Excess mortality among the elderly in long-term care hospitals during the COVID-19 pandemic: a system failure to protect the most vulnerable population in South Korea

The elderly in long-term care facilities were hit hardest during the COVID-19 pandemic. The elderly in long-term care facilities were hit hardest during the COVID-19 pandemic. In South Korea, outbreaks continuously occurred in long-term care hospitals (LTCHs) despite intense control measures, resulting in a surge in deaths. We aim to estimate excess mortality in LTCHs during the pandemic and explore contributing factors. We extracted weekly death counts from 2015 to 2022 among patients over 65 years who died during LTCH hospitalizations from National Health Insurance Service (NHIS) data. Based on the SARIMA model fitted with 2015–2019 data, we forecasted death counts from 2020 to 2022. We compared observed and predicted death counts from 2020 to 2022. Subgroup analysis was conducted by age, gender, and health security type. We found notable excess deaths among elderly hospitalized at LTCHs during COVID-19 (2020–2022; 5260.1, 95% CI = 5244.9–5275.3). Men had higher excess mortality than women, and elderly ≥85 and 65–74 years had more observed deaths than predicted. Excess mortality was higher in Medical Aid beneficiaries than those with National Health Insurance. To ensure LTCHs can successfully respond to future public health emergencies, their general medical capacity should be strengthened.