Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea.
National Emergency Medical Center, National Medical Center, Seoul, Korea.
J Korean Med Sci. 2021 Apr 5;36(13):e100. doi: 10.3346/jkms.2021.36.e100.
The objective of this study was to examine the effect of the coronavirus disease 2019 (COVID-19) outbreak on excess in-hospital mortality among patients who visited emergency departments (EDs) and to assess whether the excess mortality during the COVID-19 pandemic varies by community income level.
This is a cross-sectional study using the National Emergency Department Information System (NEDIS) database in Korea. The study population was defined as patients who visited all 402 EDs with medical conditions other than injuries between January 27 and May 31, 2020 (after-COVID) and for the corresponding time period in 2019 (before-COVID). The primary outcome was in-hospital mortality. The main exposure was the COVID-19 outbreak, and the interaction variable was county per capita income tax. We calculated the risk-adjusted in-hospital mortality rates by COVID-19 outbreak, as well as the difference-in-difference of risk-adjusted rates between the before-COVID and after-COVID groups according to the county income tax using a multilevel linear regression model with the interaction term.
A total of 11,662,167 patients (6,765,717 in before-COVID and 4,896,450 in after-COVID) were included in the study with a 1.6% crude in-hospital mortality rate. The risk-adjusted mortality rate in the after-COVID group was higher than that in the before-COVID group (1.82% vs. 1.50%, difference: 0.31% [0.30 to 0.33]; adjusted odds ratio: 1.22 [1.18 to 1.25]). The excess in-hospital mortality rate of the after-COVID in the lowest quartile group of county income tax was significantly higher than that in the highest quartile group (difference-in-difference: 0.18% (0.14 to 0.23); P-for-interaction: < 0.01).
During the COVID-19 pandemic, there was excess in-hospital mortality among patients who visited EDs, and there were disparities in excess mortality depending on community socioeconomic positions.
本研究旨在探讨 2019 年冠状病毒病（COVID-19）疫情对急诊患者住院超额死亡率的影响，并评估 COVID-19 大流行期间的超额死亡率是否因社区收入水平而异。
这是一项使用韩国国家急诊部信息系统（NEDIS）数据库的横断面研究。研究人群定义为 2020 年 1 月 27 日至 5 月 31 日（COVID-19 后）期间在除外伤以外的所有 402 家急诊部就诊的患者，以及 2019 年同期（COVID-19 前）的患者。主要结局为院内死亡率。主要暴露因素为 COVID-19 疫情，交互变量为县人均所得税。我们使用具有交互项的多层次线性回归模型，根据县所得税计算了 COVID-19 疫情后的风险调整院内死亡率以及 COVID-19 前组和后组的风险调整率差异。
共纳入 11662167 例患者（COVID-19 前组 6765717 例，COVID-19 后组 4896450 例），粗死亡率为 1.6%。COVID-19 后组的风险调整死亡率高于 COVID-19 前组（1.82%比 1.50%，差异：0.31%[0.30 至 0.33]；调整后的优势比：1.22[1.18 至 1.25]）。县所得税最低四分位组 COVID-19 后组的院内超额死亡率明显高于最高四分位组（差异：0.18%（0.14 至 0.23）；P 交互作用：<0.01）。
在 COVID-19 大流行期间，急诊患者的住院死亡率出现了超额死亡，并且超额死亡率存在社区社会经济地位差异。
