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Journal of The Korean Society of Emergency Medicine 2026;37(1): 29-38. |
| Interaction effects between coronavirus disease 2019 outbreak and socioeconomic status on mortality among cancer patients visiting emergency departments: a retrospective observational study |
Chang Min Park1
, Sung Hyun Lee1
, Eujene Jung2
, Tag Heo2
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1Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
2Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Korea |
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Received: January 27, 2026; Revised: January 28, 2026 Accepted: January 29, 2026. Published online: February 28, 2026. |
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| ABSTRACT |
Objective:
The coronavirus disease 2019 (COVID-19) pandemic disrupted healthcare systems worldwide, leading to increased mortality rates across various conditions. This study assessed the impact of COVID-19 on excess in-hospital mortality among emergency department patients and examined variations by community income levels, thereby highlighting socioeconomic disparities.
Methods:
This retrospective cross-sectional study used data from the National Emergency Department Information System in Korea. Cancer patients who visited emergency departments between January 27 and December 31 in 2019 (pre-COVID) and 2020 (during COVID) were included. The primary outcome was in-hospital mortality. The main exposure was the COVID-19 outbreak, with county per capita income tax serving as the interaction variable. The risk-adjusted in-hospital mortality rates were calculated. A multilevel linear regression model with an interaction term was used to estimate the difference-in-difference between the periods based on county income tax.
Results:
A total of 206,400 cancer patients were included 110,879 pre-COVID and 95,521 during COVID with an unadjusted in-hospital mortality rate of 1.0%. The risk-adjusted mortality rate was significantly higher during COVID than pre-COVID (1.2% vs. 0.9%, P<0.01). Using the highest socioeconomic status group (Q1) as the reference, the excess inhospital mortality odds during COVID were higher in Q3 (adjusted odds ratio [aOR], 1.32; 95% confidence interval [CI], 1.17-1.54) and Q4 (aOR, 1.43; 95% CI, 1.15-1.77).
Conclusion:
The COVID-19 pandemic exacerbated in-hospital mortality disparities among cancer patients, imposing a greater burden on lower socioeconomic groups. These findings highlight the importance of implementing equitable healthcare strategies to protect vulnerable populations during health emergencies. |
| Key words:
COVID-19; Socioeconomic factors; Neoplasms; Mortality; Hospital emergency service |
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