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COVID-19: Original Article
Changes in food sufficiency among Korean adults in urban and rural areas during the COVID-19 pandemic: an analysis of the 7th and 8th Korea National Health and Nutrition Examination Survey
Sarang Jeong, Jin-Young Jeong, Sohyun Park
Epidemiol Health. 2024;46:e2024045.   Published online April 16, 2024
DOI: https://doi.org/10.4178/epih.e2024045
  • 2,635 View
  • 97 Download
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Understanding changes in food sufficiency within various demographic groups during emergency situations, such as the global coronavirus disease 2019 (COVID-19) pandemic, is crucial in formulating public health policies for future preparedness. This study investigated potential differences between urban and rural residents in food sufficiency trends during the COVID-19 pandemic and examined how these changes varied according to socio-demographic factors.
METHODS
This cross-sectional study analyzed data from 19,724 adults aged 20 years and older, utilizing information from the 7th-8th Korea National Health and Nutrition Examination Survey (2018-2021).
RESULTS
In urban areas, across all subpopulations, food sufficiency improved significantly during the COVID-19 period relative to pre-pandemic levels (p<0.001). However, in rural regions, a significant increase in food sufficiency during the COVID-19 era was observed only among female, with an odds ratio of 1.42 (95% confidence interval, 1.06 to 1.89). Nevertheless, no significant interaction terms were found between region and various socio-demographic factors regarding changes in food sufficiency during the COVID-19 period.
CONCLUSIONS
During the COVID-19 pandemic, food sufficiency among urban residents improved compared to the pre-pandemic era, whereas their rural counterparts saw no such improvement. Additionally, no significant interaction was detected between urban versus rural areas and changes in food sufficiency during the COVID-19 period. These findings indicate the need for targeted food policies to prepare for potential future pandemics, particularly in rural areas, where food sufficiency did not improve.
Summary
Korean summary
- 본 연구는 COVID-19 팬데믹 동안 도시와 농촌 지역의 성인들 사이에서 식품 충분성의 변화를 조사하고, 이 변화를 사회인구학적 요인에 따라 분석하였다.
- 연구 결과, 코로나19 기간 동안 도시 지역의 다양한 인구통계학적 하위 그룹에서 식품 충분성이 크게 증가했으며, 농촌 지역에서는 여성들을 제외하고는 유의미한 변화가 나타나지 않았다.
- 본 연구는 향후 팬데믹 대비를 위한 식품 충분성 정책을 개발할 때 인구통계학적 요인과 지역적 차이를 고려하는 것이 중요하며, 특히 농촌 지역에서의 필요성을 강조한다.
Key Message
- This study examined changes in food sufficiency among adults in urban and rural areas during the COVID-19 pandemic, focusing on socio-demographic factors.
- Findings revealed that food sufficiency significantly increased in urban areas across various demographic subgroups during the COVID-19 period, while rural areas showed no significant overall change, except for an increase among women.
- The study highlights the importance of considering socio-demographic factors and regional differences, particularly the need for targeted food assistance programs in rural areas, for future pandemic preparedness.
COVID-19: Original Article
Worsening of health disparities across COVID-19 pandemic stages in Korea
Hyejin Lee, Hyunwoo Nam, Jae-ryun Lee, Hyemin Jung, Jin Yong Lee
Epidemiol Health. 2024;46:e2024038.   Published online March 13, 2024
DOI: https://doi.org/10.4178/epih.e2024038
  • 3,339 View
  • 135 Download
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
With the end of the coronavirus disease 2019 (COVID-19) pandemic, the health outcomes of this disease in Korea must be examined. We aimed to investigate health outcomes and disparities linked to socioeconomic status during the COVID-19 pandemic in Korea and to identify risk factors for hospitalization and mortality.
METHODS
This nationwide retrospective study incorporated an analysis of individuals with and without COVID-19 in Korea between January 1, 2020 and December 31, 2022. The study period was divided into 4 stages. Prevalence, hospitalization, mortality, and case-fatality rates were calculated per 100,000 population. Multivariate logistic regression was performed to identify risk factors for COVID-19 hospitalization and mortality.
RESULTS
Overall, the incidence rate was 40,601 per 100,000 population, the mortality rate was 105 per 100,000 population, and the case-fatality rate was 259 per 100,000 cases. A total of 12,577,367 new cases (24.5%) were recorded in stage 3 and 8,979,635 cases (17.5%) in stage 4. Medical Aid recipients displayed the lowest 3-year cumulative incidence rate (32,737 per 100,000) but the highest hospitalization (5,663 cases per 100,000), mortality (498 per 100,000), and case-fatality (1,521 per 100,000) rates. Male sex, older age, lower economic status, non-metropolitan area of residence, high Charlson comorbidity index, and disability were associated with higher risk of hospitalization and death. Vaccination was found to reduce mortality risk.
CONCLUSIONS
As the pandemic progressed, surges were observed in incidence, hospitalization, and mortality, exacerbating disparities associated with economic status and disability. Nevertheless, Korea has maintained a low case-fatality rate across all economic groups.
Summary
Korean summary
국민건강보험공단 자료를 이용하여 2020-2022년 후향적 코호트를 구축하여 시기별 코로나19 유병률, 입원률, 사망률, 치명률과 장애, 소득에 따른 건강격차를 확인하였을 때, 코로나19 대유행이 진행됨에 따라 발병률, 입원률, 사망률이 급증하고 건강 격차가 확대되었다. 그러나 이러한 격차에도 불구하고 한국은 다른 국가들과 비교하여 모든 소득수준에서 낮은 치명률을 유지하였다.
Key Message
Using data from the National Health Insurance Service, a retrospective cohort for the years 2020-2022 was established. By examining the COVID-19 prevalence rate, hospitalisation rate, mortality rate, and case-fatality rate, along with health disparities based on disability and economic status, as the pandemic progressed, there was a surge in incidence, hospitalisation, and mortality, widening disparities related to economic status and disability. Despite these disparities, Korea has maintained a low case-fatality rate across all economic groups.
COVID-19: Original Article
Influence of practice location on prescribing, diabetes care, and colorectal cancer screening among Czech general practitioners during the COVID-19 pandemic
Jan Bělobrádek, Luděk Šídlo, Tom Philipp
Epidemiol Health. 2024;46:e2024033.   Published online February 23, 2024
DOI: https://doi.org/10.4178/epih.e2024033
  • 3,525 View
  • 92 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The provision of primary health care was not interrupted during the coronavirus disease 2019 (COVID-19) pandemic in Czechia, although the capacity and resources of providers changed. We examined how the pandemic affected individual general practices throughout 2017-2021, focusing on differences between urban and rural practices.
METHODS
We analysed data from the largest health insurance company in Czechia, which provides care to 4.5 million people (60% of the population). We evaluated the prescription volume, diabetes care procedures, and faecal immunochemical test (FIT) in preventive care and new pandemic-related procedures (remote consultations, testing, and vaccinations). For the spatial distribution of practices, we adapted the Organisation for Economic Cooperation and Development typology.
RESULTS
We observed minimal declines in 2020 in the rate of prescribing (-1.0%) and diabetes care (-5.1%), with a rapid resumption in 2021, but a substantial decline in FIT (-17.8% in 2020) with slow resumption. Remote consultations were used by 94% of all practices regardless of location, with testing and vaccinations more commonly performed by rural general practitioners (GPs).
CONCLUSIONS
Primary care in Czechia rose to the challenge of the COVID-19 pandemic, as shown by the finding that the volume of healthcare services provided through primary care did not decrease across most of the monitored parameters. This study also confirmed that rural GPs provide more care in-house, both in terms of prescribing and procedures performed in their practices. Future studies will need to focus on preventive care, which the pandemic has dampened in GP practices in Czechia.
Summary
Key Message
Primary care in Czechia has effectively adapted to the changes brought about by the COVID-19 pandemic. Minimal impact was observed in prescribtions and diabetic patient care. There was a significant decline in colorectal cancer screening, with a slow restitution after the pandemic subsided. Rural GPs consistently provided in-house treatment and have higher shares of both prescribing and diabetes care, as well as performing more COVID-19 specific procedures.
COVID-19: Original Article
Public holidays increased the transmission of COVID-19 in Japan, 2020-2021: a mathematical modelling study
Jiaying Qiao, Hiroshi Nishiura
Epidemiol Health. 2024;46:e2024025.   Published online January 22, 2024
DOI: https://doi.org/10.4178/epih.e2024025
  • 3,716 View
  • 184 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Although the role of specific holidays in modifying transmission dynamics of infectious diseases has received some research attention, the epidemiological impact of public holidays on the transmission of coronavirus disease 2019 (COVID-19) remains unclear.
METHODS
To assess the extent of increased transmission frequency during public holidays, we collected COVID-19 incidence and mobility data in Hokkaido, Tokyo, Aichi, and Osaka from February 15, 2020 to September 30, 2021. Models linking the estimated effective reproduction number (Rt) with raw or adjusted mobility, public holidays, and the state of emergency declaration were developed. The best-fit model included public holidays as an essential input variable, and was used to calculate counterfactuals of Rt in the absence of holidays.
RESULTS
During public holidays, on average, Rt increased by 5.71%, 3.19%, 4.84%, and 24.82% in Hokkaido, Tokyo, Aichi, and Osaka, respectively, resulting in a total increase of 580 (95% confidence interval [CI], 213 to 954), 2,209 (95% CI, 1,230 to 3,201), 1,086 (95% CI, 478 to 1,686), and 5,211 (95% CI, 4,554 to 5,867) cases that were attributable to the impact of public holidays.
CONCLUSIONS
Public holidays intensified the transmission of COVID-19, highlighting the importance of considering public holidays in designing appropriate public health and social measures in the future.
Summary
Key Message
• The number of COVID-19 cases increased during public holidays in Japan.
• The increase may have occurred because of elevated mobility rate and altered contact behaviours.
• The effect of holidays varied by prefecture in Japan.
COVID-19: Original Article
Forecasting the effects of vaccination on the COVID-19 pandemic in Malaysia using SEIRV compartmental models
Mei Cheng Lim, Sarbhan Singh, Chee Herng Lai, Balvinder Singh Gill, Mohd Kamarulariffin Kamarudin, Ahmed Syahmi Syafiq Md Zamri, Cia Vei Tan, Asrul Anuar Zulkifli, Mohamad Nadzmi Md Nadzri, Nur'ain Mohd Ghazali, Sumarni Mohd Ghazali, Nuur Hafizah Md Iderus, Nur Ar Rabiah Binti Ahmad, Jeyanthi Suppiah, Kok Keng Tee, Tahir Aris, Lonny Chen Rong Qi Ahmad
Epidemiol Health. 2023;45:e2023093.   Published online October 17, 2023
DOI: https://doi.org/10.4178/epih.e2023093
  • 6,409 View
  • 104 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study aimed to develop susceptible-exposed-infectious-recovered-vaccinated (SEIRV) models to examine the effects of vaccination on coronavirus disease 2019 (COVID-19) case trends in Malaysia during Phase 3 of the National COVID-19 Immunization Program amidst the Delta outbreak.
METHODS
SEIRV models were developed and validated using COVID-19 case and vaccination data from the Ministry of Health, Malaysia, from June 21, 2021 to July 21, 2021 to generate forecasts of COVID-19 cases from July 22, 2021 to December 31, 2021. Three scenarios were examined to measure the effects of vaccination on COVID-19 case trends. Scenarios 1 and 2 represented the trends taking into account the earliest and latest possible times of achieving full vaccination for 80% of the adult population by October 31, 2021 and December 31, 2021, respectively. Scenario 3 described a scenario without vaccination for comparison.
RESULTS
In scenario 1, forecasted cases peaked on August 28, 2021, which was close to the peak of observed cases on August 26, 2021. The observed peak was 20.27% higher than in scenario 1 and 10.37% lower than in scenario 2. The cumulative observed cases from July 22, 2021 to December 31, 2021 were 13.29% higher than in scenario 1 and 55.19% lower than in scenario 2. The daily COVID-19 case trends closely mirrored the forecast of COVID-19 cases in scenario 1 (best-case scenario).
CONCLUSIONS
Our study demonstrated that COVID-19 vaccination reduced COVID-19 case trends during the Delta outbreak. The compartmental models developed assisted in the management and control of the COVID-19 pandemic in Malaysia.
Summary
Key Message
The effectiveness of the Coronavirus disease 2019 (COVID-19) vaccination against the highly transmissible Delta variant remained uncertain during the initial phase of the Delta outbreak in Malaysia. The innovative use of compartmental models provided scientific evidence of the potential impact of COVID-19 vaccination in reducing COVID-19 case trends based on local epidemiological data and offered forecasts of COVID-19 case trends based on varying vaccination rates which assisted resource planning and enhanced healthcare system preparedness. This evidence played a crucial role in bolstering public confidence in vaccination efforts and assisted in the control and management of the pandemic.
COVID-19: Cohort Profile
Cohort profile: investigating SARS-CoV-2 infection and the health and psychosocial impact of the COVID-19 pandemic in the Canadian CHILD Cohort
Rilwan Azeez, Larisa Lotoski, Aimée Dubeau, Natalie Rodriguez, Myrtha E. Reyna, Tyler Freitas, Stephanie Goguen, Maria Medeleanu, Geoffrey L. Winsor, Fiona S. L. Brinkman, Emily E. Cameron, Leslie Roos, Elinor Simons, Theo J. Moraes, Piush J. Mandhane, Stuart E. Turvey, Shelly Bolotin, Kim Wright, Deborah McNeil, David M. Patrick, Jared Bullard, Marc-André Langlois, Corey R. Arnold, Yannick Galipeau, Martin Pelchat, Natasha Doucas, Padmaja Subbarao, Meghan B. Azad
Epidemiol Health. 2023;45:e2023091.   Published online October 13, 2023
DOI: https://doi.org/10.4178/epih.e2023091
  • 9,348 View
  • 117 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has affected all Canadian families, with some impacted differently than others. Our study aims to: (1) determine the prevalence and transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among Canadian families, (2) identify predictors of infection susceptibility and severity of SARS-CoV-2, and (3) identify health and psychosocial impacts of the COVID-19 pandemic. This study builds upon the CHILD Cohort Study, an ongoing multi-ethnic general population prospective cohort consisting of 3,454 Canadian families with children born in Vancouver, Edmonton, Manitoba, and Toronto between 2009 and 2012. During the pandemic, CHILD households were invited to participate in the CHILD COVID-19 Add-On Study involving: (1) brief biweekly surveys about COVID-19 symptoms and testing; (2) quarterly questionnaires assessing COVID-19 exposure and testing, vaccination status, physical and mental health, and pandemic-driven life changes; and (3) in-home biological sampling kits to collect blood and stool. In total, 1,462 households (5,378 participants) consented to the CHILD COVID-19 Add-On Study: 2,803 children (mean±standard deviation [SD], 9.0±2.7 years; range, 0-17 years) and 2,576 adults (mean±SD, 43.0±6.5 years; range, 18-85 years). We will leverage the wealth of pre-pandemic CHILD data to identify risk and resilience factors for susceptibility and severity to the direct and indirect pandemic effects. Our short-term findings will inform key stakeholders and knowledge users to shape current and future pandemic responses. Additionally, this study provides a unique resource to study the long-term impacts of the pandemic as the CHILD Cohort Study continues.
Summary
Key Message
· This study of 1,462 Canadian families (5,378 individuals) leverages a decade of extensive pre-pandemic CHILD Cohort Study data to identify risk and resilience factors for susceptibility to the direct and indirect effects of the COVID-19 pandemic. · Our short-term findings will inform key stakeholders and knowledge users to shape current and future pandemic responses. · This study provides a unique resource to study the long-term impacts of the pandemic as the CHILD Cohort Study continues.
COVID-19: Original Article
Risk of lymphadenopathy from SARS-CoV-2 vaccination in Korea: a self-controlled case series analysis
Mi-Sook Kim, Bongyoung Kim, Jeong Pil Choi, Nam-Kyong Choi, Jung Yeon Heo, Jun Yong Choi, Joongyub Lee, Sang Il Kim
Epidemiol Health. 2023;45:e2023090.   Published online October 13, 2023
DOI: https://doi.org/10.4178/epih.e2023090
  • 6,193 View
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
To assess the risk of lymphadenopathy following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination.
METHODS
A self-controlled case series design was used to determine whether the risk of lymphadenopathy was higher in the 1-day to 42-day risk interval after coronavirus disease 2019 (COVID-19) vaccination compared to the control period. In addition, subgroup analyses were conducted according to baseline characteristics, time since vaccination, and sensitivity analyses adjusted for the length of the risk interval.
RESULTS
The risk of developing lymphadenopathy in the risk interval (1-42 days) after COVID-19 vaccination compared to the control period was significantly increased, with a relative incidence (RI) of 1.17 (95% confidence interval [CI], 1.17 to 1.18) when the first, second, and third doses were combined. The RI was greater on the day of vaccination (1.47; 95% CI, 1.44 to 1.50). In subgroup analyses by baseline characteristics, a significantly increased risk or trend toward increased risk was observed in most subgroups except for those aged 70 years and older, with a significant increase in risk in younger individuals, those with a Charlson’s comorbidity index <5, and those who received mRNA vaccines (mRNA-1273>BNT162b2). Within the 1-day to 42-day post-dose risk period, the relative risk was highest during the 1-day to 7-day post-dose period (1.59; 95% CI, 1.57 to 1.60) compared to the control period, and then the risk declined. In the sensitivity analysis, we found that the longer the risk window, the smaller the RI.
CONCLUSIONS
SARS-CoV-2 vaccination is associated with a statistically significant increase in the risk of lymphadenopathy, and this risk was observed only with mRNA vaccines.
Summary
Korean summary
질병관리청의 코로나19 예방접종자료와 국민건강보험공단 자료를 이용하여 수행한 본 자기대조환자군 연구에서 코로나19 백신접종은 42일 내 림프절병증 발생위험을 1.17배 (95% 신뢰구간, 1.17-1.18) 증가시키는 것으로 나타났다. 이러한 위험의 증가는 mRNA 백신에 국한하여 관찰되었으며 연령이 낮을수록, 여성일수록 상대위험도가 높은 것으로 나타났다.
Key Message
This self-controlled case series study, using the Korea Disease Control and Prevention Agency COVID-19 vaccination database and the National Health Insurance Service database, showed an increased risk of developing lymphadenopathy following vaccination (RR 1.17; 95% CI, 1.17 to 1.18). The elevated risk of lymphadenopathy is specifically associated with mRNA platform vaccines, not viral vector vaccines, and is more pronounced in younger individuals and females.
COVID-19: Original Article
Effective vaccination strategies to control COVID-19 in Korea: a modeling study
Youngsuk Ko, Kyong Ran Peck, Yae-Jean Kim, Dong-Hyun Kim, Eunok Jung
Epidemiol Health. 2023;45:e2023084.   Published online September 7, 2023
DOI: https://doi.org/10.4178/epih.e2023084
  • 6,281 View
  • 131 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
In Korea, as immunity levels of the coronavirus disease 2019 (COVID-19) in the population acquired through previous infections and vaccinations have decreased, booster vaccinations have emerged as a necessary measure to control new outbreaks. The objective of this study was to identify the most suitable vaccination strategy for controlling the surge in COVID-19 cases.
METHODS
A mathematical model was developed to concurrently evaluate the immunity levels induced by vaccines and infections. This model was then employed to investigate the potential for future resurgence and the possibility of control through the use of vaccines and antivirals.
RESULTS
As of May 11, 2023, if the current epidemic trend persists without further vaccination efforts, a peak in resurgence is anticipated to occur around mid-October of the same year. Under the most favorable circumstances, the peak number of severely hospitalized patients could be reduced by 43% (n=480) compared to the scenario without vaccine intervention (n=849). Depending on outbreak trends and vaccination strategies, the best timing for vaccination in terms of minimizing this peak varies from May 2023 to August 2023.
CONCLUSIONS
Our findings suggest that if the epidemic persist, the best timing for administering vaccinations would need to be earlier than currently outlined in the Korean plan. It is imperative to continue monitoring outbreak trends, as this is key to determining the best vaccination timing in order to manage potential future surges.
Summary
Korean summary
본 연구는 자연감염 혹은 백신으로 획득된 면역의 저하를 고려한 수리모델을 사용하여 COVID-19에 대한 백신 접종 전략 분석 결과를 보인다. 시뮬레이션 결과는 추가 백신 접종이 없을 경우 재유행의 정점이 800명을 넘을 것임을 나타내며, 적절한 시기에 백신을 접종하면 최대 재원 위중증환자수를 약 40%까지 줄일 수 있음을 보인다. 본 연구는 확진자 추세의 지속적인 모니터링이 백신 접종의 적정 시기를 결정하고 미래 COVID-19의 재유행을 효과적으로 관리하는 데 필요하다는 점을 강조한다.
Key Message
Our study analyzes strategies for COVID-19 through vaccination, using a mathematical model considering waning immunity from past infections and vaccinations. Results indicate that a resurgence peak would reach more than 800 without further vaccination, and suggest vaccination in proper timing can reduce the peak size of administered severe patients by up to approximately 40%. The study emphasizes the importance of ongoing monitoring of outbreak trends to manage vaccination timing and future COVID-19 surges effectively.

Citations

Citations to this article as recorded by  
  • Global stability analysis of an extended SUC epidemic mathematical model
    Mengxin Chen, Soobin Kwak, Seokjun Ham, Youngjin Hwang, Junseok Kim
    Zeitschrift für Naturforschung A.2024;[Epub]     CrossRef
COVID-19: Original Article
Body mass index and prevalence of metabolic syndrome among Korean adults before and after the COVID-19 outbreak: a retrospective longitudinal study
Joo-Eun Jeong, Hoon-Ki Park, Hwan-Sik Hwang, Kye-Yeung Park, Myoung-Hye Lee, Seon-Hi Shin, Nayeon Choi
Epidemiol Health. 2023;45:e2023081.   Published online August 29, 2023
DOI: https://doi.org/10.4178/epih.e2023081
  • 7,134 View
  • 137 Download
  • 1 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Studies evaluating weight changes during the coronavirus disease 2019 (COVID-19) pandemic have yielded inconsistent results, and most of those studies were based on self-reported anthropometric measures. We investigated changes in body mass index (BMI), professionally measured waist circumference (WC), and metabolic syndrome components from before to during the pandemic in a sample of the adult population in Korea.
METHODS
This retrospective study included 1,118 male and female (age≥18 years) who underwent health checkups at a university medical center between January 1, 2016 and March 31, 2022. Changes in BMI, lifestyles, and metabolic syndrome components during the pandemic were analyzed using the paired t-test, McNemar test, generalized estimating equations, and repeated-measures analysis of variance.
RESULTS
Changes in body weight, BMI, and body fat percentage during the pandemic were not clinically significant. However, statistically significant results were found for decreased physical activity (p<0.001) and WC (p<0.001), and exacerbation of all metabolic syndrome components (except serum triglyceride levels). Moreover, the metabolic syndrome prevalence increased significantly from 20.2% to 31.2% during the pandemic (p<0.001). The prevalence of abdominal obesity and high fasting blood glucose levels also significantly increased from 2019 to 2021.
CONCLUSIONS
Metabolic syndrome, its components, and fat distribution worsened significantly after the implementation of social distancing and lockdowns, despite no clinically significant changes in body weight and BMI. Further studies on the post- pandemic period should investigate the long-term impact of social lockdowns on BMI and the prevalence of metabolic syndrome.
Summary
Korean summary
본 연구에서는 한국인 성인들의 코로나 팬대믹으로 인한 사회적 거리 두기, 봉쇄 정책 전 후의 체질량지수, 생활습관, 그리고 대사증후군과 그 구성 요소들의 변화를 건강검진을 통해 측정한 객관적인 지표의 변화를 통해 알아보고자 하였다. 연구 결과, 사회적 거리 두기 및 봉쇄 전후의 체질량지수와 체중은 유의미한 변화가 없었으나, 신체 활동량은 유의미하게 감소하였고, 체지방률, 허리둘레가 늘어났다. 그리고 중성지방을 제외하고 다른 대사증후군의 구성 요소인 혈압, 고밀도지단백 콜레스테롤, 공복혈당 지표는 악화되었다. 하위 그룹 분석에서 매년 검진을 시행 받은 대상자들 및 고혈압, 당뇨병, 이상지질혈증 약을 복용하지 않는 대상자들의 코로나-19 전후 연도별 대사 지표의 변화를 분석한 결과, 복부비만 유병률과 공복 혈당의 증가 양상이 뚜렷하였다.
Key Message
Although there was no significant change in BMI and weight, the prevalence of metabolic syndrome, abdominal obesity, and fasting blood glucose level prominently worsened after the implementation of social distancing and lockdowns. Such findings may indicate deterioration of insulin resistance during the COVID-19 pandemic. This study provides valuable information for healthcare professionals, policymakers, and the general public towards mitigating the negative consequences of the pandemic on metabolic health, regardless of weight gain.

Citations

Citations to this article as recorded by  
  • Effects of Online-based Exercise on Body Composition and Muscular Function during the COVID-19 Pandemic
    Juseong Lee, Jooeun Park, Hyunmin Kim, Geon Woo Lee, Junghoon Kim
    The Asian Journal of Kinesiology.2024; 26(3): 74.     CrossRef
  • Changes in food sufficiency among Korean adults in urban and rural areas during the COVID-19 pandemic: an analysis of the 7th and 8th Korea National Health and Nutrition Examination Survey
    Sarang Jeong, Jin-Young Jeong, Sohyun Park
    Epidemiology and Health.2024; : e2024045.     CrossRef
COVID-19: Original Article
Clinical symptom profile of hospitalized COVID-19 Brazilian patients according to SARS-CoV-2 variants
Natália Satchiko Hojo-Souza, Vander Luis de Souza Freitas, Daniel Ludovico Guidoni, Fernanda Sumika Hojo de Souza
Epidemiol Health. 2023;45:e2023079.   Published online August 28, 2023
DOI: https://doi.org/10.4178/epih.e2023079
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
The aim of this study was to investigate the prevalence of the main symptoms in Brazilian coronavirus disease 2019 (COVID-19) patients hospitalized during 4 distinct waves, based on their infection with different severe acute respiratory disease coronavirus 2 (SARS-CoV-2) variants.
METHODS
This study included hospitalized patients who tested positive for SARS-CoV-2 during 15 weeks around the peak of each of 4 waves: W1, ancestral strain/B.1 lineage (May 31 to September 12, 2020); W2, Gamma/P.1 variant (January 31 to May 15, 2021); W3, Omicron variant (December 5, 2021 to March 19, 2022); and W4, BA.4/BA.5 subvariants (May 22 to September 3, 2022). Symptom data were extracted from the Brazilian Severe Acute Respiratory Syndrome Database. Relative risks were calculated, and an analysis of symptom networks was performed.
RESULTS
Patients who were hospitalized during the prevalence of the Gamma/P.1 variant demonstrated a higher risk, primarily for symptoms such as fatigue, abdominal pain, low oxygen saturation, and sore throat, than patients hospitalized during the first wave. Conversely, patients who were hospitalized during the predominance of the Omicron variant exhibited a lower relative risk, particularly for symptoms such as loss of smell, loss of taste, diarrhea, fever, respiratory distress, and dyspnea. Similar results were observed in COVID-19 patients who were hospitalized during the wave of the Omicron subvariants BA.4/BA.5. A symptom network analysis, conducted to explore co-occurrence patterns among different variants, revealed significant differential profiles across the 4 waves, with the most notable difference observed between the W2 and W4 networks.
CONCLUSIONS
Overall, the relative risks and patterns of symptom co-occurrence associated with different SARS-CoV-2 variants may reflect disease severity.
Summary
Key Message
The study highlights the varying prevalence and distinct symptom profiles among Brazilian COVID-19 patients hospitalized during different waves linked to specific SARS-CoV-2 variants. It suggests that the manifestation of symptoms differs significantly across variant-driven waves, signifying potential shifts in disease severity. Specifically, patients during the Gamma/P.1 variant wave showed higher risks for symptoms like fatigue, abdominal pain, and respiratory impairment, while those during the Omicron wave exhibited lower risks for certain symptoms like loss of smell and taste, indicating changing symptomatology and potentially evolving disease impact linked to different variants.

Citations

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  • Gastrointestinal symptoms in COVID-19 and disease severity: a Japanese registry-based retrospective cohort study
    Yuta Matsubara, Hiroki Kiyohara, Yohei Mikami, Kosaku Nanki, Ho Namkoong, Shotaro Chubachi, Hiromu Tanaka, Shuhei Azekawa, Shinya Sugimoto, Yusuke Yoshimatsu, Tomohisa Sujino, Kaoru Takabayashi, Naoki Hosoe, Toshiro Sato, Makoto Ishii, Naoki Hasegawa, Yuk
    Journal of Gastroenterology.2024;[Epub]     CrossRef
  • Prevalence and Factors Associated with Olfactory Dysfunction in Individuals with COVID-19 in Brazil: A Study of 20,669 Cases from 2020 to 2021
    Carlos Dornels Freire de Souza, Amanda Júlia de Arruda Magalhães, Yasmin Vitória Silva Nobre, Carlos Alberto Souza, André Luis Oliveira do Nascimento, Luísa Robalinho de Faria, Márcio Bezerra-Santos, Anderson da Costa Armstrong, Jandir Mendonça Nicácio, O
    Medical Principles and Practice.2024; 33(2): 164.     CrossRef
  • Risks of Adverse Outcomes for Hospitalized COVID-19 Patients during the Four Waves in Brazil According to SARS-CoV-2 Variants, Age Group, and Vaccine Status
    Natália Satchiko Hojo-Souza, Waasila Jassat, Daniel Ludovico Guidoni, Fernanda Sumika Hojo de Souza
    Viruses.2023; 15(10): 1997.     CrossRef
COVID-19: Original Article
Korea Seroprevalence Study of Monitoring of SARS-COV-2 Antibody Retention and Transmission (K-SEROSMART): findings from national representative sample
Jina Han, Hye Jin Baek, Eunbi Noh, Kyuhyun Yoon, Jung Ae Kim, Sukhyun Ryu, Kay O Lee, No Yai Park, Eunok Jung, Sangil Kim, Hyukmin Lee, Yoo-Sung Hwang, Jaehun Jung, Hun Jae Lee, Sung-il Cho, Sangcheol Oh, Migyeong Kim, Chang-Mo Oh, Byengchul Yu, Young-Seoub Hong, Keonyeop Kim, Sun Jae Jung, Mi Ah Han, Moo-Sik Lee, Jung-Jeung Lee, Young Hwangbo, Hyeon Woo Yim, Yu-Mi Kim, Joongyub Lee, Weon-Young Lee, Jae-Hyun Park, Sungsoo Oh, Heui Sug Jo, Hyeongsu Kim, Gilwon Kang, Hae-Sung Nam, Ju-Hyung Lee, Gyung-Jae Oh, Min-Ho Shin, Soyeon Ryu, Tae-Yoon Hwang, Soon-Woo Park, Sang Kyu Kim, Roma Seol, Ki-Soo Park, Su Young Kim, Jun-wook Kwon, Sung Soon Kim, Byoungguk Kim, June-Woo Lee, Eun Young Jang, Ah-Ra Kim, Jeonghyun Nam, The Korea Community Health Survey Group, Soon Young Lee, Dong-Hyun Kim
Epidemiol Health. 2023;45:e2023075.   Published online August 17, 2023
DOI: https://doi.org/10.4178/epih.e2023075
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
We estimated the population prevalence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including unreported infections, through a Korea Seroprevalence Study of Monitoring of SARS-CoV-2 Antibody Retention and Transmission (K-SEROSMART) in 258 communities throughout Korea.
METHODS
In August 2022, a survey was conducted among 10,000 household members aged 5 years and older, in households selected through two stage probability random sampling. During face-to-face household interviews, participants self-reported their health status, COVID-19 diagnosis and vaccination history, and general characteristics. Subsequently, participants visited a community health center or medical clinic for blood sampling. Blood samples were analyzed for the presence of antibodies to spike proteins (anti-S) and antibodies to nucleocapsid proteins (anti-N) SARS-CoV-2 proteins using an electrochemiluminescence immunoassay. To estimate the population prevalence, the PROC SURVEYMEANS statistical procedure was employed, with weighting to reflect demographic data from July 2022.
RESULTS
In total, 9,945 individuals from 5,041 households were surveyed across 258 communities, representing all basic local governments in Korea. The overall population-adjusted prevalence rates of anti-S and anti-N were 97.6% and 57.1%, respectively. Since the Korea Disease Control and Prevention Agency has reported a cumulative incidence of confirmed cases of 37.8% through July 31, 2022, the proportion of unreported infections among all COVID-19 infection was suggested to be 33.9%.
CONCLUSIONS
The K-SEROSMART represents the first nationwide, community-based seroepidemiologic survey of COVID-19, confirming that most individuals possess antibodies to SARS-CoV-2 and that a significant number of unreported cases existed. Furthermore, this study lays the foundation for a surveillance system to continuously monitor transmission at the community level and the response to COVID-19.
Summary
Korean summary
인구집단을 기반으로 하여 대표성 있는 표본을 추출하여 COVID-19 항체유병률 조사를 전국적으로 수행함으로 지역사회 단위에서 지속적으로 모니터링할 수 있는 COVID-19 감시체계 구축의 기반을 마련하였다. 2022년 8월 우리나라 국민의 대부분이 COVID-19에 대한 항체를 보유하고 있었고 인구 3명 중 1명은 미확진 감염자로 추정되었다.
Key Message
The K-SEROSMART represents the first nationwide, community-based seroepidemiologic survey of COVID-19. In August 2022, most of the Korean people had antibodies to COVID-19, and one in three people was estimated to have an unreported infection. This study lays the foundation for a surveillance system to continuously monitor transmission at the community level and the response to COVID-19.

Citations

Citations to this article as recorded by  
  • Infection-mediated immune response in SARS-CoV-2 breakthrough infection and implications for next-generation COVID-19 vaccine development
    Sho Miyamoto, Tadaki Suzuki
    Vaccine.2024; 42(6): 1401.     CrossRef
  • Changes in the intrinsic severity of severe acute respiratory syndrome coronavirus 2 according to the emerging variant: a nationwide study from February 2020 to June 2022, including comparison with vaccinated populations
    Boyeong Ryu, Eunjeong Shin, Dong Hwi Kim, HyunJu Lee, So Young Choi, Seong-Sun Kim, Il-Hwan Kim, Eun-Jin Kim, Sangwon Lee, Jaehyun Jeon, Donghyok Kwon, Sungil Cho
    BMC Infectious Diseases.2024;[Epub]     CrossRef
COVID-19: Original Article
Did the socioeconomic inequalities in avoidable and unavoidable mortality worsen during the first year of the COVID-19 pandemic in Korea?
Rora Oh, Myoung-Hee Kim, Juyeon Lee, Rangkyoung Ha, Jungwook Kim
Epidemiol Health. 2023;45:e2023072.   Published online August 3, 2023
DOI: https://doi.org/10.4178/epih.e2023072
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study examined changes in socioeconomic inequalities in mortality in Korea before and after the outbreak of coronavirus disease 2019 (COVID-19).
METHODS
From 2017 to 2020, age-standardized mortality rates were calculated for all-cause deaths, avoidable deaths (preventable deaths, treatable deaths), and unavoidable deaths using National Health Insurance claims data and Statistics Korea’s cause of death data. In addition, the slope index of inequality (SII) and the relative index of inequality (RII) by six income levels (Medical Aid beneficiary group and quintile of health insurance premiums) were computed to analyze the magnitude and change of mortality inequalities.
RESULTS
All-cause and avoidable mortality rates decreased steadily between 2017 and 2020, whereas unavoidable mortality remained relatively stable. In the case of mortality inequalities, the disparity in all-cause mortality between income classes was exacerbated in 2020 compared to 2019, with the SII increasing from 185.44 to 189.22 and the RII increasing from 3.99 to 4.29. In particular, the preventable and unavoidable mortality rates showed an apparent increase in inequality, as both the SII (preventable: 91.31 to 92.01, unavoidable: 69.99 to 75.38) and RII (preventable: 3.42 to 3.66, unavoidable: 5.02 to 5.89) increased.
CONCLUSIONS
In the first year of the COVID-19 pandemic, mortality inequality continued to increase, although there was no sign of exacerbation. It is necessary to continuously evaluate mortality inequalities, particularly for preventable and unavoidable deaths.
Summary
Korean summary
이 연구는 COVID-19 발생 전후 한국에서의 사망률 추이와 사망률 불평등 변화를 조사했다. 2017~2020년 사이에 총사망률과 회피가능사망률은 줄어들었지만, 사망률의 사회경제적 불평등은 더 커지는 경향을 보였다. 특히 예방가능사망과 회피불가능사망에서 불평등이 커져 지속적인 추적과 평가가 필요하다.
Key Message
This study examined the trends in mortality rates and changes in mortality inequality in Korea before and after the onset of COVID-19. Between 2017 and 2020, while the all-cause and avoidable mortality rates decreased, there was a growing trend of inequality in mortality rates based on income levels. Particularly, inequalities in preventable and unavoidable deaths have increased, emphasizing the need for ongoing evaluation.
COVID-19: Original Article
Unequal burdens of COVID-19 infection: a nationwide cohort study of COVID-19-related health inequalities in Korea
Jeangeun Jeon, Jieun Park, Min-Hyeok Choi, Hongjo Choi, Myoung-Hee Kim
Epidemiol Health. 2023;45:e2023068.   Published online July 31, 2023
DOI: https://doi.org/10.4178/epih.e2023068
  • 4,616 View
  • 127 Download
  • 3 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
While the Korean government’s response to the coronavirus disease 2019 (COVID-19) pandemic is considered effective given the relatively low mortality rate, issues of inequality have been insufficiently addressed. This study explored COVID-19-related health inequalities in Korea.
METHODS
Age standardization for various health inequality indices was derived using data from the Korean National Health Insurance Service, the Korea Disease Control and Prevention Agency, and the Microdata Integrated Service of Statistics Korea. The slope index of inequality (SII) and relative index of inequality (RII) were calculated for socioeconomic variables, while absolute difference (AD) and relative difference (RD) were used for gender and disability inequalities.
RESULTS
We observed a number of COVID-19-related health outcome inequalities. Gender inequality was particularly noticeable in infection rates, with the rate of women 1.16 times higher than that of men. In contrast, socioeconomic inequality was evident in vaccination rates, with a 4.5-fold (SII, -4.519; 95% confidence interval, -7.403 to -1.634) difference between the highest and lowest household income groups. Regarding clinical progression post-infection, consistent findings indicated higher risk for men (RD for hospitalization, 0.90; severe cases, 0.54; and fatality, 0.65), individuals with disabilities (RD for hospitalization, 2.27; severe cases, 2.29; and fatality, 2.37), and those from lower socioeconomic groups (SII for hospitalization, 1.778; severe cases, 0.089; and fatality, 0.451).
CONCLUSIONS
While the infection risk was nearly ubiquitous, not everyone faced the same level of risk post-infection. To prevent further health inequalities, it is crucial to develop a thoughtful policy acknowledging individual health conditions and resources.
Summary
Korean summary
2020년 10월-2022년 4월까지의 국내 코로나-19 확진자 데이터와 건강보험 빅데이터, 사망등록통계를 연계하여 건강결과의 불평등 지표를 산출한 결과, 감염율, 백신접종율, 입원율, 중증화율, 치명률에서 소득수준(건강보험료 소득분위 기준), 성별, 장애유무에 따른 건강결과의 불평등이 확인되었다. 감염율은 여성이 남성보다 높았고, 백신접종율은 장애인과 의료급여 수급권자의 비율이 낮게 나타났고, 코로나-19로 인한 입원율과 중증화율, 치명율에서는 남성, 의료급여 수급권자, 장애인의 취약성이 두드러졌다. 본 연구의 분석결과는 국내 방역정책이 기존의 사회불평등을 충분하게 고려하지 못했을 가능성이 크며, 미래 감염병 관리 시 이를 고려하여 불평등을 완화시킬 수 있는 방향의 정책적 전략이 필요하다는 점을 시사한다.
Key Message
This study sought to investigate COVID-19-related health inequalities in Korea by linking COVID-19 registry data to the KNHIS big data and the cause of death data for the period October 2020 - April 2022. COVID-19-related health outcome inequalities were observed in infection, vaccination, hospitalization, clinical progress, and fatality by household income, gender, and disability. The infection rate was higher in women, the vaccination proportion was lower in the disabled and medical-aid beneficiaries, and men, the disabled and medical-aid beneficiaries were vulnerable in clinical progression post-infection which implies that a policy necessarily should consider existing socioeconomic inequalities for future pandemics.

Citations

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  • The role of area deprivation index in health care disruptions among cancer survivors during the SARS-CoV-2 pandemic
    R.W. Wagner, A. Natori, S. Prinsloo, A.K. Otto, E. Saez-Clarke, J.M. Ochoa, S.S. Tworoger, C.M. Ulrich, C.A. Hathaway, S. Ahmed, J.L. McQuade, A.R. Peoples, M.H. Antoni, F.J. Penedo, L. Cohen
    Public Health.2024; 232: 52.     CrossRef
  • Universal health coverage saves more lives among severely ill COVID-19 patients: A difference-in-differences analysis of individual patient data in South Korea
    Daseul Moon, Jeangeun Jeon, Jieun Park, Min-Hyeok Choi, Myoung-Hee Kim, Hongjo Choi
    Health Research Policy and Systems.2024;[Epub]     CrossRef
COVID-19: Original Article
Direct indicators of social distancing effectiveness in COVID-19 outbreak stages: a correlational analysis of case contacts and population mobility in Korea
Sojin Choi, Chanhee Kim, Kun-Hee Park, Jong-Hun Kim
Epidemiol Health. 2023;45:e2023065.   Published online July 10, 2023
DOI: https://doi.org/10.4178/epih.e2023065
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The effectiveness of social distancing during the coronavirus disease 2019 (COVID-19) pandemic has been evaluated using the magnitude of changes in population mobility. This study aimed to investigate a direct indicator—namely, the number of close contacts per patient with confirmed COVID-19.
METHODS
From week 7, 2020 to week 43, 2021, population movement changes were calculated from the data of two Korean telecommunication companies and Google in accordance with social distancing stringency levels. Data on confirmed cases and their close contacts among residents of Gyeonggi Province, Korea were combined at each stage. Pearson correlation analysis was conducted to compare the movement data with the change in the number of contacts for each confirmed case calculated by stratification according to age group. The reference value of the population movement data was set using the value before mid-February 2020, considering each data’s characteristics.
RESULTS
In the age group of 18 or younger, the number of close contacts per confirmed case decreased or increased when the stringency level was strengthened or relaxed, respectively. In adults, the correlation was relatively low, with no correlation between the change in the number of close contacts per confirmed case and the change in population movement after the commencement of vaccination for adults.
CONCLUSIONS
The effectiveness of governmental social distancing policies against COVID-19 can be evaluated using the number of close contacts per confirmed case as a direct indicator, especially for each age group. Such an analysis can facilitate policy changes for specific groups.
Summary
Korean summary
1. 사회적 거리두기의 효과를 간접적인 자료인 이동통신사와 구글데이터를 이용하여 인구 이동성 변화의 크기를 평가하였고, 직접적인 자료인 역학조사서의 확진자 1인당 밀접 접촉자 수를 산출하여 비교 평가하였다. 2. 18세 이하 연령대는 사회적 거리두기의 강화 또는 완화 단계에 따라 확진자 1인당 밀접 접촉자 수가 민감하게 변동되었으나, 성인의 경우에는 덜 민감하게 변동되었다. 3. 역학조사서에 기반하여 시계열 자료로 재가공한 확진자 1인당 밀접 접촉자 수는 사회적 거리두기 정책의 효과를 평가하는 직접적인 평가 지표로 사용될 수 있기에 충분히 검토되어야 한다.
Key Message
1. The study assessed social distancing's effectiveness by analyzing population mobility changes through mobile operator and Google data. And it was also compared with the number of close contacts per confirmed COVID-19 case based on the epidemiological survey report. 2. Younger age groups were more influenced by the social distancing policy in close contacts per confirmed COVID-19 case than adults. 3. The study suggests using close contacts per confirmed COVID-19 case from the epidemiological survey report as a direct measure of social distancing policy effectiveness.
COVID-19: Original Article
Lack of compensation for COVID-19-related overtime work and its association with burnout among EMS providers in Korea
Ji-Hwan Kim, Jaehong Yoon, Soo Jin Kim, Ja Young Kim, Jinwook Bahk, Seung-Sup Kim
Epidemiol Health. 2023;45:e2023058.   Published online June 15, 2023
DOI: https://doi.org/10.4178/epih.e2023058
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study examined the association between lack of compensation for COVID-19-related overtime work (LCCOW) and burnout among emergency medical service (EMS) providers in Seoul, Korea.
METHODS
We conducted a cross-sectional survey of 693 EMS providers in Seoul, Korea. Participants were classified into 3 groups according to their experience of coronavirus disease 2019 (COVID-19)-related overtime work and LCCOW: (1) “did not experience,” (2) “experienced and was compensated,” and (3) “experienced and was not compensated.” Burnout was measured using the Korean version of the Copenhagen Burnout Inventory, which has 3 subdomains: personal burnout (PB), work-related burnout (WRB), and citizen-related burnout (CRB). Multiple linear regression was applied to examine whether LCCOW was associated with burnout after adjusting for potential confounders.
RESULTS
In total, 74.2% of participants experienced COVID-19-related overtime work, and 14.6% of those who worked overtime experienced LCCOW. COVID-19-related overtime work showed a statistically non-significant association with burnout. However, the association differed by LCCOW. Compared to the “did not experience” group, the “experienced and was not compensated” group was associated with PB (β=10.519; 95% confidence interval [CI], 3.455 to 17.584), WRB (β=10.339; 95% CI, 3.398 to 17.280), and CRB (β=12.290; 95% CI, 6.900 to 17.680), whereas no association was observed for the “experienced and was compensated” group. Furthermore, an analysis restricted to EMS providers who worked overtime due to COVID-19 showed that LCCOW was associated with PB (β=7.970; 95% CI, 1.064 to 14.876), WRB (β=7.276; 95% CI, 0.270 to 14.283), and CRB (β=10.000; 95% CI, 3.435 to 16.565).
CONCLUSIONS
This study suggests that LCCOW could be critical in worsening burnout among EMS providers who worked overtime due to COVID-19.
Summary
Korean summary
본 연구는 2021년에 진행된 서울시 구급대원 693 명의 설문조사 자료를 이용해서 COVID-19으로 인한 초과근무 경험에 대한 보상 부족과 번아웃의 연관성을 살펴보았다. 초과근무 경험이 없었던 구급대원의 번아웃 점수와 비교할 때, 초과근무 경험이 있고 항상 적절한 보상을 받은 구급대원의 번아웃 점수는 통계적으로 유의한 차이가 관찰되지 않았지만, 초과근무 경험이 있고 적절한 보상을 받지 못한 적이 있는 구급대원의 번아웃 점수는 통계적으로 유의하게 높게 나타났다. 초과근무를 경험한 구급대원으로 한정한 분석에서는 적절한 보상을 항상 받은 구급대원에 비해서 적절한 보상을 받지 못한 적이 있는 구급대원의 번아웃 점수가 통계적으로 유의하게 높았다.
Key Message
Using a survey of 693 EMS providers in Seoul, Korea, we examined the association between lack of compensation for COVID-19-related overtime work (LCCOW) and burnout. Higher scores of burnouts were observed among those with LCCOW, but not among those without LCCOW, compared to the EMS providers who did not experience overtime work due to COVID-19. Furthermore, in the analysis restricted to EMS providers who had worked overtime due to COVID-19, LCCOW was associated with burnout.

Citations

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  • Effects of Post-COVID-19 Syndrome on Quality of Life Among Airline Crew
    Jung-Ha Kim, Seunghye Choi
    Workplace Health & Safety.2024; 72(9): 374.     CrossRef
  • People-Oriented Culture and Its Association With Burnout, Depressive Symptoms, and Sleep Problems During COVID-19 Pandemic Among EMS Providers in Korea
    Ji-Hwan Kim, Jaehong Yoon, Soo Jin Kim, Ja Young Kim, Seung-Sup Kim
    Journal of Occupational & Environmental Medicine.2024; 66(8): e359.     CrossRef

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