• 한국병원경영학회지
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• 제25권4호
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• pp.1-12
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• 2020

During the COVID-19 pandemic, most of the western countries with advanced medical technology failed to contain coronavirus. This fact triggered our research question of what factors influence the clinical outcomes like infection rates and case mortality rates. This study aims to identify the determinants of COVID-19 related infection rates and case mortality rates. We considered three sets of independent variables: 1) socio-demographic characteristics; 2) cultural characteristics; 3) healthcare system characteristics. For the analysis, we created an international dataset from diverse sources like World Bank, Worldometers, Hofstede Insight, GHS index etc. The COVID-19 related statistics were retrieved from Aug. 1. Total cases are from 95 countries. We used hierarchical regression method to examine the linear relationship among variables. We found that obesity, uncertainty avoidance, hospital beds per 1,000 made a significant influence on the standardized COVID-19 infection rates. The countries with higher BMI score or higher uncertainty avoidance showed higher infection rates. The standardized COVID-19 infection rates were inversely related to hospital beds per 1,000. In the analysis on the standardized COVID-19 case mortality rates, we found that two cultural characteristics(e.g., individualism, uncertainty avoidance) showed statistically significant influence on the case mortality rates. The healthcare system characteristics did not show any statistically significant relationship with the case mortality rates. The cultural characteristics turn out to be significant factors influencing the clinical outcomes during COVID-19 pandemic. The results imply that the persuasive communication is important to trigger the public commitment to follow preventive measures. The strategy to keep the hospital surge capacity needs to be developed.

• 보건행정학회지
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• 제33권1호
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• pp.65-74
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• 2023

Background: The government should find ways to improve the effectiveness of the policies to control the incidence and mortality of the infectious disease. The purpose of this study is to find out whether the trust in the government's ability to respond to coronavirus disease 2019 (COVID-19) affects the quarantine and hospitalization rate, incidence and mortality rates of COVID-19 and quarantine rules compliance in each region of Korea. Methods: The subject of this study is 250 regions (si·gun·gu) in Korea, and the 2020 Community Health Survey data from the Korea Disease Control and Prevention Agency (KDCA) was used for the trust in the government's ability to respond to COVID-19, quarantine and hospitalization rate and quarantine rules compliance. For the incidence and mortality of COVID-19 and community factors, data was obtained from KDCA and Korean Statistical Information Service. Path analysis was used to find out the degree of inter-variable influence, and community factors (socio-demographic factors, community health factors, and health behavior factors) were used as control variables. Results: The regional disparity in key variables showed that the late pandemic period cumulative incidence and mortality of COVID-19 were large, while the early pandemic period quarantine and hospitalization rate and quarantine rules compliance were small. Path analysis showed that when community factors were controlled, the trust in government was statistically significant in all of the late pandemic period cumulative incidence (p=0.024) and mortality (p=0.017), and quarantine rules compliance (p=0.011). Conclusion: This study revealed that the higher the trust in the government's ability to respond to COVID-19, the lower the COVID-19 mortality and the higher the quarantine rules compliance at the regional level in Korea. This suggests that when the government implements healthcare policies to control infectious diseases, it is necessary to consider trust to improve policy compliance and control the mortality of the disease and maintain high trust through several effective methods.

• Journal of Preventive Medicine and Public Health
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• 제55권2호
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• pp.144-152
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• 2022

Objectives: This study aimed to identify the social and policy determinants of coronavirus disease 2019 (COVID-19) infection across 23 countries. Methods: COVID-19 indicators (incidence, mortality, and fatality) for each country were calculated by direct and indirect standardization. Multivariable regression analyses were used to identify the social and policy determinants of COVID-19 infection. Results: A higher number of doctors per population was related to lower incidence, mortality, and fatality rates of COVID-19 in 23 countries (β=-0.672, -0.445, and -0.564, respectively). The number of nurses/midwives per population was associated with lower mortality and fatality rates of COVID-19 in 23 countries (β=-0.215 and -0.372, respectively). Strengthening of policy restriction indicators, such as restrictions of public gatherings, was related to lower COVID-19 incidence (β=-0.423). A national Bacillus Calmette-Guérin vaccination policy conducted among special groups or in the past was associated with a higher incidence of COVID-19 in 23 countries (β=0.341). The proportion of the elderly population (aged over 70 years) was related to higher mortality and fatality rates (β=0.209 and 0.350, respectively), and income support was associated with mortality and fatality rates (β=-0.362 and -0.449, respectively). Conclusions: These findings do not imply causality because this was a country-based correlation study. However, COVID-19 transmission can be influenced by social and policy determinants such as integrated health systems and policy responses to COVID-19. Various social and policy determinants should be considered when planning responses to COVID-19.

• 응용통계연구
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• 제36권5호
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• pp.447-455
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• 2023

신종감염병인 코로나19는 치명률과 전파력, 치료법이 밝혀지지 않은 상태이다. 게다가 종식 시기 마져 알 수 없어 상당한 신체·정신적 피해가 발생하고 있다. 이에 세계 각국은 코로나19 치료제 및 백신 개발에 힘쓰고 있으며 현재 몇 가지 치료제와 백신이 개발됨에 따라 긴급 승인으로 사용하고 있다. 그러나 치료제는 일부 중증환자들을 위해 사용되기에 대중적이지 않다. 따라서 본 연구는 백신 접종이 사망률에 미치는 영향을 살펴보고자 한다. 코로나19 확진율과 사망률, 백신접종률을 살펴보면, 2차 백신 접종 완료 후 확진율은 감소하였다. 2022년 초 오미크론으로 확진율은 다시 증가한 반면 사망률은 감소하였으며, 누적 백신 접종 완료율이 50% 이상 되면서 사망률은 완만한 곡선 형태를 보였다. 이는 백신 접종이 사망률에 영향을 주는 결과라 하겠다. 그러나 백신 효과의 지속성이 상당히 짧아, 누적 백신 접종 완료율이 100%에 가까워질수록 초기 접종 효과가 떨어지고 월별 사망률이 높아졌다. 본 연구는 코로나19 상황 속에서 진행된 연구로 데이터가 충분하지 않았다. 그러나 국가별로 코로나19의 영향을 비교·분석하는 것은 의미가 있으며, 본 연구가 코로나19에 대한 부족한 데이터를 채우고 다른 연구의 기초가 되기를 바란다.

• Tuberculosis and Respiratory Diseases
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• 제85권4호
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• pp.349-357
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• 2022

Background: The most consistently identified mortality determinants for the new coronavirus 2019 (COVID-19) infection are aging, male sex, cardiovascular/respiratory diseases, and cancer. They were determined from heterogeneous cohorts that included patients with different disease severity and previous conditions. The main goal of this study was to determine if activities of daily living (ADL) dependence measured by Barthel's index could be a predictor for COVID-19 mortality. Methods: A prospective cohort study was performed with a consecutive sample of 340 COVID-19 patients representing patients from all over the northern region of Portugal from October 2020 to March 2021. Mortality risk factors were determined after controlling for demographics, ADL dependence, admission time, comorbidities, clinical manifestations, and delay-time for diagnosis. Central tendency measures were used to analyze continuous variables and absolute numbers (proportions) for categorical variables. For univariable analysis, we used t test, chi-square test, or Fisher exact test as appropriate (α=0.05). Multivariable analysis was performed using logistic regression. IBM SPSS version 27 statistical software was used for data analysis. Results: The cohort included 340 patients (55.3% females) with a mean age of 80.6±11.0 years. The mortality rate was 19.7%. Univariate analysis revealed that aging, ADL dependence, pneumonia, and dementia were associated with mortality and that dyslipidemia and obesity were associated with survival. In multivariable analysis, dyslipidemia (odds ratio [OR], 0.35; 95% confidence interval [CI], 0.17-0.71) was independently associated with survival. Age ≥86 years (pooled OR, 2.239; 95% CI, 1.100-4.559), pneumonia (pooled OR, 3.00; 95% CI, 1.362-6.606), and ADL dependence (pooled OR, 6.296; 95% CI, 1.795-22.088) were significantly related to mortality (receiver operating characteristic area under the curve, 82.1%; p<0.001). Conclusion: ADL dependence, aging, and pneumonia are three main predictors for COVID-19 mortality in an elderly population.

• 한국임상약학회지
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• 제30권3호
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• pp.169-176
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• 2020

Background: Most meta-analyses of risk factors for severe or critical outcomes in patients with COVID-19 only included studies conducted in China and this causes difficulties in generalization. Therefore, this study aimed to systematically evaluate the risk factors in patients with COVID-19 from various countries. Methods: PubMed, Embase, and Web of Science were searched for studies published on the mortality risk in patients with COVID-19 from January 1 to May 7, 2020. Pooled estimates were calculated as odds ratio (OR) with 95% confidence interval (CI) using the random-effects model. Results: We analyzed data from seven studies involving 26,542 patients in total in this systematic review and meta-analysis. Among the patients, 2,337 deaths were recorded (8.8%). Elderly patients and males showed significantly higher mortality rates than young patients and females; the OR values were 3.6 (95% CI 2.5-5.1) and 1.2 (95% CI 1.0-1.3), respectively. Among comorbidities, hypertension (OR 2.3, 95% CI 1.1-4.6), diabetes (OR 2.2, 95% CI 1.2-3.9), cardiovascular disease (OR 3.1, 95% CI 1.5-6.3), chronic obstructive pulmonary disease (OR 4.4, 95% CI 1.7-11.5), and chronic kidney disease (OR 4.2, 95% CI 2.0-8.6) were significantly associated with increased mortalities. Conclusion: This meta-analysis, involving a huge global sample, employed a systematic method for synthesizing quantitative results of studies on the risk factors for mortality in patients with COVID-19. It is helpful for clinicians to identify patients with poor prognosis and improve the allocation of health resources to patients who need them most.

• 대한조현병학회지
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• 제24권2호
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• pp.45-51
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• 2021

The coronavirus disease 2019 (COVID-19) pandemic has drastically impacted our society and health care system. People with schizophrenia are more vulnerable to this burden of illness and related societal changes. In addition, they are more susceptible to the transmission of COVID-19 and have a significantly higher mortality rate compared to the general population. In a recent study, vaccinated patients with schizophrenia showed a greatly decreased mortality level similar to that of the general population. However, patients with schizophrenia were less likely to be vaccinated. Mental health professionals should provide them with appropriate information on prevention strategies against COVID-19 and vaccination. Long-lasting social distancing and social disconnection can make people with schizophrenia more vulnerable to loneliness and depression. Furthermore, patients with schizophrenia may face challenges continuing psychiatric treatment due to the COVID-19 pandemic. Social support and suitable mental health services using novel technologies should be developed and provided to patients with schizophrenia.

• Journal of Preventive Medicine and Public Health
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• 제56권3호
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• pp.231-237
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• 2023

Objectives: This study aimed to identify risk factors associated with coronavirus disease 2019 (COVID-19) mortality in pre-elderly and elderly individuals in Jakarta, Indonesia. Methods: We employed a case-control study design, utilizing secondary data from the Epidemiology Surveillance, Immunization Prevention, and Disease Control Sections of the DKI Jakarta Provincial Health Office, collected from December 2020 to January 2021. The study included 188 cases and an equal number of controls. Cases were COVID-19 patients confirmed to have died, as reported by hospitals and communities and subsequently verified by healthcare workers. Control subjects were patients who completed a 14-day isolation period and had been officially declared recovered by healthcare professionals. The dependent variable was the mortality of COVID-19 patients in the January 2021 period. The independent variables consisted of demographic data (age and sex), clinical symptoms (cough, runny nose, anosmia, diarrhea, headaches, abdominal pain, muscle pain, and nausea/vomiting), and comorbidities (hypertension, heart disease, and diabetes). Multivariate analysis was conducted using multiple logistic regression. Results: The multiple logistic regression analysis revealed several factors associated with COVID-19 fatalities in Jakarta: age of 60 years or older (odds ratio [OR], 4.84; 95% CI, 3.00 to 7.80), male (OR, 2.38; 95% CI, 2.41 to 3.68), dyspnea (OR, 3.93; 95% CI, 2.04 to 7.55), anosmia (OR, 0.13; 95% CI, 0.04 to 0.46), and heart disease (OR, 4.38; 95% CI, 1.04 to 18.46). Conclusions: The control and prevention of COVID-19 among elderly individuals require particular vigilance. When a COVID-19 case is detected within this demographic, prompt treatment and medication administration are crucial to mitigate the presenting symptoms.

• Tuberculosis and Respiratory Diseases
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• 제84권1호
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• pp.13-21
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• 2021

Several clinical trials are being conducted worldwide to investigate the protective effect of the bacillus Calmette-Guérin (BCG) vaccine against death in healthcare providers who are working directly with coronavirus disease 2019 (COVID-19) patients. Clinical studies suggested that certain live vaccines, particularly the BCG vaccine, could reduce the mortality due to other diseases caused by non-targeted pathogens, most probably through the nonspecific effects (heterologous effects). By the end of May 2020, the available information on the COVID-19 pandemic indicated the great effect of the BCG vaccine in reducing the number of COVID-19 death cases. The occurrence of death due to COVID-19 was found to be 21-fold lower in countries with a national BCG vaccination policy than in countries without such a policy, based on the medians of COVID-19 death case per 1 million of the population in these two groups of countries (p<0.001, Mann-Whitney test). Therefore, it can be concluded that the early establishment of a BCG vaccination policy in any country is a key element in reducing the number of COVID-19 and tuberculosis death cases.

• Journal of Preventive Medicine and Public Health
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• 제56권2호
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• pp.180-189
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• 2023

Objectives: The coronavirus disease 2019 (COVID-19) pandemic has led to a global shortage of medical resources; therefore, we investigated whether COVID-19 impacted the quality of non-COVID-19 hospital care in Korea by comparing hospital standardized mortality rates (HSMRs) before and during the pandemic. Methods: This retrospective cohort study analyzed Korean National Health Insurance discharge claim data obtained from January to June in 2017, 2018, 2019, and 2020. Patients' in-hospital deaths were classified according to the most responsible diagnosis categories. The HSMR is calculated as the ratio of expected deaths to actual deaths. The time trend in the overall HSMR was analyzed by region and hospital type. Results: The final analysis included 2 252 824 patients. In 2020, the HSMR increased nationwide (HSMR, 99.3; 95% confidence interval [CI], 97.7 to 101.0) in comparison to 2019 (HSMR, 97.3; 95% CI, 95.8 to 98.8). In the COVID-19 pandemic zone, the HSMR increased significantly in 2020 (HSMR, 112.7; 95% CI, 107.0 to 118.7) compared to 2019 (HSMR, 101.7; 95% CI, 96.9 to 106.6). The HSMR in all general hospitals increased significantly in 2020 (HSMR, 106.4; 95% CI, 104.3 to 108.5) compared to 2019 (HSMR, 100.3; 95% CI, 98.4 to 102.2). Hospitals participating in the COVID-19 response had a lower HSMR (HSMR, 95.6; 95% CI, 93.9 to 97.4) than hospitals not participating in the COVID-19 response (HSMR, 124.3; 95% CI, 119.3 to 129.4). Conclusions: This study suggests that the COVID-19 pandemic may have negatively impacted the quality of care in hospitals, especially general hospitals with relatively few beds. In light of the COVID-19 pandemic, it is necessary to prevent excessive workloads in hospitals and to properly employ and coordinate the workforce.