Mortality In South Korea Research Articles

Transcriptome Analysis of Dryadomyces quercus-mongolicae, a Fungus Associated with Korean Oak Wilt Disease that Causes Oak Mortality in South Korea

Korean oak wilt disease associated with Dryadomyces quercus-mongolicae recently emerged as a major tree disease in South Korea. A comprehensive transcriptome analysis is presented for D. quercus-mongolicae grown in vitro on three different culture media, identifying nearly 7,000 expressed transcripts. Most transcripts are associated with proteins essential for fungal survival and growth. The 40S ribosomal protein S25, ceramide very long chain fatty acid hydroxylase, Epl1 protein, and ADP/ATP translocase are particularly important due to their critical roles in the metabolism and environmental adaptation of fungi. Gene ontology analyses revealed that 39.4%, 61.2%, and 43.3% of transcripts were successfully annotated to biological process, molecular functions, and cellular component aspects, respectively. Furthermore, key metabolic pathways were elucidated, including sphingolipid metabolism, L-tryptophan biosynthesis, and glycolysis, which provide important information on physiological functioning of D. quercus-mongolicae. Overall, these findings provide key information on fundamental biological mechanisms of D. quercus-mongolicae.

Effects of Prenatal Exposure to PM 2.5 Chemical Components on Adverse Birth Outcomes and Under-5 Mortality in South Korea.

Exposure to fine particulate matter (PM 2.5 ) during pregnancy has been associated with adverse birth outcomes. However, limited evidence exists on the effects of specific PM 2.5 components. We investigated the association of prenatal exposure to PM 2.5 and its components with birth outcomes and mortality at age <5 years in four metropolitan cities in South Korea. We obtained data from Statistic Korea linking birth records for 2013-2015 to death records under age 5 years. Data for PM 2.5 and 10 of its components were collected from four monitoring stations. We calculated exposures during pregnancy and each trimester for a total of 324,566 births. We used logistic regression to estimate the associations between exposure and risk of preterm birth (PTB) (<37 weeks), low birth weight (<2.5 kg), small for gestational age (birth weight <10 th percentile for the same gestational age), and under-5 mortality. An interquartile range (8.7 µg/m 3 ) increase in exposure to PM 2.5 during the entire pregnancy was associated with increased odds of PTB (odds ratio [OR] = 1.17; 95% confidence interval [CI] = 1.11, 1.23). We observed no association with low birth weight, small for gestational age, or under-5 mortality for the entire pregnancy exposure. Elemental carbon and secondary inorganic aerosols showed higher effect estimates for PTB than did other components. In urban populations of South Korea, exposure to PM 2.5 during pregnancy was associated with an increased risk of PTB. Different components showed varying associations with adverse birth outcomes.

A comparative analysis of trauma-related mortality in South Korea using classification models.

A comparative analysis of trauma-related mortality in South Korea using classification models.

How much can we reduce delivery-related medical costs associated with maternal mortality? A nationwide cohort study from 2003 to 2021.

This study aims to examine the association between maternal mortality and childbirth-related medical costs using both unadjusted and adjusted models and to assess the potential reduction in delivery-related medical costs associated with maternal mortality in South Korea. This retrospective cohort study used data from the National Health Insurance Service Delivery Cohort Database of South Korea. A total of 7,171,578 participants were included. The outcome measured was delivery-related medical costs associated with maternal mortality. A Generalized Estimating Equation model with a log link and gamma distribution was used to estimate delivery-related medical costs. The maternal death rates were 9.7 per 100,000 births. The adjusted mean delivery-related medical costs were approximately six times higher in cases with maternal death than in those without ($2,802 vs. $480, p < 0.0001). The total delivery-related medical costs for all women with maternal mortality were approximately $2 million, accounting for 0.06% of total delivery-related medical costs. Although this proportion is relatively small, 83% of the direct medical costs associated with maternal mortality among South Korean women were potentially reducible. This study found that maternal mortality is associated with significantly higher delivery-related medical costs, nearly six times those of non-maternal mortality cases. Therefore, policymakers should consider reducing costs and improving maternal health outcomes, expanding access to prenatal care for early risk detection and strengthen nationwide maternal health monitoring systems.

Short-term exposure to outdoor nitrogen dioxide and respiratory mortality, with high-risk populations: a nationwide time-stratified case-crossover study

Numerous existing studies reported the negative impacts of outdoor nitrogen dioxide (NO2) on respiratory mortality. However, the evidence of related high-risk populations was considerably limited, especially associated with ages, causes of death, and district-level characteristics. In addition, most earlier studies were based on monitored areas, thus previous risk estimates of NO2 could be biased to provide nationwide risk estimates and high-risk populations. Therefore, this study performed a nationwide time-stratified case-crossover study to evaluate the association between short-term ambient NO2 and respiratory mortality in South Korea (2015–2019). A machine learning-ensemble daily NO2 prediction model was used to cover unmonitored areas. To examine high-risk populations, we assessed NO2 risk estimates by age group, sex, cause of mortality, and district-level characteristics. In the total population, NO2 was weakly associated with increased mortality risk due to respiratory disease (OR [odds ratio]: 1.011, 95% CI [confidence interval]: 0.995–1.027), and the association became evident only in individuals aged 80 y or older (1.022, 1.000–1.044), especially related to pneumonia. Further, in people aged 60–69 years, NO2 was marginally associated with mortality for chronic lower respiratory diseases. Lower district-level socioeconomic status and medical services were marginally related to higher respiratory mortality risks related to NO2. The excess respiratory mortality fractions and YLL (year of life lost) attributable to NO2 were 4.13% and 93,851.63 years, and around 70% of the excess deaths were due to noncompliance with the World Health Organization air quality guidelines (daily average NO2 > 25 µg/m3). This study provides evidence for high-risk populations and the appropriateness of target-specific action plans against NO2. In addition, based on the excess death estimates, we suggest stricter NO2 standards are required.

An explainable AI framework for spatiotemporal risk factor analysis in public health: a case study of cardiovascular mortality in South Korea

ABSTRACT Understanding environmental disease risk factor analysis at the district level is essential for gaining valuable insights into regional disease variations, offering a broader perspective compared to individual-level studies. Recently, explainable artificial intelligence (XAI) has received increasing attention in the analysis of factors affecting public health. However, previous purely data-driven XAI-based risk factor analyses faced challenges in capturing regional effect of environmental variables, leading to confusion regarding key spatiotemporal risk factors. Therefore, this study proposes a framework that includes two complementary XAI-based risk factor analyses following two assumptions. Regionally rescaled environmental variables must account for the unequal effects on environmental factors, which are likely influenced by variations in adaptation capacity to weather conditions and differences in exposure-response relationships to air pollutants. District-level disease distribution highlights geographic disparity in sociodemographic vulnerability, whereas temporal variation in diseases by district underscores temporal environmental impacts. Based on these two hypotheses, we rescaled environmental variables using two complementary schemes: one that employs the district-level disease distribution as the target variable, and another that utilizes the temporal residual of the disease within each district. We evaluated this framework by analyzing the association between cardiovascular age-standardized mortality rate (CVD-ASMR) and various risk factors in South Korea from 2010 to 2019, using high-performing random forest and light gradient boosting models with additive Shapley explanation. Compared to previous purely data-driven XAI-based analyses, the proposed schemes achieved significantly better results in capturing regional exposure-response relationships. In two complementary schemes, the most explainable factor to districts with high CVD-ASMR was low education level related to sociodemographic vulnerability, whereas the most explainable factors to high temporal CVD-ASMR patterns were low greenness and high air pollution levels. In addition, the two complementary schemes enabled us to reasonably analyze the interaction effect of the two risk factors, i.e. temperature and air pollutants. Furthermore, high CVD-ASMR and its high temporal variation were observed in situations of high sociodemographic vulnerability with poor air quality. These findings provide insightful public health planning for sustainable cities and society by pinpointing high-risk areas and tailoring strategies to address regional environmental challenges.

Adherence to the Cancer Prevention Recommendations from World Cancer Research Fund/American Institute for Cancer Research After Cancer Diagnosis on Mortality in South Korea.

The World Cancer Research Fund/American Institute for Cancer Research recommends following the recommendations for cancer prevention even after cancer diagnosis. To provide evidence on the potential benefits of adherence on improved survival, we investigated the effects of post-diagnostic adherence to the recommendations regarding diet, physical activity, and body weight on all-cause mortality among Korean cancer survivors. Among the total number of cancer survivors (n = 173,195) recruited from 2004 to 2013 for the Health Examinees study, 5485 were selected for the analyses and classified by tertiles according to the adherence score. The Cox proportional hazards model was used to estimate the adjusted hazard ratios (HR) and their 95% confidence intervals (CI) of the adherence groups on all-cause mortality. Although no clear association was observed overall during a mean follow-up of 10.1 (standard deviation = 3.0) years, reduced mortality was observed for the middle (HR = 0.74 [95% CI = 0.51-1.08]) and highest adherent group (0.66 [0.43-0.99]) in comparison to the lowest adherent group among long-term survivors (>5 years after cancer diagnosis). Among the cancer prevention recommendation items, "be physically active" and "limit consumption of fast foods" were inversely associated with mortality. Adhering to the WCRF/AICR cancer prevention recommendations may help improve the prognosis of long-term cancer survivors.

Frailty transition and burden on mortality risk in middle-aged and older population: a prospective cohort study

The effect of frailty transition and burden on the risk of all-cause mortality in South Korea remains unclear. This study aimed to investigate the risk of all-cause mortality using the most recent frailty index (FI), changes in FI, and frailty burden. We analyzed data from the Korean Genome and Epidemiology Study (2013–2020). A total of 3,134 participants aged 53–87 years with a computable FI based on the osteoporotic fracture index during their initial visit. The FI was updated biennially during re-examinations and changes between the initial and last visits were categorized into four groups: (1) improved or maintained to non-frail, (2) worsened to pre-frail, (3) improved or maintained to pre-frail, and (4) worsened or maintained to frail. We used the Cox proportional hazards model, adjusted for age, sex, education, lifestyle factors, and diseases. During the follow-up, 218 participants died. Compared to those who were robust at the last visit, pre-frailty and frailty were associated with an increased risk of all-cause death. Of those who visited > 2 times, 62.3% improved or remained robust, and had a decreased risk of all-cause death. Those with > 63% of pre-frailty or frailty burden significantly higher risk of death, with > 60% increase compared to their non-frail counterparts. Maintaining or achieving robustness is associated with a decreased risk of mortality. To prevent premature death and extend healthy life expectancy, identifying biological aging through surrogate measures and implementing interventions to maintain or achieve a robust health status are needed.

Trends in Regional Disparities of Cardiovascular Surgery and Mortality in South Korea

Abstract Objectives Regional disparities in cardiovascular care in South Korea have led to uneven patient outcomes. Although procedure access and needs are increasing, few studies have linked regional service availability to mortality rates. This study analyzed variation in utilization of major cardiovascular procedures by region and association with short-term mortality to provide better evidence on links between healthcare resources distribution and patient survival. Methods A cross-sectional study was conducted using nationwide claims data on patients who underwent coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), stent insertion, or aortic aneurysm resection in 2022. Regional variation was assessed by a Relevance Index (RI). The associations between regional RI and 30-day mortality were analyzed. Results The RI was lowest for aortic aneurysm resection (mean, 26.2; standard deviation, 26.1), indicating the most uneven regional distribution among the surgical procedures. Patients undergoing this procedure in regions with higher RIs showed significantly lower 30-day mortality (adjusted odds ratio [aOR], 0.73; 95% confidence interval, 0.55 to 0.96; p = 0.026) versus those with lower RIs. This suggests that cardiovascular surgery regional availability, as measured by RI, has an impact on mortality rates for certain complex surgical procedures. The RI was not associated with significant mortality differences for more widely available procedures like CABG (aOR, 0.96), PCI (aOR, 1.00), or stent insertion (aOR, 0.91). Conclusions Significant regional variation and underutilization of cardiovascular surgery were found, with reduced access linked to worse mortality for complex surgeries. Addressing disparities through cooperation among hospitals and policy efforts is warranted to improve outcomes. Key messages • This study analyzed regional variations in major cardiovascular procedures using the Relevance Index and investigated their impact on mortality rates within 30 days of admission. • Addressing regional disparities requires improved healthcare infrastructure and comprehensive networks of specialists to ensure timely and high-quality cardiovascular care across South Korea.

Long-term exposure to PM2.5 and mortality: a national health insurance cohort study.

Previous studies with large data have been widely reported that exposure to fine particulate matter (PM2.5) is associated with all-cause mortality; however, most of these studies adopted ecological time-series designs or have included limited study areas or individuals residing in well-monitored urban areas. However, nationwide cohort studies including cause-specific mortalities with different age groups were sparse. Therefore, this study examined the association between PM2.5 and cause-specific mortality in South Korea using the nationwide cohort. A longitudinal cohort with 187917 National Health Insurance Service-National Sample Cohort participants aged 50-79 years in enrolment between 2002 and 2019 was used. Annual average PM2.5 was collected from a machine learning-based ensemble model (a test R2 = 0.87) as an exposure. We performed a time-varying Cox regression model to examine the association between long-term PM2.5 exposure and mortality. To reduce the potential estimation bias, we adopted generalized propensity score weighting method. The association with long-term PM2.5 (2-year moving average) was prominent in mortalities related to diabetes mellitus [hazard ratio (HR): 1.03 (95% CI: 1.01, 1.06)], circulatory diseases [HR: 1.02 (95% CI: 1.00, 1.03)] and cancer [HR: 1.01 (95% CI: 1.00, 1.02)]. Meanwhile, circulatory-related mortalities were associated with a longer PM2.5 exposure period (1 or 2-year lags), whereas respiratory-related mortalities were associated with current-year PM2.5 exposure. In addition, the association with PM2.5 was more evident in people aged 50-64 years than in people aged 65-79 years, especially in heart failure-related deaths. This study identified the hypothesis that long-term exposure to PM2.5 is associated with mortality, and the association might be different by causes of death. Our result highlights a novel vulnerable population: the middle-aged population with risk factors related to heart failure.

Effect of community attitudes on suicide mortality in South Korea: a nationwide ecological study.

Attitudes toward suicide are essential in suicide prevention, as suicide is socio-culturally nuanced. Although the relationship between individual attitudes and suicidal behavior has been extensively studied, the effect of community attitudes-aggregated by region-on suicide mortality remains ambiguous. This study explored the association between community attitudes and real-world suicide mortality. Data on attitudes toward suicide from the 2018 Korea National Suicide Survey (N = 1500) and individual mortality data from the MicroData Integrated System were obtained. Confirmatory factor analysis supported a factor structure with three factors: "Permissiveness," "Unjustified behavior," and "Readiness to help/Preventability." Thirty regional units in South Korea aggregated the data for ecological analysis. We used negative binomial models to examine the association at the regional level, and stratified analysis by gender and age group was conducted. "Permissiveness" was associated with reduced suicide rates in a univariate model (P < 0.001). Adjusting for gender, age, and additional sociodemographics did not alter the association. Additionally, this relationship was observed in males and individuals under 60 years of age after stratification. However, "Unjustified Behavior" and "Readiness to help/Preventability" exhibited no significant association with suicide in any model or stratum. The observed inverse association between permissive community attitudes and suicide contradicts the findings of previous research that links permissive individual attitudes to increased suicidal behavior. Our findings suggest that attitudes may operate differently at the individual and group levels. Although the cross-sectional design and single-country focus of this study warrant further investigation, our findings indicate that attitudes are significant contextual factors in the process of suicide, which could lead to novel approaches in suicide prevention.

Exercise for fall prevention in older adults

Background: Global population aging has significantly increased fall-related incidents among older adults, which is associated with major health risks and challenges for healthcare systems. Falls are a leading cause of injury, disability, and mortality in South Korea, which has shown rapid expansion of the elderly population. Development of effective fall-prevention strategies, including exercise-based interventions is important to address this issue.Current Concepts: Exercise-based fall prevention programs include several key types such as strength and functional movement training and balance exercises. Strength training includes resistance exercises and weightbearing activities to enhance muscle strength, which is essential for stability and fall prevention. Balance exercises improve stability and coordination, including standing on one leg and heel-to-toe walking. Functional movement training includes exercises that simulate daily activities and help individuals to improve their ability to safely perform routine tasks. Programs such as the Otago Exercise Program integrate these elements and offer a comprehensive approach to fall prevention. Such regimens combined with training in safe falling techniques are important to reduce fall risk and improve outcomes. Assessment tools, including the timed up-and-go and senior fitness tests, are useful to identify at-risk individuals and tailor interventions accordingly.Discussion and Conclusion: An effective fall prevention exercise program requires a multifaceted approach that combines various exercise types and focuses on improving muscle strength, balance, flexibility, and functional skills, as well as safe falling and floor recovery techniques. Tailoring these interventions to individual needs and regular risk assessments can enhance their usefulness.

Relationship between smoking experience and risk of suicide mortality in South Korean adults: A nationwide population-based retrospective cohort study

Relationship between smoking experience and risk of suicide mortality in South Korean adults: A nationwide population-based retrospective cohort study

Long-term exposure to PM2.5 and mortality in South Korea: Effect modification by community deprivation, medical infrastructure, and greenness

Long-term exposure to PM2.5 and mortality in South Korea: Effect modification by community deprivation, medical infrastructure, and greenness

Relationship between short-term ozone exposure, cause-specific mortality, and high-risk populations: A nationwide, time-stratified, case-crossover study

Relationship between short-term ozone exposure, cause-specific mortality, and high-risk populations: A nationwide, time-stratified, case-crossover study

One-year post-acute COVID-19 syndrome and mortality in South Korea: a nationwide matched cohort study using claims data.

Current understanding of post-COVID-19 syndrome in South Korea is primarily based on survey studies or research targeting specific patient groups, such as those hospitalized. Moreover, the majority of relevant studies have been conducted in European and North American populations, which may limit their applicability to the South Korean context. To address this gap, our study explores the one-year outcomes of COVID-19, focusing on the potential post-acute syndrome and all-cause mortality in South Korea. This retrospective cohort study used nationwide claims data in South Korea, including adults aged >18 with records between January 20, 2020, and February 25, 2021. Patients were classified into COVID-19 and non-COVID-19 groups and matched 1:1 based on propensity scores. Primary outcomes were 12-month post-acute COVID-19 syndrome and all-cause mortality. The study involved 34,802 matched patients. The COVID-19 group had significantly elevated risks of coagulopathies (OR = 2.70 [2.24, 3.28]; p < 0.001), chronic lower respiratory diseases (OR = 1.96 [1.80, 2.14]; p < 0.001), symptoms of the circulatory and respiratory systems (OR = 1.91 [1.80, 2.04]; p < 0.001), mood disorders (OR = 1.67 [1.51, 1.86]; p < 0.001), cardiac diseases (OR = 1.39 [1.21, 1.59]; p < 0.001), and symptoms of cognition, perception, emotional state, and behavior (OR = 1.15 [1.04, 1.27]; p = 0.005). All-cause mortality was higher in the COVID-19 group during the 6 months (OR = 1.34 [1.06, 1.69]; p = 0.015), but gradually decreased, reaching an OR of 0.996 ([0.83, 1.19]; p = 0.964) at 1 year. In South Korea, the 12-month post-acute COVID-19 syndrome includes coagulopathies, respiratory issues, mood disorders, and cardiac diseases. The risk of all-cause mortality post-COVID-19 is heightened for up to 6 months, then significantly decreases and resolves within a year.

Long-term exposure to PM2.5 and mortality in a national cohort in South Korea: effect modification by community deprivation, medical infrastructure, and greenness

BackgroundLong-term exposure to PM2.5 has been linked to increased mortality risk. However, limited studies have examined the potential modifying effect of community-level characteristics on this association, particularly in Asian contexts. This study aimed to estimate the effects of long-term exposure to PM2.5 on mortality in South Korea and to examine whether community-level deprivation, medical infrastructure, and greenness modify these associations.MethodsWe conducted a nationwide cohort study using the National Health Insurance Service-National Sample Cohort. A total of 394,701 participants aged 30 years or older in 2006 were followed until 2019. Based on modelled PM2.5 concentrations, 1 to 3-year and 5-year moving averages of PM2.5 concentrations were assigned to each participant at the district level. Time-varying Cox proportional-hazards models were used to estimate the association between PM2.5 and non-accidental, circulatory, and respiratory mortality. We further conducted stratified analysis by community-level deprivation index, medical index, and normalized difference vegetation index to represent greenness.ResultsPM2.5 exposure, based on 5-year moving averages, was positively associated with non-accidental (Hazard ratio, HR: 1.10, 95% Confidence Interval, CI: 1.01, 1.20, per 10 µg/m3 increase) and circulatory mortality (HR: 1.22, 95% CI: 1.01, 1.47). The 1-year moving average of PM2.5 was associated with respiratory mortality (HR: 1.33, 95% CI: 1.05, 1.67). We observed higher associations between PM2.5 and mortality in communities with higher deprivation and limited medical infrastructure. Communities with higher greenness showed lower risk for circulatory mortality but higher risk for respiratory mortality in association with PM2.5.ConclusionsOur study found mortality effects of long-term PM2.5 exposure and underlined the role of community-level factors in modifying these association. These findings highlight the importance of considering socio-environmental contexts in the design of air quality policies to reduce health disparities and enhance overall public health outcomes.

The Association of Body Mass Index and Waist Circumference with Sepsis-Related Mortality in South Korea.

Obesity is a major public health problem worldwide and is associated with increased morbidity and mortality. However, studies have shown that obesity has sepsis-related mortality benefits. We aimed to determine whether there is an improved sepsis-related survival rate in patients with obesity in South Korea. We included data from 77,810 adults with sepsis between 1 January 2013 and 31 December 2020, extracted from the National Health Insurance Service database in South Korea. The patients underwent standard health examinations within a year before sepsis, and body mass index (BMI) and waist circumference (WC) were used to reflect obesity. Lower 30-day and 1-year mortality rates were observed in the overweight and obesity groups after adjusting for confounders, including WC. However, there was no difference in mortality between the patients with severe obesity and those with normal BMI. Underweight was associated with higher 30-day and 1-year mortality. Higher 30-day and 1-year mortality was found in the high and very high WC groups. In conclusion, patients with abdominal obesity and overweight and obesity and with sepsis showed reduced mortality, whereas underweight patients with sepsis showed increased mortality in South Korea.

Insomnia disorder and cancer mortality in South Korea: a secondary analysis of musculoskeletal disease cohort.

The association between insomnia disorder and cancer-related mortality risk remains controversial. Therefore, this study aimed to investigate the correlation between insomnia disorder and cancer-related mortality. Patients who were diagnosed with musculoskeletal disease (MSD) between 2010 and 2015 were included in this study as a secondary analysis of a patient cohort with MSD in South Korea. Cancer mortality was evaluated between January 1, 2016, and December 31, 2020, using multivariable Cox regression modeling. Patients with and without insomnia disorder constituted the ID and non-ID groups, respectively. The final analysis incorporated a total of 1,298,314 patients diagnosed with MSDs, of whom 11,714 (0.9%) died due to cancer. In the multivariable Cox regression model, the risk of total cancer-related mortality was 14% (hazard ratio [HR], 1.14; 95% confidence interval [CI], 1.10-1.19; P < 0.001) higher in the ID group than in the non-ID group. Moreover, the ID group had a higher risk of mortality due to esophageal (HR, 1.46; 95% CI, 1.08-1.96; P = 0.015), colorectal (HR, 1.20; 95% CI, 1.05-1.36; P = 0.007), head and neck (HR, 1.39; 95% CI, 1.01-1.94; P = 0.049), lung (HR, 1.17; 95% CI, 1.08-1.27; P < 0.001), and female genital organ (HR: 1.39, 95% CI: 1.09, 1.77; P = 0.008) cancers; leukemia; and lymphoma (HR, 1.30; 95% CI, 1.12-1.49; P < 0.001). Insomnia disorder was associated with elevated overall cancer mortality in patients with MSDs, which was more evident for cancer mortality due to esophageal, colorectal, head and neck, lung, and female genital organ cancers; leukemia; and lymphoma.

COVID-19 vaccine safety: Background incidence rates of anaphylaxis, myocarditis, pericarditis, Guillain-Barré Syndrome, and mortality in South Korea using a nationwide population-based cohort study

BackgroundTo properly assess an association between vaccines and specific adverse events requires a comparison between the observed and background rates; however, studies in South Korea are currently limited. Therefore, in this study, we estimated the background incidence of anaphylaxis, myocarditis, pericarditis, Guillain-Barré syndrome (GBS), and mortality in South Korea.MethodsA retrospective cohort study was conducted using the National Sample Cohort (NSC) data. Using NSC, the background incidence rate was estimated by dividing the number of episodes during 2009–2019 by the total population by year and then multiplying by 100,000. Using Statistics Korea data, the background mortality rate was estimated by dividing the number of deaths, during 2009–2019 by the standard population for that year and then multiplying by 100,000. Using background mortality rates, we predicted mortality rates for 2021 using autoregressive integrated moving average models. Further, the expected mortality rates were compared with observed mortality rates.ResultsThe age-adjusted incidence rate (AIR) of anaphylaxis increased from 4.28 to 22.90 cases per 100,000 population (p = 0.003); myocarditis showed no significant increase, changing from 0.56 to 1.26 cases per 100,000 population (p = 0.276); pericarditis increased from 0.94 to 1.88 cases per 100,000 population (p = 0.005); and GBS increased from 0.78 to 1.21 cases per 100,000 population (p = 0.013). The age-adjusted mortality rate decreased from 645.24 to 475.70 deaths per 100,000 population (p <0.001). The 2021 observed/expected mortality rates for overall (ratio: 1.08, 95% confidence interval [CI]: 1.07–1.08), men (ratio: 1.07, 95% CI: 1.07–1.08), and women (ratio: 1.08, 95% CI: 1.07–1.09), were all significantly higher. When stratified by age group, those aged ≥80 (ratio: 1.16, 95% CI: 1.15–1.17), 60–69 (ratio: 1.11, 95% CI: 1.10–1.13), and 20–29 years old (ratio: 1.07, 95% CI: 1.02–1.13) were also significantly higher.ConclusionThrough the estimation of background rates related to anaphylaxis, myocarditis, pericarditis, GBS, and mortality, we established a reference point for evaluating the potential excess occurrence of adverse events following COVID-19 vaccination. This reference point serves as substantive evidence supporting the safety profile of COVID-19 vaccines.