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Acute Crit Care
. 2026 Mar 27.
doi: 10.4266/acc.003375. Online ahead of print.
Direct and indirect effects of the COVID-19 pandemic on mortality and critical care utilization in South Korea
Mindong Sung 1 , Hye Jin Jang 2 , Soyul Han 3 , Sungho Won 4 5 6 , Bora Lee 5 , Young Sam Kim 1
Affiliations
Background: The coronavirus disease 2019 (COVID-19) pandemic has had unprecedented global impact, with significant effects on mortality and healthcare utilization. This study evaluated the direct and indirect impacts of COVID-19 on mortality and healthcare utilization in South Korea, a country that implemented strict public health measures.
Methods: We conducted a retrospective analysis using national databases from January 2015 through May 2022. The study compared mortality patterns and intensive care unit (ICU) utilization during the epidemic period (2020-2021) with the reference period (2015-2019). We analyzed excess mortality using a random-coefficient Poisson regression model and examined cause-specific mortality patterns for pneumonia, cardiovascular disease, and cancer. ICU admission trends were assessed using annual percent change (APC) and average annual percent change (AAPC) analyses.
Results: The study revealed a distinctive two-phase pattern in COVID-19-related excess mortality: minimal excess deaths until June 2021, followed by a significant increase culminating in 18,068 excess deaths (P-score, 68.39%) during the fifth wave in March 2022. COVID-19 deaths accounted for approximately 45% of excess deaths during this period. Analysis of cause-specific mortality demonstrated temporal shifts in cardiovascular disease and pneumonia deaths from their typical January peaks to March-April 2022. Cardiovascular disease showed significant excess mortality during the fifth wave (z=6.18, P<0.001), while pneumonia mortality was below expected levels when accounting for pre-existing trends. Case fatality rate declined from an initial 9.50% to below 1% by 2022, despite increased case numbers. ICU admissions for non-COVID patients showed a consistent declining trend, with the most substantial decrease (-11.48%) observed in April 2020 during the first epidemic wave.
Conclusions: These findings suggest that COVID-19 affected population health through both direct viral infection and indirect effects on healthcare systems and utilization patterns. The study highlights the importance of maintaining critical care capacity for all patient groups during public health emergencies and the need for strategies to balance resource allocation.
Keywords: COVID-19; South Korea; critical care; health care utilization; health services; mortality.
. 2026 Mar 27.
doi: 10.4266/acc.003375. Online ahead of print.
Direct and indirect effects of the COVID-19 pandemic on mortality and critical care utilization in South Korea
Mindong Sung 1 , Hye Jin Jang 2 , Soyul Han 3 , Sungho Won 4 5 6 , Bora Lee 5 , Young Sam Kim 1
Affiliations
- PMID: 41889228
- DOI: 10.4266/acc.003375
Background: The coronavirus disease 2019 (COVID-19) pandemic has had unprecedented global impact, with significant effects on mortality and healthcare utilization. This study evaluated the direct and indirect impacts of COVID-19 on mortality and healthcare utilization in South Korea, a country that implemented strict public health measures.
Methods: We conducted a retrospective analysis using national databases from January 2015 through May 2022. The study compared mortality patterns and intensive care unit (ICU) utilization during the epidemic period (2020-2021) with the reference period (2015-2019). We analyzed excess mortality using a random-coefficient Poisson regression model and examined cause-specific mortality patterns for pneumonia, cardiovascular disease, and cancer. ICU admission trends were assessed using annual percent change (APC) and average annual percent change (AAPC) analyses.
Results: The study revealed a distinctive two-phase pattern in COVID-19-related excess mortality: minimal excess deaths until June 2021, followed by a significant increase culminating in 18,068 excess deaths (P-score, 68.39%) during the fifth wave in March 2022. COVID-19 deaths accounted for approximately 45% of excess deaths during this period. Analysis of cause-specific mortality demonstrated temporal shifts in cardiovascular disease and pneumonia deaths from their typical January peaks to March-April 2022. Cardiovascular disease showed significant excess mortality during the fifth wave (z=6.18, P<0.001), while pneumonia mortality was below expected levels when accounting for pre-existing trends. Case fatality rate declined from an initial 9.50% to below 1% by 2022, despite increased case numbers. ICU admissions for non-COVID patients showed a consistent declining trend, with the most substantial decrease (-11.48%) observed in April 2020 during the first epidemic wave.
Conclusions: These findings suggest that COVID-19 affected population health through both direct viral infection and indirect effects on healthcare systems and utilization patterns. The study highlights the importance of maintaining critical care capacity for all patient groups during public health emergencies and the need for strategies to balance resource allocation.
Keywords: COVID-19; South Korea; critical care; health care utilization; health services; mortality.