Health and Social Welfare Review

Abstract

Older people in nursing homes are particularly vulnerable to infectious diseases, yet studies quantifying the impact of the COVID-19 pandemic on their mortality remain limited. To estimate excess mortality among older nursing home residents during the pandemic, we analyzed mortality data from Statistics Korea for individuals aged ≥65 years who died in social welfare facilities between 2015 and 2022. A seasonal autoregressive integrated moving average model fitted to 2015–2019 data was applied to estimate expected deaths for 2020–2022, which were compared with observed deaths. Excess mortality during 2020–2022 was estimated at 6,992 deaths (95% confidence interval [CI]=142.7–15,027.4), approximately 15% above the expected level, and was concentrated in 2022 (6,191.2, 95% CI=2,899.6–10,057.6). Significant excesses were observed for “not elsewhere classified” (R00-R99, 3,089.2, 95% CI=1,422.1–4,775.9), neoplasms (734.4, 95% CI=604.0–865.9), and diseases of the genitourinary system (139.6, 95% CI=78.8–201.1), whereas deaths from mental and behavioral disorders and from external causes were lower than expected. These findings are consistent with indirect pandemic effects, such as healthcare system strain and disrupted chronic disease management, although studies linking healthcare utilization data are required to disentangle the mechanisms.

초록

본 연구는 통계청 사망원인 통계자료(2015-2022년, 65세 이상)를 이용하여 SARIMA 모형을 구축하고 코로나19 팬데믹 기간 요양시설 노인의 초과 사망을 추정하였다. 2020–2022년 초과 사망은 6,992명(95% 신뢰구간 142.7–15,027.4)이었으며, 2022년에 집중되었다(6,191.2명, 95% 신뢰구간 2,899.6–10,057.6). 사인별로는 달리 분류되지 않은 증상 및 임상소견(3,089.2명, 95% 신뢰구간 1,422.1–4,775.9), 신생물(734.4명, 95% 신뢰구간 604.0–865.9), 비뇨생식계 질환(139.6명, 95% 신뢰구간 78.8–201.1)에서 유의한 초과 사망이 관찰된 반면, 정신 및 행동장애와 외인에 의한 사망은 기대보다 적었다. 이는 의료체계 부담 및 만성질환 관리의 어려움 등 팬데믹의 간접적 영향과 부합하나, 기전 규명을 위한 의료이용 자료와의 연계 등 후속 연구가 필요하다.