Concentration of hospital utilization in the capital area among elderly inpatients from non-capital regions in South Korea: Before and during the COVID-19 pandemic

Hospital utilization in South Korea exhibits a significant concentration in the capital area, posing a persistent social issue. Given the heightened vulnerability of elderly patients to COVID-19, their continued travel to capital-area hospitals during the pandemic could have facilitated rapid virus dissemination, necessitating a review of the regional healthcare delivery system. This study therefore aimed to analyze the sustained concentration of hospital utilization in the capital area among regional elderly patients and to identify the characteristics of those who utilized these facilities during the pandemic. Data for this study were obtained from the Korea National Hospital Discharge In-Depth Injury Survey (KNHDIS) for the periods 2018-2019 (pre-COVID-19) and 2020-2021 (during COVID-19). A total of 6,026,155 weighted patient data points for non-capital area residents aged over 65 years were analyzed. Statistical analyses, including chi-square tests and logistic regression, were conducted using SAS 9.4 to examine changes in capital-area hospitalization and to identify the characteristics of the study subjects during the pandemic. The overall rate of capital-area hospitalization among regional elderly patients remained stable at 7.5% both before and during the COVID-19 pandemic. However, detailed results revealed statistically significant shifts across specific age groups and main diagnoses, with increases observed in some characteristics. Logistic regression analysis indicated that during the pandemic, regional elderly patients with diagnoses of cancer, higher disease severity (CCI > 3 points), and those undergoing surgery demonstrated a significantly higher likelihood of hospitalizing in the capital area compared to their respective comparison groups. The observed persistent concentration of hospitalizations in the capital area necessitates the urgent implementation of governmental policies aimed at revitalizing regional medical systems. Furthermore, hospitals located in non-capital areas are urged to strategically invest in facilities and advanced medical devices and develop targeted strategies to attract regional patients, considering the identified characteristics of elderly regional patients who utilize capital-area hospitals.