Abstract
BACKGROUND: We compared all-cause mortality between individuals in South Korea with and without coronavirus disease 2019 (COVID-19) using propensity score (PS) matching. METHODS: This population-based cohort study used data from the National Health Insurance Service COVID-19 cohort database. In the database, we included individuals (COVID-19 patients, control population, and test-negative individuals) aged 20 years or older, regardless of hospitalization. The primary end point was all-cause mortality between January 1, 2020, and August 27, 2020. RESULTS: A total of 328 374 adults were included in the study: 7713 and 320 660 in the COVID-19 group and the control group. After PS matching, a total of 15 426 individuals (7713 per group) were included in the analysis. All-cause mortality was 3.2% (248/7713) and 1.6% (126/7713) in the COVID-19 group and the control group, respectively. In Cox regression analysis after PS matching, the risk of death in the COVID-19 group was twice as high (hazard ratio, 2.00; 95% CI, 1.61-2.48; P < .001) as that in the control group. Among patients aged ≥60 years, the COVID-19 group had a 2.32-fold higher all-cause mortality compared with the control group, while statistically significant differences were not observed in the age groups 20-39 years (P = .339) and 40-59 years (P = .562). CONCLUSIONS: In South Korea, all-cause mortality was twice as high among individuals with COVID-19 as among those with similar underlying risks, primarily because of the elevated COVID-19-associated mortality in those aged ≥60 years. Our results highlight the need for prevention of COVID-19 with respect to mortality as a public health outcome.