Risk Management and Healthcare Policy (Nov 2020)
Intensive Care Unit Capacity and Its Associated Risk Factors During the COVID-19 Surge in the Republic of Korea: Analysis Using Nationwide Health Claims Data
Abstract
Seung Heon Lee,1 So-Youn Park,2 Jeong-Yeon Seon,3 Woo-Hwi Jeon,3 Sung-Il Nam,4 Jong-Hak Park,5 Jae Seok Park,6 Hae-Young Kim,7 Niket Thakkar,8 Prashanth Selvaraj,8 Anna Bershteyn,7 In-Hwan Oh3 1Division of Pulmonary, Sleep, and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea; 2Department of Medical Education and Humanities, School of Medicine, Kyung Hee University, Seoul, Republic of Korea; 3Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea; 4Department of Otolaryngology-Head & Neck Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea; 5Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea; 6Division of Pulmonology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea; 7Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA; 8Institute for Disease Modeling, Seattle, WA, USACorrespondence: In-Hwan Oh Department of Preventive MedicineSchool of Medicine, Kyung Hee University, Seoul, Republic of KoreaFax +82-2-969-0792Email [email protected]: To identify risk factors for intensive care unit (ICU) admission and mechanical ventilator usage among confirmed coronavirus disease (COVID-19) patients and estimate the effects of mitigation efforts on ICU capacity in Korea.Patients and Methods: Data on profiles and medical history of all confirmed COVID-19 patients in the past 1 year were extracted from the Korean National Health Insurance System’s claims database to assess risk factors for ICU admission and ventilator use. We used a time-series epidemic model to estimate the ICU census in Daegu from the reported hospital data.Findings: Multivariate regression analysis revealed male sex, old age, and residing in Daegu city as significant risk factors for ICU admission. The number of patients requiring ICU admission exceeded the bed capacity across all Daegu hospitals before March 9, 2020, and therefore, critically ill patients were transferred to nearby hospitals outside Daegu. This finding was consistent with our prediction that the ICU census in Daegu would peak on March 16, 2020, at 160 through mitigation efforts, without which it would have reached 300 by late March 2020.Conclusion: Older age and male sex were risk factors for ICU admission. In addition, the geographic location of the hospital seems to contribute to the severity of the COVID-19 patients admitted to the ICU and to the ICU capacity.Keywords: COVID-19 pandemic, ICU admission, Korea, risk factors
