Abstract：
BACKGROUND: Excess mortality during the COVID-19 pandemic provides a comprehensive measure of disease burden, and its local variation highlights regional health inequalities. We investigated local excess mortality in 2020 and its determinants at the community level.
METHODS: We collected data from 250 districts in South Korea, including monthly all-cause mortality for 2015-2020 and community characteristics from 2019. Excess mortality rate was defined as the difference between observed and expected mortality rates. A Seasonal Autoregressive Integrated Moving Average model was applied to predict the expected rates for each district. Penalized regression methods were used to derive relevant community predictors of excess mortality based on the elastic net.
RESULTS: In 2020, South Korea exhibited significant variation in excess mortality rates across 250 districts, ranging from no excess deaths in 46 districts to more than 100 excess deaths per 100 000 residents in 30 districts. Economic status or the number of medical centres in the community did not correlate with excess mortality rates. The risk was higher in ageing, remote communities with limited cultural and sports infrastructure, a higher density of welfare facilities, and a higher prevalence of hypertension. Physical distancing policies and active social engagement in voluntary activities protected from excess mortality.
CONCLUSIONS: Substantial regional disparities in excess mortality existed within South Korea during the early stages of COVID-19 pandemic. Weaker segments of the community were more vulnerable. Local governments should refine their preparedness for future novel infectious disease outbreaks, considering community circumstances.
METHODS: We collected data from 250 districts in South Korea, including monthly all-cause mortality for 2015-2020 and community characteristics from 2019. Excess mortality rate was defined as the difference between observed and expected mortality rates. A Seasonal Autoregressive Integrated Moving Average model was applied to predict the expected rates for each district. Penalized regression methods were used to derive relevant community predictors of excess mortality based on the elastic net.
RESULTS: In 2020, South Korea exhibited significant variation in excess mortality rates across 250 districts, ranging from no excess deaths in 46 districts to more than 100 excess deaths per 100 000 residents in 30 districts. Economic status or the number of medical centres in the community did not correlate with excess mortality rates. The risk was higher in ageing, remote communities with limited cultural and sports infrastructure, a higher density of welfare facilities, and a higher prevalence of hypertension. Physical distancing policies and active social engagement in voluntary activities protected from excess mortality.
CONCLUSIONS: Substantial regional disparities in excess mortality existed within South Korea during the early stages of COVID-19 pandemic. Weaker segments of the community were more vulnerable. Local governments should refine their preparedness for future novel infectious disease outbreaks, considering community circumstances.
摘要：
背景：COVID-19大流行期间的超额死亡率提供了疾病负担的综合指标，其局部差异突出了区域卫生不平等。我们调查了2020年当地超额死亡率及其在社区一级的决定因素。
方法：我们收集了来自韩国250个地区的数据，包括2015-2020年的每月全因死亡率和2019年的社区特征。超额死亡率定义为观察和预期死亡率之间的差异。应用季节性自回归综合移动平均模型来预测每个地区的预期费率。使用惩罚回归方法根据弹性网络得出相关的社区超额死亡率预测因子。
结果：在2020年，韩国在250个地区的超额死亡率上表现出显著差异，从46个地区的无超额死亡到30个地区的每10万居民超过100个超额死亡。经济状况或社区医疗中心的数量与超额死亡率无关。衰老的风险更高，文化和体育基础设施有限的偏远社区，更高密度的福利设施，高血压患病率较高。身体距离政策和社会积极参与志愿活动，避免死亡率过高。
结论：在COVID-19大流行的早期阶段，韩国的超额死亡率存在很大的地区差异。社区中较弱的部分更脆弱。地方政府应加强对未来新型传染病暴发的防范,考虑到社区情况。
方法：我们收集了来自韩国250个地区的数据，包括2015-2020年的每月全因死亡率和2019年的社区特征。超额死亡率定义为观察和预期死亡率之间的差异。应用季节性自回归综合移动平均模型来预测每个地区的预期费率。使用惩罚回归方法根据弹性网络得出相关的社区超额死亡率预测因子。
结果：在2020年，韩国在250个地区的超额死亡率上表现出显著差异，从46个地区的无超额死亡到30个地区的每10万居民超过100个超额死亡。经济状况或社区医疗中心的数量与超额死亡率无关。衰老的风险更高，文化和体育基础设施有限的偏远社区，更高密度的福利设施，高血压患病率较高。身体距离政策和社会积极参与志愿活动，避免死亡率过高。
结论：在COVID-19大流行的早期阶段，韩国的超额死亡率存在很大的地区差异。社区中较弱的部分更脆弱。地方政府应加强对未来新型传染病暴发的防范,考虑到社区情况。
