The road to recovery: impact of COVID-19 on healthcare utilization in South Korea in 2016-2022 using an interrupted time-series analysis

National trends in dyslipidemia prevalence, awareness, treatment, and control in South Korea from 2005 to 2022

Dyslipidemia has steadily increased in South Korea over the past two decades, emerging as a major public health concern and key risk factor for cardiovascular disease. Thus, our study aimed to investigate long-term trends in the prevalence, awareness, treatment, and control of dyslipidemia in South Korea, including the COVID-19 pandemic. This study utilized data from nationally representative cross-sectional surveys conducted as part of the Korea National Health and Nutrition Examination Survey from 2005 to 2022, analyzing long-term trends of dyslipidemia among 98,396 individuals aged over 30. Weighted linear and binary logistic regression were performed to calculate the β coefficients, βdiff, and weighted odds ratios with 95% confidence intervals (CIs). Weighted odds ratios were computed for various socioeconomic groups using aggregated data from 2005 to 2022. The prevalence of dyslipidemia increased from 41.30% (95% CI 40.40-42.21) in 2005-2009 to 48.41% (47.36-49.47) in 2020-2022. Awareness increased from 17.87% (16.75-18.99) to 48.90% (47.34-50.47), treatment from 7.10% (6.39-7.80) to 38.19% (36.61-39.76), and control among prevalence from 6.49% (5.79-7.19) to 31.82% (30.33-33.32). Treatment (βdiff, 3.94 [1.97-5.92]) and control among prevalence (βdiff, 3.52 [1.67-5.38]) increased more rapidly during the pandemic. Higher odds of dyslipidemia were associated with male sex, older population, rural residence, high BMI, central adiposity, low education and income levels, smoking, and high-risk alcohol consumption. Lower odds of awareness, treatment, and control among individuals with dyslipidemia were associated with male sex, younger population, rural residence, higher education and income levels, smoking, and high-risk alcohol consumption. Over the past 18 years, the prevalence, awareness, treatment, and control of dyslipidemia have steadily increased, with persistent disparities among socioeconomic groups.

What was associated with suicide planning in middle-aged and older adults during the COVID-19 lockdown?

BACKGROUNDS

During the lockdown period, the challenges faced and their consequences differed by age group, making it necessary to understand the factors influencing suicidal behaviors, such as suicide planning, across different ages. This study aimed to identify the risk factors for suicide planning in middle-aged and older adults.

METHODS

A cross-sectional analysis was performed by combining KNHANES 2020-2021 data for people aged 40 and older with National Mental Health Statistics 2020-2021 data on the number of mental health professionals per capita. Logistic regression analysis was conducted to identify demographic, health behavior, health status, and health access factors that affected suicide planning by dividing the participants into the middle-aged (40-64 years old) and older adult (65 years old or older) groups.

RESULTS

The proportion of suicide planning among middle-aged and older adults was 1.21% and 1.36%, respectively. The proportion of participants with suicide plans who had attempted suicide was 20.52% among older adults and 14.09% among middle-aged adults. In both groups, a diagnosis of depression and high stress were consistently associated with suicide planning. In the middle-aged group, current smoking (OR = 2.27, p = 0.023) and unmet healthcare needs (OR = 2.32, p = 0.024) increased the risk of suicide planning. In the older adult group, living alone (OR = 2.72, p = 0.002) increased this risk.

CONCLUSION

The prevalence of suicide attempts was higher among those with a suicide plan than among those without a suicide plan. For both middle-aged and older adult groups, it is important to provide mental health care aimed at suicide prevention, especially for those with depressive disorders or high stress levels. Additionally, providing alternative stress management resources for middle-aged smokers and monitoring isolated older adults could be effective prevention strategies.

Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2022

PURPOSE

The current study provides national cancer statistics and their secular trends in Korea, including incidence, mortality, survival, and prevalence in 2022, with international comparisons.

MATERIALS AND METHODS

Cancer incidence, survival, and prevalence rates were calculated using the Korea National Cancer Incidence Database (1999-2022), with survival follow-up until December 31, 2023. Mortality data obtained from Statistics Korea, while international comparisons were based on GLOBOCAN data.

RESULTS

In 2022, 282,047 newly diagnosed cancer cases (age-standardized rate [ASR], 287.0 per 100,000) and 83,378 deaths from cancer (ASR, 65.7 per 100,000) were reported. The proportion of localized-stage cancers increased from 45.6% in 2005 to 50.9% in 2022. Stomach, colorectal, and breast cancer showed increased localized-stage diagnoses by 18.1, 18.5, and 9.9 percentage points, respectively. Compared to 2001-2005, the 5-year relative survival (2018-2022) increased by 20.4 percentage points for stomach cancer, 7.6 for colorectal cancer, and 5.6 for breast cancer. Korea had the lowest cancer mortality among countries with similar incidence rates and the lowest mortality-to-incidence (M/I) ratios for these cancers. The 5-year relative survival (2018-2022) was 72.9%, contributing to over 2.59 million prevalent cases in 2022.

CONCLUSION

Since the launch of the National Cancer Screening Program in 2002, early detection has improved, increasing the diagnosis of localized-stage cancers and survival rates. Korea recorded the lowest M/I ratio among major comparison countries, demonstrating the effectiveness of its National Cancer Control Program.

Using electronic medical records to analyze outpatient visits of persons with epilepsy during the pandemic-experience from a low middle income country

BACKGROUND

Electronic medical records (EMR) can be utilized to understand the impact of the disruption in care provision caused by the pandemic. We aimed to develop and validate an algorithm to identify persons with epilepsy (PWE) from our EMR and to use it to explore the effect of the pandemic on outpatient service utilization.

METHODS

EMRs from the neurology specialty, covering the period from January 2018 to December 2023, were used. An algorithm was developed using an iterative approach to identify PWE with a critical lower bound of 0.91 for negative predictive value. Manual internal validation was performed. Outpatient visit data were extracted and modeled as a time series using the autoregressive integrated moving average model. All statistical analyses were performed using STATA version 14.2 (Statacorp, USA).

RESULTS

Four iterations resulted in an algorithm, with a negative predictive value 0.98 (95% CI: 0.95-0.99), positive predictive value of 0.98 (95% CI: 0.85-0.99), and an F-score accuracy of 0.96, which identified 4474 PWE. The outpatient service utilization was abruptly reduced by the pandemic, with a change of -902.1 (95%CI: -936.55 to -867.70), and the recovery has also been slow, with a decrease of -5.51(95%CI: -7.00 to -4.02). Model predictions aligned closely with actual visits with median error of -3.5%.

CONCLUSIONS

We developed an algorithm for identifying people with epilepsy with good accuracy. Similar methods can be adapted for use in other resource-limited settings and for other diseases. The COVID pandemic appears to have caused a lasting reduction of service utilization among PWE.

Interrupted time series analysis to evaluate the impact of COVID-19-pandemic on the incidence of notifiable infectious diseases in the Lazio region, Italy

BACKGROUND

The coronavirus disease 2019 (COVID-19) emergency has represented a profound upheaval in the dynamics of infectious diseases transmission worldwide. This phenomenon has been at least in part driven by the introduction of non-pharmaceutical interventions (NPIs), implemented to counteract viral transmission. Our study aimed to assess the magnitude and the features of the impact of the COVID-19 pandemic on the incidence of notifiable infectious diseases (NIDs) in the Lazio region, Italy.

METHODS

Data on NIDs in the Lazio Region with symptom onset date included in the time interval from 1 January 2017 to 31 December 2023 were collected from different surveillance system databases available at SERESMI/Lazio Region Unit and classified into five categories based on the main transmission route of the disease. Descriptive statistics were performed and interrupted time series (ITS) analysis was used to assess the effect of the COVID-19 pandemic and subsequent recovery period on monthly NIDs cases.

RESULTS

Immediately after the start of the COVID-19 pandemic, a significant, sharp and immediate reduction in monthly cases was recorded for all NIDs (-86.73%), regardless of the transmission route. The decrease was particularly significant for vector-borne, food-borne and respiratory-transmitted diseases (RDs), and in general in females. During the COVID-19 recovery phase, monthly cases of all NIDs showed a significant positive level change, particularly significant for sexually transmitted/blood-borne diseases, contact diseases and RDs.

DISCUSSION

The COVID-19 pandemic has been responsible for the disruption of all NIDs transmission patterns, while the magnitude and dynamics of its effects varied depending on the transmission route; furthermore, the impact of the pandemic wave was still noticeable during the post-COVID-19 era and the incidence trajectories of NIDs in this phase were peculiar for each disease category.

Current Trends in the Epidemiology and Treatment of Esophageal Cancer in South Korea

According to 2021 statistics, esophageal cancer ranked as the 18th most common cancer and the 10th leading cause of cancer-related deaths in Korea, predominantly manifesting as squamous cell carcinoma. The incidence of esophageal cancer in Korea has been on a gradual decline, while the proportion of early-stage diagnoses has increased, leading to an improvement in the 5-year relative survival rate. The Health Insurance Review & Assessment Service, reports that around 800 esophagectomy procedures are performed each year. However, due to the absence of recent updates, there is a pressing need to establish a comprehensive nationwide registry or database for esophageal cancer and esophagectomy.

The economic and psychological impacts of covid-19: a exploratory study of the intersection of traditional and new vulnerable groups in South Korea

BACKGROUND

The global impact of the COVID-19 pandemic has been extensive, disproportionately affecting various vulnerable populations. In addition to traditional vulnerable groups (TVGs) such as the elderly, women, people with lower education, disabled individuals, and low-income groups, new vulnerable groups (NVGs) have emerged, including essential workers, face-to-face workers, temporary workers, and the self-employed. This study focuses on exploring the economic and psychological effects of the pandemic on both traditional and newly recognized vulnerable groups within Korea.

METHODS

The study employed multiple logistic regression using micro-level social survey data from Statistics Korea to calculate the odds ratio relating to two categories of vulnerable groups and their economic and mental health impacts. Additionally, through interaction term analysis, we tried to uncover the complex interrelationship between these non-vulnerable groups and target vulnerable groups.

RESULTS

Both the newly identified and traditional vulnerable groups showed higher likelihood of facing economic and mental health challenges compared to non-vulnerable groups. The likelihood of encountering a decrease in income and work-related stress was 2.17 times higher (95% CI = 1.90-2.47) for NVGs, while those belonging to TVGs had a 1.75-fold increase (95% CI = 1.47-2.08). Moreover, female self-employed workers faced higher overall stress at 1.36 times greater risk (95% CI = 1.08-1.71), whereas elderly individuals who are self-employed exhibited lower odds of experiencing such stress at the intersection between TVGs and NVGs.

CONCLUSION

This research offers in-depth understanding of the diverse impacts of COVID-19 on at-risk groups. Furthermore, examinations that take into account interactions between NVGs and TVGs uncovered subtle effects within subgroup dynamics, suggesting that intersecting factors play a role in different levels of vulnerability. This provides valuable evidence for informing policy decisions and allocating resources.

Preoperative COVID-19 and Postoperative Mortality in Cancer Surgery: A South Korean Nationwide Study

BACKGROUND

We evaluated the impact of preoperative COVID-19 on early postoperative mortality in patients undergoing time-sensitive cancer surgery.

METHODS

This retrospective, nationwide cohort study included adult patients who underwent various cancer (thyroid, breast, stomach, colorectal, hepatobiliary, genitourinary, lung, and multiple cancer) surgeries under general anesthesia in South Korea in 2022. Patients were grouped according to the duration from the date of COVID-19 confirmation to the date of surgery (0-2 weeks, 3-4 weeks, 5-6 weeks, and ≥7 weeks). Patients without preoperative COVID-19 also were included. Multivariable logistic regression analysis with Firth correction was performed to investigate the association between preoperative COVID-19 and 30-day and 90-day postoperative mortality. The covariates encompassed sociodemographic factors, the type of surgery, and vaccination status in addition to the aforementioned groups.

RESULTS

Of the 99,555 patients analyzed, 30,933 (31.1%) were preoperatively diagnosed with COVID-19. Thirty-day mortality was increased in those who underwent surgery within 0-2 weeks after diagnosis of COVID-19 (adjusted odds ratio [OR], 1.47; 95% confidence interval [CI], 1.02-2.12; P = 0.038); beyond 2 weeks, there was no significant increase in mortality. A similar pattern was observed for 90-day mortality. Full vaccination against COVID-19 was associated with reduced 30-day (OR 0.38; 95% CI 0.29-0.50; P < 0.001) and 90-day (OR 0.39; 95% CI 0.33-0.46; P < 0.001) mortality.

CONCLUSIONS

Cancer surgery within 2 weeks of COVID-19 diagnosis was associated with increased early postoperative mortality. These findings support current guidelines that recommend postponing elective surgery for at least 2 weeks after the diagnosis of COVID-19.

Prevalence, Awareness, Treatment, and Control of Type 2 Diabetes in South Korea (1998 to 2022): Nationwide Cross-Sectional Study

BACKGROUND

Type 2 diabetes poses an increasing disease burden in South Korea. The development and management of type 2 diabetes are closely related to lifestyle and socioeconomic factors, which have undergone substantial changes over the past few decades, including during the COVID-19 pandemic.

OBJECTIVE

This study aimed to investigate long-term trends in type 2 diabetes prevalence, awareness, treatment, and control. It also aimed to determine whether there were substantial alterations in the trends during the pandemic and whether these changes were more pronounced within specific demographic groups.

METHODS

This study examined the prevalence, awareness, treatment, and control of type 2 diabetes in a representative sample of 139,786 South Koreans aged >30 years, using data from the National Health and Nutrition Examination Survey and covering the period from 1998 to 2022. Weighted linear regression and binary logistic regression were performed to calculate weighted β coefficients or odds ratios. Stratified analyses were performed based on sex, age, region of residence, obesity status, educational background, household income, and smoking status. β (difference) was calculated to analyze the trend difference between the prepandemic period and the COVID-19 pandemic. To identify groups more susceptible to type 2 diabetes, we estimated interaction terms for each factor and calculated weighted odds ratios.

RESULTS

From 1998 to 2022, a consistent increase in the prevalence of type 2 diabetes was observed among South Koreans, with a notable rise to 15.61% (95% CI 14.83-16.38) during the pandemic. Awareness followed a U-shaped curve, bottoming out at 64.37% (95% CI 61.79-66.96) from 2013 to 2015 before increasing to 72.56% (95% CI 70.39-74.72) during the pandemic. Treatment also increased over time, peaking at 68.33% (95% CI 65.95-70.71) during the pandemic. Control among participants with diabetes showed no substantial change, maintaining a rate of 29.14% (95% CI 26.82-31.47) from 2020 to 2022, while control among treated participants improved to 30.68% (95% CI 27.88-33.48). During the pandemic, there was a steepening of the curves for awareness and treatment. However, while the slope of control among participants being treated increased, the slope of control among participants with diabetes showed no substantial change during the pandemic. Older populations and individuals with lower educational level exhibited less improvement in awareness and control trends than younger populations and more educated individuals. People with lower income experienced a deceleration in prevalence during the pandemic.

CONCLUSIONS

Over the recent decade, there has been an increase in type 2 diabetes prevalence, awareness, treatment, and control. During the pandemic, a steeper increase in awareness, treatment, and control among participants being treated was observed. However, there were heterogeneous changes across different population groups, underscoring the need for targeted interventions to address disparities and improve diabetes management for susceptible populations.

Restricted health service utilization and subsequent positive self-care behavior during the early COVID-19 pandemic in China

Background

The reallocation of health resources, epidemic prevention and control measures during the COVID-19 pandemic triggered widespread restricted health service utilization, some residents and patients tried positive self-care behavior to maintain their health, yet the efficacy of this intervention remains unclear.

Object

Based on the reasoned action approach (RAA) theory, this study aimed to investigate the correlation between self-care behavior and restricted health service utilization among adults in China, trying to discover the vulnerable groups and external and intrinsic factors that affect self-care behavior among Chinese adults.

Methods

Data on demographics, socioeconomic, health status, and self-care behavior were collected in "The Early China COVID-19 Survey," a cross-sectional anonymous online survey of the general population in China. Self-care behavior was measured by four indicators: weight control (WC), physical activity (PA), prevention behavior (PB), and online medical consultation (OMC). The multiple linear models and binary logistic regression were used to examine whether restricted health service utilization (RHSU) is associated with self-care behaviors; also, adjusted multivariate logistic regression was used to analyze subgroup heterogeneity.

Results

In total, 8,428 adult participants completed the survey, the mean OMC score was 1.51 (SD 1.34), the mean PB score was 18.17 (SD 3.44), and the proportion of participants who engaged in WC and PA was 42.30 and 62.57%, respectively. According to the multiple regression model, the RHSU was significantly positively correlated with all four indicators of self-care (WC: OR = 1.34, p < 0.001, PA: OR = 1.34, p < 0.05, MC: OR = 1.30, p < 0.001, PB: coef = 0.16, p < 0.05). We also observed some significant differences in the intensity of this relationship by subgroup analysis, precisely, OMC (high vs. moderate vs. low infection-risk level: OR = 1.48; 1.41; 1.19, p < 0.1), PA (male vs. female: OR = 1.27;1.06; p < 0.05, high vs. Moderate and low infection-risk level: OR = 1.51; 1.17; 1.02, p < 0.05), PB (Chronic disease groups vs. no: coef = 0.46; 0.1, p < 0.05).

Conclusion

Restricted health service utilization predicts more positive self-care behavior, and the intensity of partial correlation was significantly different in the subgroups of sex, actual infection risk level of the living area, and chronic diseases. These findings highlight the urgent demand for self-care behavior among Chinese adults during the pandemic and provide new insights for developing self-care and reducing the burden on the healthcare system in the long term.

The impact of the COVID-19 pandemic on the rehabilitation therapy of children and adolescents with cerebral palsy: a nationwide, health insurance data-based study

Introduction

The coronavirus disease 2019 (COVID-19) pandemic has profoundly affected the utilization of rehabilitation services. Existing evidence investigating this issue at the nationwide level is lacking, and it is uncertain whether the effects of the COVID-19 pandemic on the use of rehabilitation therapy of children and adolescents with cerebral palsy. This study aimed to investigate the impact of COVID-19 on the rehabilitation therapy of children and adolescents with cerebral palsy.

Methods

We obtained data from South Korea's Health Insurance Review and Assessment Agency for 2017-2021. By analyzing the claims data, we focused on rehabilitation therapy in individuals with CP under 18 years of age. We categorized these according to therapy type (physical, occupational, or dysphagia), medical facility, hospital visits, and insurance. We calculated the patient counts and average claims per person and compared the average from before to during the COVID-19 pandemic.

Results

Over the 5 years, there was a significant decline in the number of patients undergoing rehabilitation therapy (trend p = 0.004), but the average claims per person remained stable (trend p = 0.971). During the COVID-19 pandemic, the average number of claims per person decreased significantly compared to the control period (p = 0.013). Both the physical (p = 0.049) and occupational therapy groups (p = 0.019) showed significant differences in claims. General hospitals and hospitals experienced a decrease in average cases by 2.2 (p < 0.001) and 2.4 (p < 0.001) respectively, while long-term care hospitals increased by 3.1 cases (p < 0.001). Outpatients showed a decline of 2.0 cases (p < 0.001), whereas inpatients showed an increase of 5.9 cases (p < 0.001). Individuals with health insurance decreased by 0.5 cases (p = 0.007), but the decrease of 0.08 cases among medical aid-covered individuals was not statistically significant (p = 0.898).

Conclusion

In 2020-2021, the average number of claims per person showed a significant decrease compared to the pre-COVID-19 pandemic period (2017-2019). Depending on the type of treatment, the number of claims for physical and occupational therapy significantly decreased.

Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2021

PURPOSE

The current study provides national cancer statistics and their secular trends in Korea, including incidence, mortality, survival, and prevalence in 2021.

MATERIALS AND METHODS

Incidence, survival, and prevalence rates of cancer were calculated using the Korea National Cancer Incidence Database, from 1999 to 2021, with survival follow-up until December 31, 2022. Deaths from cancer were assessed using causes-of-death data obtained from Statistics Korea.

RESULTS

The number of new cancer diagnoses in 2021 increased by 27,002 cases (10.8%) compared to 2020. In 2021, newly diagnosed cancer cases and deaths from cancer were reported as 277,523 (age-standardized rate [ASR], 289.3 per 100,000) and 82,688 (ASR, 67.6 per 100,000), respectively. The overall cancer incidence rates increased by 3.3% annually from 1999 to 2012, and decreased by 5.3% from 2012 to 2015, thereafter, followed by non-significant changes. Cancer mortality rates have been decreasing since 2002, with more rapid decline in recent years (annual decrease of 2.8% from 2002 to 2013; 3.2% from 2013 to 2021). The 5-year relative survival between 2017 and 2021 was 72.1%, which contributed to prevalent cases reaching over 2.4 million in 2021.

CONCLUSION

In 2021, the number of newly diagnosed cancer patients increased as healthcare utilization recovered from the coronavirus disease 2019-related declines of 2020. Revised cancer registration guidelines expanded the registration scope, particularly for stomach and colorectal cancer. Survival rates have improved over the years, leading to a growing population of cancer survivors, necessitating a comprehensive cancer control strategy. The long-term impact of the pandemic on cancer statistics requires future investigation.

Impact of coronavirus disease 2019 on cancer care: How the pandemic has changed cancer utilization and expenditures

PURPOSE

Since identified in December 2019, the novel coronavirus disease 2019 (COVID-19) has had a global impact on medical resource use and costs for patients with cancer in South Korea. This study aimed to identify the medical use and costs among patients with cancer during the COVID-19 pandemic, to predict these patterns in South Korea in the future.

METHODS

We conducted a secondary claims data analysis using the National Health Insurance Service database for the calendar period of 2019-2020. Monthly relative percent changes in cancer incidence, medical use, and billing costs for medical care utilization by cancer type were calculated. Then, the medical use and costs after January 2020 were predicted using a time series model with data before the COVID-19 outbreak (2014-2019).

RESULTS

The incidence of cancer diagnoses has seen a notable decline since the outbreak of the COVID-19 in 2020 as compared to 2019. Despite the impact of COVID-19, there hasn't been a distinct decline in outpatient utilization when compared to inpatient utilization. While medical expenses for both inpatient and outpatient visits have slightly increased, the number of patients treated for cancer has decreased significantly compared to the previous year. In June 2020, overall outpatient costs experienced the highest increase (21.1%), while individual costs showed the most significant decrease (-4.9%) in June 2020. Finally, the number of hospitalisations and outpatient visits increased slightly from June-July in 2020, reducing the difference between the actual and predicted values. The decrease in the number of inpatient hospitalisations (-22~-6%) in 2020 was also high.

CONCLUSIONS

The overall use of medical services by patients with cancer decreased in 2020 compared with that in the pre-COVID-19 pandemic period. In the future, the government should consider how to recover from the COVID-19 pandemic, and establish permanent health policies for patients with cancer.