4.4 (4.2–4.7) 1,048 3.9 (3.7–4.1) −95 0.88 (0.81, 0.96)

Endocrine, nutritional and metabolic diseases 4,817 19.3 (18.7–19.8) 5,105 19.5 (19.0–20.0) 1.01 (0.97, 1.05)
 Diabetes mellitus 4,121 16.5 (16.0–17.0) 4,320 16.5 (16.0–17.0) 199 1.00 (0.96, 1.04)

Mental and behavioral disorders and nervous system diseases 7,135 29.9 (29.2–30.7) 7,576 29.9 (29.2–30.6) 1.00 (0.97, 1.03)
 Dementia 3,114 14.1 (13.6–14.6) 3,329 13.9 (13.5–14.4) 215 0.99 (0.94, 1.04)
 Alcoholism 825 3.0 (2.8–3.2) 969 3.4 (3.2–3.7) 144 1.14 (1.04, 1.25)
 Parkinson’s disease 1,549 6.5 (6.2–6.8) 1,643 6.5 (6.1–6.8) 94 0.99 (0.93, 1.07)

Diseases of the circulatory system 28,672 117.7 (116.3–119.0) 29,568 115.1 (113.7–116.4) 0.98 (0.96, 0.99)
 Hypertensive diseases 1,795 7.8 (7.4–8.2) 1,997 8.1 (7.8–8.5) 202 1.04 (0.97, 1.11)
 Ischemic heart diseases 7,696 31.0 (30.3–31.7) 7,959 30.4 (29.7–31.1) 263 0.98 (0.95, 1.01)
 Heart failure 2,268 9.9 (9.5–10.3) 2,420 9.9 (9.5–10.3) 152 1.00 (0.95, 1.06)
 Cerebrovascular diseases 10,626 43.5 (42.6–44.3) 10,630 41.2 (40.5–42.0) 4 0.95 (0.92, 0.98)
  Hemorrhagic stroke 3,561 14.0 (13.6–14.5) 3,534 13.4 (12.9–13.8) −27 0.95 (0.91, 1.00)
  Ischemic stroke 3,435 14.6 (14.1–15.1) 3,614 14.4 (13.9–14.9) 179 0.99 (0.94, 1.03)
  Other stroke 3,630 14.8 (14.4–15.3) 3,482 13.5 (13.0–14.0) −148 0.91 (0.87, 0.95)

Diseases of the respiratory system 20,513 89.0 (87.8–90.3) 20,671 83.5 (82.3–84.6) 0.94 (0.92, 0.96)
 Pneumonia 12,157 53.3 (52.4–54.3) 12,085 49.2 (48.3–50.0) −72 0.92 (0.90, 0.95)
 Chronic lower respiratory diseases 4,055 17.6 (17.0–18.1) 3,678 14.9 (14.4–15.3) −377 0.85 (0.81, 0.88)
 Pneumonitis due to solids and liquids 1,525 6.7 (6.3–7.0) 1,906 7.8 (7.4–8.1) 381 1.16 (1.09, 1.24)
 Interstitial pulmonary diseases 1,180 4.7 (4.4–5.0) 1,185 4.5 (4.2–4.8) 5 0.96 (0.88, 1.04)

Diseases of the digestive system 7,316 28.2 (27.5–28.8) 7,922 29.4 (28.8–30.1) 1.04 (1.01, 1.08)
 Liver diseases 4,772 17.8 (17.3–18.3) 5,192 18.9 (18.4–19.4) 420 1.06 (1.02, 1.11)
  Alcoholic liver disease 3,140 11.6 (11.2–12.0) 3,354 12.0 (11.6–12.5) 214 1.04 (0.99, 1.09)
  Liver cirrhosis 1,248 4.7 (4.4–5.0) 1,333 4.9 (4.6–5.2) 85 1.04 (0.97, 1.13)

Diseases of the genitourinary system 3,712 15.6 (15.1–16.1) 4,113 16.3 (15.8–16.8) 1.04 (1.00, 1.09)
 Renal failure 2,990 12.5 (12.0–12.9) 3,323 13.0 (12.6–13.5) 333 1.05 (1.00, 1.10)

Symptoms, signs and abnormal clinical and laboratory findings 12,542 52.9 (51.9–53.8) 14,135 56.4 (55.5–57.4) 1.07 (1.04, 1.09)
 Senility 4,210 19.8 (19.2–20.4) 5,150 22.2 (21.6–22.8) 940 1.12 (1.08, 1.17)
 Other ill-defined and unspecified causes of mortality 5,391 21.0 (20.5–21.6) 5,602 21.1 (20.5–21.6) 211 1.00 (0.96, 1.04)

External causes of morbidity and mortality 18,896 73.1 (72.0–74.1) 18,032 68.2 (67.2–69.2) 0.93 (0.91, 0.95)
 Transport accidents 3,162 12.1 (11.7–12.6) 2,955 11.0 (10.6–11.4) −207 0.91 (0.86, 0.95)
 Falls 1,928 7.5 (7.2–7.8) 1,926 7.2 (6.8–7.5) −2 0.96 (0.90, 1.02)
 Intentional self-harm 9,730 37.3 (36.6–38.1) 9,093 34.5 (33.8–35.3) −637 0.93 (0.90, 0.95)

Sub-specific causes
 Alcohol-specific disorders and poisonings 4,084 15.0 (14.6–15.5) 4,459 16.0 (15.5–16.5) 375 1.06 (1.02, 1.11)
 Smoking-related causes (+35 yr) 86,831 351.1 (348.8–353.5) 87,599 335.5 (333.2–337.7) 768 0.96 (0.95, 0.96)
 Avoidable causes (0–74 yr) 58,665 214.2 (212.5–215.9) 58,339 206.2 (204.5–207.9) −326 0.96 (0.95, 0.97)
  Amenable causes 20,793 75.8 (74.8–76.9) 20,999 73.6 (72.6–74.6) 206 0.97 (0.95, 0.99)
  Preventable causes 49,725 181.4 (179.8–183.0) 49,148 174.0 (172.4–175.5) −577 0.96 (0.95, 0.97)

COVID-19, coronavirus disease 2019; RR, rate ratio; CI, confidence interval.

Table 3

Age-standardized mortality rates and differences between 2019 and 2020 by specific causes among Korean women

Causes 2019 2020 Between 2019 and 2020



No. of deaths Age-standardized mortality rates (per 100,000) No. of deaths Age-standardized mortality rates (per 100,000) No. of difference RR (95% CI)
Certain infectious and parasitic diseases 4,589 11.1 (10.7–11.4) 5,529 12.6 (12.3–13.0) 1.14 (1.10, 1.19)
 Tuberculosis 633 1.5 (1.4–1.6) 514 1.2 (1.1–1.3) −119 0.78 (0.69, 0.88)
 Sepsis 2,890 6.8 (6.5–7.1) 3,533 7.9 (7.6–8.2) 643 1.16 (1.10, 1.22)
 COVID-19 - - 467 1.1 (1.0–1.2) 467 -

Malignant neoplasms 30,922 89.3 (88.3–90.3) 31,387 87.5 (86.5–88.5) 0.98 (0.96, 1.00)
 Esophageal cancer 129 0.4 (0.3–0.4) 160 0.5 (0.4–0.5) 31 1.22 (0.96, 1.54)
 Stomach cancer 2,668 7.5 (7.2–7.8) 2,703 7.4 (7.1–7.7) 35 0.99 (0.94, 1.05)
 Colorectal cancer 3,901 10.6 (10.3–11.0) 3,884 10.1 (9.8–10.4) −17 0.95 (0.91, 1.00)
 Liver cancer 2,802 8.0 (7.7–8.3) 2,753 7.5 (7.2–7.8) −49 0.93 (0.89, 0.99)
 Gallbladder cancer 1,101 3.0 (2.8–3.2) 1,052 2.8 (2.6–2.9) −49 0.92 (0.85, 1.01)
 Biliary tract cancer 1,319 3.5 (3.3–3.7) 1,356 3.4 (3.2–3.6) 37 0.98 (0.91, 1.06)
 Pancreatic cancer 2,972 8.4 (8.1–8.7) 3,323 9.0 (8.7–9.3) 351 1.07 (1.02, 1.13)
 Lung cancer 4,876 13.5 (13.1–13.9) 4,849 12.9 (12.5–13.2) −27 0.95 (0.92, 0.99)
 Breast cancer 2,622 8.9 (8.6–9.3) 2,725 9.1 (8.7–9.4) 103 1.02 (0.96, 1.07)
 Ovarian cancer 1,234 4.0 (3.8–4.2) 1,369 4.3 (4.1–4.5) 135 1.08 (1.00, 1.17)
 Bladder cancer 383 1.0 (0.9–1.0) 358 0.9 (0.8–1.0) −25 0.91 (0.78, 1.05)
 Non-Hodgkin’s lymphoma 846 2.5 (2.3–2.6) 877 2.4 (2.3–2.6) 31 0.99 (0.90, 1.09)
 Leukemia 768 2.4 (2.2–2.5) 777 2.4 (2.2–2.5) 9 1.00 (0.90, 1.11)

Endocrine, nutritional and metabolic diseases 4,685 11.7 (11.3–12.0) 4,947 11.7 (11.4–12.0) 1.00 (0.96, 1.04)
 Diabetes mellitus 3,981 9.9 (9.6–10.2) 4,136 9.8 (9.5–10.1) 155 0.99 (0.94, 1.03)

Mental and behavioral disorders and nervous system diseases 10,440 24.0 (23.5–24.5) 10,562 22.9 (22.4–23.3) 0.95 (0.93, 0.98)
 Dementia 7,243 15.4 (15.0–15.7) 7,312 14.4 (14.1–14.8) 69 0.94 (0.91, 0.97)
 Alcoholism 91 0.3 (0.3–0.4) 120 0.4 (0.4–0.5) 29 1.30 (0.98, 1.71)
 Parkinson’s disease 1,927 4.7 (4.5–4.9) 1,928 4.5 (4.3–4.7) 1 0.95 (0.89, 1.02)

Diseases of the circulatory system 31,580 75.3 (74.4–76.1) 32,628 73.3 (72.5–74.1) 0.97 (0.96, 0.99)
 Hypertensive diseases 3,836 8.4 (8.1–8.6) 4,103 8.4 (8.1–8.7) 267 1.00 (0.96, 1.05)
 Ischemic heart diseases 6,003 14.3 (14.0–14.7) 6,097 13.8 (13.4–14.2) 94 0.96 (0.93, 1.00)
 Heart failure 4,490 9.9 (9.6–10.2) 4,836 10.0 (9.7–10.3) 346 1.01 (0.97, 1.05)
 Cerebrovascular diseases 10,960 27.2 (26.7–27.7) 11,230 26.3 (25.8–26.8) 270 0.97 (0.94, 0.99)
  Hemorrhagic stroke 3,381 9.5 (9.1–9.8) 3,558 9.5 (9.2–9.8) 177 1.00 (0.95, 1.05)
  Ischemic stroke 3,668 8.4 (8.2–8.7) 3,800 8.2 (7.9–8.4) 132 0.97 (0.93, 1.02)
  Other stroke 3,911 9.3 (9.0–9.6) 3,872 8.6 (8.3–8.9) −39 0.93 (0.89, 0.97)

Diseases of the respiratory system 16,142 36.7 (36.1–37.3) 15,697 33.7 (33.2–34.3) 0.92 (0.90, 0.94)
 Pneumonia 11,011 24.7 (24.3–25.2) 10,172 21.6 (21.2–22.0) −839 0.87 (0.85, 0.90)
 Chronic lower respiratory diseases 2,121 4.8 (4.6–5.0) 1,990 4.2 (4.0–4.4) −131 0.88 (0.82, 0.93)
 Pneumonitis due to solids and liquids 1,106 2.5 (2.4–2.7) 1,476 3.2 (3.0–3.3) 370 1.26 (1.16, 1.37)
 Interstitial pulmonary diseases 633 1.7 (1.5–1.8) 621 1.5 (1.4–1.7) −12 0.93 (0.83, 1.04)

Diseases of the digestive system 4,647 12.3 (11.9–12.7) 4,948 12.5 (12.1–12.9) 1.01 (0.97, 1.06)
 Liver diseases 1,724 5.3 (5.0–5.6) 1,787 5.4 (5.1–5.7) 63 1.02 (0.95, 1.09)
  Alcoholic liver disease 518 1.9 (1.8–2.1) 587 2.2 (2.0–2.4) 69 1.12 (0.99, 1.26)
  Liver cirrhosis 885 2.5 (2.3–2.7) 869 2.3 (2.2–2.5) −16 0.94 (0.85, 1.03)

Diseases of the genitourinary system 4,853 11.7 (11.4–12.1) 5,230 11.9 (11.6–12.3) 1.02 (0.98, 1.06)
 Renal failure 3,046 7.5 (7.3–7.8) 3,266 7.6 (7.4–7.9) 220 1.01 (0.96, 1.07)

Symptoms, signs and abnormal clinical and laboratory findings 15,634 35.2 (34.6–35.8) 17,666 37.0 (36.4–37.5) 1.05 (1.03, 1.07)
 Senility 9,312 19.3 (18.9–19.7) 10,673 20.4 (20.0–20.8) 1,361 1.06 (1.03, 1.09)
 Other ill-defined and unspecified causes of mortality 3,158 8.5 (8.2–8.8) 3,541 8.8 (8.5–9.1) 383 1.04 (0.99, 1.09)

External causes of morbidity and mortality 8,386 27.1 (26.5–27.7) 8,410 26.6 (26.0–27.2) 0.98 (0.95, 1.01)
 Transport accidents 1,059 3.3 (3.1–3.5) 992 3.0 (2.8–3.2) −67 0.90 (0.83, 0.99)
 Falls 737 2.0 (1.8–2.1) 737 1.9 (1.7–2.0) 0 0.93 (0.84, 1.04)
 Intentional self-harm 4,069 15.1 (14.6–15.5) 4,102 15.2 (14.7–15.6) 33 1.01 (0.96, 1.05)

Sub-specific causes
 Alcohol-specific disorders and poisonings 641 2.4 (2.2–2.6) 732 2.7 (2.5–2.9) 91 1.13 (1.02, 1.26)
 Smoking-related causes (+35 yr) 63,876 159.6 (158.3–160.8) 64,129 152.4 (151.2–153.7) 253 0.96 (0.94, 0.97)
 Avoidable causes (0–74 yr) 22,888 82.5 (81.4–83.5) 23,034 81.1 (80.0–82.1) 146 0.98 (0.97, 1.00)
  Amenable causes 11,743 41.6 (40.9–42.4) 11,844 40.7 (40.0–41.5) 101 0.98 (0.95, 1.00)
  Preventable causes 16,066 58.0 (57.1–58.9) 16,106 56.9 (56.0–57.8) 40 0.98 (0.96, 1.00)

COVID-19, coronavirus disease 2019; RR, rate ratio; CI, confidence interval.

Table 4

Age-specific mortality rates and differences between 2019 and 2020 by specific causes among Koreans

Gender 2019 2020 Between 2019 and 2020



No. of deaths Age-specific mortality rates (per 100,000) No. of deaths Age-specific mortality rates (per 100,000) No. of difference RR (95% CI)
Total
 0–4 1,055 55 (52–59) 859 49 (46–52) −196 0.88 (0.81, 0.97)
 5–9 178 8 (7–9) 142 6 (5–7) −36 0.80 (0.64, 1.00)
 10–14 184 8 (7–9) 203 9 (8–10) 19 1.10 (0.90, 1.34)
 15–19 610 22 (21–24) 563 22 (20–24) −47 0.99 (0.88, 1.11)
 20–24 1,126 34 (32–36) 1,118 34 (32–36) −8 1.02 (0.94, 1.11)
 25–29 1,435 42 (40–44) 1,588 45 (43–48) 153 1.08 (1.01, 1.16)
 30–34 1,788 57 (54–59) 1,752 56 (53–59) −36 0.99 (0.92, 1.05)
 35–39 3,117 79 (76–82) 3,007 79 (77–82) −110 1.01 (0.96, 1.06)
 40–44 4,219 109 (106–113) 4,155 108 (104–111) −64 0.98 (0.94, 1.03)
 45–49 7,701 172 (168–176) 7,419 169 (166–173) −282 0.98 (0.95, 1.02)
 50–54 11,096 261 (256–265) 10,802 249 (245–254) −294 0.96 (0.93, 0.98)
 55–59 16,195 380 (374–386) 15,588 371 (365–376) −607 0.97 (0.95, 1.00)
 60–64 19,261 535 (527–542) 19,894 523 (516–530) 633 0.98 (0.96, 1.00)
 65–69 20,181 826 (814–837) 21,201 804 (794–815) 1,020 0.97 (0.96, 0.99)
 70–74 26,083 1,371 (1,355–1,388) 26,466 1,323 (1,307–1,339) 383 0.96 (0.95, 0.98)
 75–79 42,208 2,633 (2,608–2,658) 41,835 2,610 (2,585–2,635) −373 0.99 (0.98, 1.01)
 80–84 53,140 5,031 (4,989–5,074) 55,154 4,965 (4,923–5,006) 2,014 0.99 (0.98, 1.00)
 85+ 85,533 11,994 (11,914–12,074) 93,202 11,876 (11,800–11,952) 7,669 0.99 (0.98, 1.00)

Men
 0–4 587 60 (55–65) 493 55 (50–59) −94 0.91 (0.81, 1.03)
 5–9 108 9 (7–11) 80 7 (5–8) −28 0.75 (0.56, 1.00)
 10–14 108 9 (7–11) 121 10 (8–12) 13 1.12 (0.86, 1.45)
 15–19 374 26 (24–29) 365 28 (25–30) −9 1.04 (0.90, 1.21)
 20–24 682 39 (36–42) 650 38 (35–41) −32 0.98 (0.88, 1.09)
 25–29 938 52 (49–55) 1,010 55 (51–58) 72 1.05 (0.96, 1.15)
 30–34 1,132 70 (66–74) 1,108 68 (64–72) −24 0.98 (0.90, 1.07)
 35–39 1,990 99 (94–103) 1,860 96 (92–101) −130 0.98 (0.92, 1.04)
 40–44 2,755 141 (135–146) 2,702 138 (133–143) −53 0.98 (0.93, 1.03)
 45–49 5,328 234 (228–241) 5,035 226 (220–233) −293 0.97 (0.93, 1.00)
 50–54 8,096 377 (369–385) 7,728 354 (346–362) −368 0.94 (0.91, 0.97)
 55–59 11,942 559 (549–569) 11,443 541 (531–551) −499 0.97 (0.94, 0.99)
 60–64 14,219 800 (787–813) 14,534 774 (761–786) 315 0.97 (0.95, 0.99)
 65–69 14,417 1,224 (1,204–1,244) 15,240 1,198 (1,179–1,217) 823 0.98 (0.96, 1.00)
 70–74 17,633 1,995 (1,966–2,025) 18,128 1,940 (1,912–1,969) 495 0.97 (0.95, 0.99)
 75–79 25,443 3,765 (3,718–3,811) 25,521 3,742 (3,696–3,787) 78 0.99 (0.98, 1.01)
 80–84 27,070 6,999 (6,916–7,082) 28,418 6,875 (6,795–6,955) 1,348 0.98 (0.97, 1.00)
 85+ 27,500 14,439 (14,269–14,610) 30,727 14,332 (14,171–14,492) 3,227 0.99 (0.98, 1.01)

Women
 0–4 468 50 (46–55) 366 43 (38–47) −102 0.85 (0.74, 0.97)
 5–9 70 6 (5–8) 62 6 (4–7) −8 0.89 (0.63, 1.25)
 10–14 76 7 (5–8) 82 7 (6–9) 6 1.07 (0.79, 1.47)
 15–19 236 18 (16–20) 198 16 (14–18) −38 0.89 (0.74, 1.08)
 20–24 444 28 (25–30) 468 30 (27–33) 24 1.08 (0.94, 1.22)
 25–29 497 31 (28–33) 578 35 (32–38) 81 1.14 (1.01, 1.29)
 30–34 656 43 (40–46) 644 43 (39–46) −12 0.99 (0.89, 1.11)
 35–39 1,127 58 (55–61) 1,147 62 (58–66) 20 1.07 (0.98, 1.16)
 40–44 1,464 77 (73–81) 1,453 76 (73–80) −11 0.99 (0.92, 1.06)
 45–49 2,373 108 (103–112) 2,384 111 (106–115) 11 1.03 (0.97, 1.09)
 50–54 3,000 142 (137–147) 3,074 143 (138–148) 74 1.01 (0.96, 1.06)
 55–59 4,253 200 (194–206) 4,145 198 (192–204) −108 0.99 (0.95, 1.03)
 60–64 5,042 277 (269–284) 5,360 278 (271–286) 318 1.01 (0.97, 1.05)
 65–69 5,764 455 (444–467) 5,961 437 (426–448) 197 0.96 (0.93, 1.00)
 70–74 8,450 830 (812–847) 8,338 782 (765–799) −112 0.94 (0.91, 0.97)
 75–79 16,765 1,808 (1,780–1,835) 16,314 1,772 (1,745–1,799) −451 0.98 (0.96, 1.00)
 80–84 26,070 3,895 (3,847–3,942) 26,736 3,833 (3,787–3,879) 666 0.98 (0.97, 1.00)
 85+ 58,033 11,103 (11,013–11,193) 62,475 10,953 (10,867–11,039) 4,442 0.99 (0.98, 1.00)

RR, rate ratio; CI, confidence interval.