National trends in the unmet healthcare needs among patients with hypertension or type 2 diabetes mellitus in Korea from 2009 to 2023

Unmet healthcare needs are defined as situations in which individuals required medical care within the past year but were unable to receive it. Among individuals with chronic conditions, such gaps in care may lead to serious complications, although previous studies during the COVID-19 pandemic remain limited. Therefore, this study aimed to address those gaps by examining long-term trends and identifying vulnerable populations among individuals with hypertension or type 2 diabetes mellitus (T2DM) in South Korea. We analyzed data from the Korean Community Health Survey from 2009 to 2023, including patients aged 30 years and older diagnosed with hypertension or T2DM (n = 2,704,712; 1,214,521 males [44.90%]). Among patients who reported experiencing unmet healthcare needs, only those with hypertension or T2DM were included in this analysis. Temporal trends in unmet healthcare needs were examined using complex-sample analyses and pandemic-related changes in temporal slopes were evaluated using weighted linear regression models with β-coefficients. Vulnerable subgroups were identified based on covariates defined according to Andersen's behavioral model, using weighted odds ratios (wORs) from logistic regression models. From 2009 to 2023, the prevalence of unmet healthcare needs decreased from 16.02% to 4.76% among patients with hypertension and from 15.93% to 4.60% among those with T2DM. The lowest prevalence was observed at the onset of the COVID-19 pandemic in 2020; however, during the pandemic period, unmet needs subsequently reversed into an increasing trend, with statistically significant upward slopes (hypertension: β_diff, 0.487 [95% CI, 0.458-0.516]; T2DM: 0.527 [0.481-0.573]). Risk factors for unmet healthcare needs included being females (hypertension: wOR, 1.44 [95% CI, 1.41-1.48]; T2DM: 1.46 [1.41-1.51]), being aged 30-44 years (hypertension: 1.70 [1.62-1.78]; T2DM: 1.93 [1.80-2.07]), and living in a single-person household (hypertension: 1.82 [1.77-1.88]; T2DM: 1.89 [1.80-1.97]). This study analyzed nationally representative data from South Korea, showing that unmet healthcare needs among patients with hypertension or T2DM declined overall but increased after the onset of the COVID-19 pandemic. Vulnerable subgroups were identified, underscoring the need for sustained and targeted management strategies.