The Effects of Income Level on Susceptibility to COVID-19 and COVID-19 Morbidity/Mortality: A Nationwide Cohort Study in South Korea.

So Young Kim,Hyo Geun Choi,Chanyang Min,Dae Myoung Yoo

doi:10.3390/jcm10204733

Abstract

This study aimed to investigate the association of income level with susceptibility to coronavirus disease 2019 (COVID-19) and COVID-19 morbidity and mortality. Using the Korean National Health Insurance COVID-19 Database cohort, medical claim data from 2015 through 2020 were collected. A total of 7943 patients who were diagnosed with COVID-19 from 1 January 2020 to 4 June 2020 were included. A total of 118,914 participants had negative COVID-19 PCR tests. Income levels were classified by 20th percentiles based on 2019 Korean National Health Insurance premiums. The 20th percentile income levels were categorized into three groups (low, middle, and high). The relationship of income level with susceptibility to COVID-19 and COVID-19 morbidity and mortality was analyzed using logistic regression analysis. A high income level was related to lower odds of COVID-19 infection (adjusted odds ratio (aOR) = 0.79, 95% confidence interval (CI) = 0.75–0.83, p < 0.001). The negative association between income level and COVID-19 infection was maintained in all subgroups. Patients with low income levels were susceptible to COVID-19 infection; however, there was no relation of COVID-19 morbidity and mortality with income level in the Korean population.

Highlights

The coronavirus disease 2019 (COVID-19) pandemic has greatly affected many aspects of life for people around the world
The distributions of age, sex, Charlson comorbidity index (CCI) score, and history of hypertension were different among income groups
Compared to the low-income group, the middle- and high-income groups demonstrated lower odds of COVID-19 infection (adjusted odds ratios (ORs) = 0.78, 95% confidence intervals (CIs) = 0.74–0.83, p < 0.001 for the middle-income group and aOR = 0.79, 95% CI = 0.75–0.83, p < 0.001 for the high-income group)

Summary

Introduction

The coronavirus disease 2019 (COVID-19) pandemic has greatly affected many aspects of life for people around the world. Health resources were redistributed and focused on coping with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection [1]. The social lockdown and restricted economic activities exposed many people to unemployment and bankruptcy. People in occupations requiring physical labor or face-to-face services, such as food service employees, supermarket or warehouse workers, telemarketers, and drivers of public transportation, selectively encountered unprecedented job loss. Individuals with contact-free jobs, such as programmers, executive officers, and capitalists, could continue their jobs from home and were less influenced by the COVID-19 epidemic. Economic inequalities have been accentuated during the COVID-19 epidemic [2,3]. Increased economic inequalities are directly connected to health inequalities [4]. The disparity of income is closely related to many factors associated with socioeconomic risks, which may contribute to susceptibility to infection and COVID-19 mortality [4]

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