Excess mortality and healthcare costs during the COVID-19 pandemic among patients with ten major chronic diseases in South korea: a nationwide analysis

초록

Background A comprehensive understanding of excess mortality for patients with underlying conditions during the COVID-19 pandemic has yet to be achieved. Thus, this study aims to investigate excess mortality and healthcare costs during the COVID-19 pandemic among patients with ten major chronic diseases in South Korea. Methods A nationwide retrospective cohort study used the Korea Disease Control and Prevention Agency-COVID-19-National Health Insurance Service (K-CoV-N) database, integrating COVID-19 testing, vaccination, mortality, and insurance claims data for the entire Korean population. We assessed mortality and medical costs from 2017 to 2022 in patients with ten chronic conditions, including chronic lung disease (CLD), heart disease, stroke, diabetes, hypertension, chronic liver disease, autoimmune disorders, chronic kidney disease (CKD), dementia/Parkinson's disease (DPD), and cancer. Multivariable logistic and negative binomial regression were used to compare mortality and costs between the pre-pandemic (2019-2019) and pandemic periods (2020-2022), stratified by COVID-19 infection status and vaccination history. Results Mortality rates increased significantly during the pandemic for CLD, stroke, chronic liver disease, autoimmune disease, CKD, and DPD (adjusted odds ratio (aOR) > 1.00 and p < 0.05). In contrast, mortality decreased for diabetes, hypertension, and cancer (aOR < 1.00 and p < 0.001). Healthcare costs also exhibited disease-specific trends, with increased spending for conditions such as CLD and autoimmune diseases, but reduced costs for diseases like stroke and DPD. Notably, diabetes, hypertension, and cancer showed decreased mortality despite rising healthcare expenditures, highlighting the role of medical innovation and advancements in chronic disease management. Conclusions This study underscores the heightened vulnerability of patients with chronic conditions during pandemics and reveals the possibility of disparities in healthcare access and resource allocation. These findings offer critical insights for future public health strategies and policy development to mitigate the impact of health crises on individuals with chronic diseases.

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