Impact of COVID-19 on healthcare utilization among chronic disease patients in South Korea.

Background: From 2020 to 2022, South Korea has experienced significant direct and indirect damage because of the coronavirus pandemic. Preventive measures aimed at controlling the spread of the virus have inadvertently limited healthcare accessibility for patients without COVID-19, leading to detrimental consequences, particularly for patients with chronic diseases. Hence, there is a growing need to comprehensively examine the changes in healthcare utilization among patients with chronic diseases owing to the COVID-19 pandemic, along with the associated factors and health outcomes. Methods: To examine changes in healthcare utilization among patients with chronic diseases and their impact on health outcomes, we used the NHIS database. Logistic regression analysis was used to investigate changes in healthcare utilization, and a two-part model was applied to explore the effects of reduced healthcare utilization on hospitalization status and length of hospital stay. Results: Since the onset of the pandemic, the likelihood of hospitalization has been 1.10 times higher than that during pre-pandemic times in the population groups with a 20 % decrease in outpatient healthcare utilization. Notably, individuals belonging to the low-income group exhibited a 1.77-fold higher likelihood of hospitalization than those in the high-income group. Furthermore, in cases where hospitalization could have been avoided, low-income individuals had an extended hospital stay of 16.7 days compared with high-income individuals. Conclusion: There is a need for a more proactive approach for classifying patients with chronic diseases based on various vulnerability factors to effectively respond to future novel infectious diseases and reduce the long-term burden on the nation.

A systematic review of psychosocial protective factors against suicide and suicidality among older adults.

BACKGROUND: Research on suicide rarely focuses on protective factors. The goal of this systematic review was to assess the evidence of the associations between protective factors and reduced suicidality among older adults. METHOD: First, a scoping review was conducted to identify pertinent terms that refer to various protective factors against suicidality. A systematic review, following the PRISMA guidelines, was then conducted on a selection of 15 protective factors (e.g., perceived control, well-being and quality of life, life satisfaction, purpose-in-life, resilience, coping, religiosity, hope, self-regulation, sense of belonging, mattering, positive relationship, social support, social connectedness, and social participation), with separate searches performed on each factor in five databases. Empirical studies were eligible if participants were adults aged 60 years and over, and if the studies reported predictive statistical analysis. RESULTS: A total of 70 studies were retained for the review. Suicidal ideation was the main outcome measure (91%). Significant associations were consistently observed between all protective factors and reduced suicidal ideations or behaviors, particularly for purpose-in-life, resilience, and positive relationships, indicating that these are solid components for suicide prevention. Using scales, instead of a single item, to measure protective factors (e.g. life satisfaction) was more efficient to capture the associations. On the other hand, results were similar whether studies used subjective (e.g., sense of belonging) or objective (e.g., social connectedness) measures. CONCLUSION: Protective factors were inversely associated with suicidal ideation. Improving protective factors is essential for the development of late-life suicide prevention and interventions, instead of merely focusing on risk factors.

Gender Inequalities in Mental Health During the COVID-19 Pandemic: A Population-based Study in Korea.

OBJECTIVES: This study explored the effect of the coronavirus disease 2019 (COVID-19) pandemic on psychosocial stress in prime working-age individuals in Korea, focusing on gender inequalities. We hypothesized that the impact of COVID-19 on mental health would differ by age and gender, with younger women potentially demonstrating heightened vulnerability relative to men. METHODS: The study involved data from the Korea Community Health Survey and included 319 592 adults aged 30 years to 49 years. We employed log-binomial regression analysis, controlling for variables including age, education, employment status, marital status, and the presence of children. The study period included 3 phases: the period prior to the COVID-19 outbreak (pre-COVID-19), the early pandemic, and the period following the introduction of vaccinations (post-vaccination). RESULTS: The findings indicated that women were at a heightened risk of psychosocial stress during the early pandemic (relative risk [RR], 1.01; 95% confidence interval [CI], 0.98 to 1.05) and post-vaccination period (RR, 1.07; 95% CI, 1.04 to 1.10) compared to men. This pattern was prominent in urban women aged 30-34 years (pre-COVID-19: RR, 1.06; 95% CI, 1.02 to 1.10; early pandemic: RR, 1.16; 95% CI, 1.08 to 1.25; post-vaccination period, RR, 1.22; 95% CI, 1.14 to 1.31). CONCLUSIONS: The COVID-19 pandemic has exerted unequal impacts on psychosocial stress among prime working-age individuals in Korea, with women, particularly those in urban areas, experiencing a heightened risk. The findings highlight the importance of addressing gender-specific needs and implementing appropriate interventions to mitigate the psychosocial consequences of the pandemic.

Child mortality of twins and singletons among late preterm and term birth: a study of national linked birth and under-five mortality data of Korea.

Twins involve a higher risk of perinatal complications compared to singletons. We compared the risk of under five mortality between twins and singletons among late preterm and term births. The national birth data of South Korea pertaining to the years 2010-2014 linked with the mortality record of children aged under 5 years in 2010-2019 was analyzed. The final study population was 2,199,632 singletons and 62,351 twins. We conducted a survival analysis of under-five mortality with adjustment for neonatal and familial factors. Overall under-five mortality rates during the study period were 3.6 and 2.0 for twins and singletons, respectively. Although the unadjusted overall under-five mortality was higher in twins (hazard ratio [HR] = 1.80, 95% confidence interval [CI]: 1.57, 2.06, overall risk), twin birth was associated with comparable or lower risk (HR = 0.70, 95% CI: 0.58, 0.85, overall; 0.70, 95% CI: 0.56, 0.87, excluding neonatal mortality; 0.59, 95% CI: 0.40, 0.86, excluding infant mortality) after controlling for both neonatal and familial factors. Twins born at a gestational age of 34-35 weeks showed a generally lower risk of under-five mortality than their singleton counterparts, regardless of model specification.Conclusion: Among late preterm and term birth, under-5-year mortalities for twins were lower than singleton births when adjusted for neonatal and familial risk factors. This highlights the differential implication of gestational age at birth between twin and singleton in the child mortality.

Is a high maintenance dose of clopidogrel suitable for overcoming clopidogrel resistance in patients?

BACKGROUND: A double maintenance dose of clopidogrel at 150 mg daily has been suggested as an effective alternative treatment for patients who have clopidogrel resistance. OBJECTIVE: To determine if a double maintenance dose of clopidogrel can overcome the low drug response rate observed in patients who have clopidogrel resistance while on a 75 mg daily standard maintenance dose of clopidogrel. METHODS: A retrospective analysis was conducted in South Korean patients who underwent a platelet function test and received a double maintenance dose of clopidogrel at a secondary medical institution between January 2011 and June 2012. The primary endpoint was to assess clopidogrel response using an adenosine diphosphate test after a double maintenance dose of clopidogrel. The secondary endpoint was the presence of factors that could affect response to clopidogrel. RESULTS: Of 389 patients identified, 77 patients were eligible for this study. Values from the adenosine diphosphate test decreased significantly in 63 patients (82%) after a double maintenance dose of clopidogrel (p < 0.001). A total of 37 patients (48%) overcame clopidogrel resistance. Concurrent disease appeared to be a contributory factor in clopidogrel resistance. CONCLUSION: A double maintenance dose of clopidogrel at 150 mg daily was associated with a reduction in adenosine diphosphate-induced platelet aggregation in South Korean patients who previously exhibited clopidogrel resistance.