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?:abstract
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Objectives: To explore socioeconomic disparites by using health insurance type as a proxy, during the ongoing COVID-19 pandemic. Methods: We conducted a retrospective cohort study using South Korea\'s nationwide healthcare database that contained all individuals who received a diagnostic test for COVID-19 (n=232,390) as of May 15, 2020. We classified our cohort by health insurance type into beneficiaries of the national health insurance (NHI) or Medicaid programs. Our study outcomes were infection with SARS-CoV-2 and COVID-19-related outcomes, a composite of all-cause death, intensive care unit admission, and mechanical ventilation use. We estimated the age, sex, and Charlson comorbidity index score adjusted odds ratio (aOR) with 95% confidence intervals (CIs) using a multivariable logistic regression analysis. Results: Of the 218,070 NHI and 14,320 Medicaid beneficiaries who received COVID-19 tests, 7,777 and 738 tested positive, respectively. Medicaid beneficiaries were older (mean age 57.5 years versus 47.8), males (47.2% versus 40.2%), and had higher comorbidity burden (mean CCI 2.0 versus 1.7) than NHI beneficiaries. Compared to NHI, Medicaid beneficiaries were associated with a 22% increased risk of SARS-CoV-2 infection (aOR 1.22, 95% CI 1.09-1.38), but had a null association for COVID-19-related outcomes (aOR 1.10, 95% CI 0.77-1.57); individual events of the composite outcome yielded similar findings. Conclusion: As socioeconomic factors, proxied by health insurance, could serve as determinants during the current pandemic, pre-emptive support is needed for high-risk groups to retard its spread.
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