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LETTER TO THE EDITOR
Dementia and Neurocognitive Disorders 2021: 20: 3: 38-40

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Dementia and COVID-19 Mortality in South Korea
Dae-Sung Kyoung , 1 Jeongwoo Lee , 1 Hyewon Nam , 1 Moon Ho Park 2
1 Department of Data Science, Hanmi Pharmaceuticals Co., Ltd, Seoul, Korea 2 Department of Neurology, Korea University Ansan Hospital, Ansan, Korea
Dementia and COVID-19 Mortality in South Korea
Dae-Sung Kyoung , 1 Jeongwoo Lee , 1 Hyewon Nam , 1 Moon Ho Park 2
1 Department of Data Science, Hanmi Pharmaceuticals Co., Ltd, Seoul, Korea 2 Department of Neurology, Korea University Ansan Hospital, Ansan, Korea
Coronavirus disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome
coronavirus 2 has continued to influence healthcare dynamics, social patterns, and economic
systems worldwide. As of mid-March 2021, COVID-19 has already resulted in more than
97,000 infections and 1,690 deaths in South Korea. To date, no treatment has demonstrated
its effectiveness with a sufficient level of scientific evidence. Fortunately, a major milestone
in the efforts against this pandemic was the rapid and successful development of different
vaccines against COVID-19. However, the development of vaccines alone cannot overcome
COVID-19. Until the transition to normalcy is achieved, appropriate management for highrisk groups will continue to be one of the main strategies for combating COVID-19.
It has been recommended that patients with high risk for COVID-19 should be given access to
early diagnosis and management.1
Older patients and those with underlying comorbidities or
at long-term care facilities may be vulnerable to COVID-19 outbreaks or an increased risk of
poor prognosis and death.2,3
Most patients with dementia have these 3 risk factors.
We conducted a retrospective observational study to examine the relationship between
the mortality of patients with COVID-19 infection and underlying comorbidities, including
dementia. Using de-identified data from the Health Insurance Review and Assessment
Service (HIRA) of Korea, which were collected until April 8, 2020, we analyzed all patients
who had been tested for COVID-19 and who had a history of medical service use for the past 5
years. All patients with COVID-19 were categorized as reverse transcription polymerase chain
reaction (RT-PCR) test-positive cases when the diagnosis was confirmed by RT-PCR using
respiratory tract specimens. Underlying comorbidities were selected with reports of possible
association with COVID-19 in Charlson's comorbidities and previous methods with HIRA of
Korea. Thus, the following data were extracted: age at the time of diagnosis, sex, underlying
comorbidities during the past 5 years, and mortality. The comorbidities were as follows:
hypertension, heart failure, chronic kidney disease, chronic lung disease, diabetes mellitus,
ischemic heart disease, dyslipidemia, history of malignancy, arthritis or arthropathy, stroke,
Parkinson's disease, epilepsy, and dementia (Supplementary Table 1). Non-surviving
patients were identified in addition to those who had died despite medical intervention after
confirmation of COVID-19.
A total of 1,697 COVID-19 patients with a PCR-confirmed diagnosis were identified. The
mean±standard deviation for age was 47.0±21.4 years (with 30.6% of patients ≥60 years old),
and 41.7% of the patients were men. The overall mortality was 3.5% (59 of 1,697 patients) in this study population. By a multivariable logistic regression analysis, independent predictors
of in-hospital death for COVID-19 were old age (odds ratio [OR], 10.75; 95% confidence
interval [CI], 4.93–23.44), chronic lung disease (OR, 2.24; 95% CI, 1.25–4.03), and dementia
(OR, 3.19; 95% CI, 1.71–5.93) (Fig. 1 and Supplementary Table 2). The age-stratified analysis
for COVID-19-related death revealed that patients ≥60 years of age had accompanying chronic
lung disease (OR, 2.14; 95% CI, 1.13–4.04) and dementia (OR, 2.68; 95% CI, 1.41–5.09),
whereas patients <60 years of age had accompanying history of malignancy (OR, 30.31; 95%
CI, 6.58–139.60) and dementia (OR, 32.37; 95% CI, 3.95–265.10).
This study showed that dementia was an important risk factor for in-hospital deaths of
COVID-19 patients in South Korea, regardless of the age. Patients with dementia face a
“double burden,” as the pandemic exacerbates both their vulnerability due to increased
morbidity and mortality and breakdown of their social support and access to the healthcare
system due to lockdown and social distancing measures.4
Clinicians and policy makers
can use our results to tailor management strategies for patients with dementia, whereas
researchers can utilize our findings to improve patient-important outcomes.
Key Words:
대한치매학회지 (Dementia and Neurocognitive Disorders)

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