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Socioeconomic disparities in Korea by health insurance type during the COVID-19 pandemic: a nationwide study

Epidemiology and Health 2021년 43권 1호 p.7 ~ 7
Jeong Han-Eol, 이종성, 신현준, 신주영,
소속 상세정보
 ( Jeong Han-Eol ) - Sungkyunkwan University School of Pharmacy
이종성 ( Lee Jong-Seong ) - Columbia University Columbia School of Social Work
신현준 ( Shin Hyun-Joon ) - Lemuel Shattuck Hospital
신주영 ( Shin Ju-Young ) - Sungkyunkwan University School of Pharmacy

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.

키워드

COVID-19; Socioeconomic disparities; Health insurance type

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