COVID-19 팬데믹 시 한국의 암 초과사망 분석: 2020-2023년 = Analysis of Excess Cancer Mortality in South Korea during the COVID-19 Pandemic: 2020-2023

다국어 초록 (Multilingual Abstract)

The COVID-19 pandemic has transcended a mere infectious disease crisis, causing unprecedented
disruptions to global healthcare systems and forcing a reallocation of medical resources. In South
Korea, strict social distancing measures and fear of infection led to significant declines in
healthcare utilization, raising concerns about a "secondary health crisis" involving delayed cancer
diagnosis and treatment. Given that cancer is the leading cause of death in Korea, timely
intervention is critical for survival. This study aims to quantitatively estimate excess mortality
from cancer in South Korea from 2020 to 2023 and analyze the pandemic's long-term impact by
sex and cancer type.
We analyzed cancer mortality data from 2015 to 2023 using cause-of-death statistics from
Statistics Korea. To estimate expected deaths during the pandemic (2020–2023), we applied linear
regression models that adjust for the rapid population aging and secular trends in cancer mortality.
To evaluate the sensitivity of excess mortality estimates to the choice of baseline period, we
compared models based on a 5-year baseline (2015–2019) versus a 3-year baseline (2017–
2019). Excess mortality was quantified using P-scores (%), which measure the percentage
difference between observed and expected deaths.
Our analysis revealed that the choice of baseline period significantly influenced excess mortality
estimates. The 5-year baseline model yielded consistently higher excess mortality than the
3-year model, as it provided a more robust prediction by mitigating the overestimation of recent
short-term mortality trends. Based on the 5-year model, a marked surge in excess cancer
mortality was observed in 2023, with females exhibiting higher excess mortality rates than males.
Stomach cancer showed the most substantial excess mortality (P-score 20.7% in 2023), likely a
consequence of "stage migration" resulting from the sharp decline in endoscopic screening during
the early pandemic. Significant excess deaths were also identified in liver cancer (9.5%) and
hematologic malignancies in females (21.0%), indicating heterogeneous impacts across different
cancer types.
This study provides empirical evidence that the COVID-19 pandemic has had a substantial and
prolonged adverse impact on cancer mortality in South Korea. The impact was particularly
pronounced in screening-dependent cancers, such as stomach cancer, and among vulnerable groups,
including women. These findings highlight the critical need for a resilient "two-track" healthcare
strategy that ensures the continuity of essential cancer care during future public health crises.
Furthermore, this study underscores the importance of employing long-term baselines for accurate
excess mortality surveillance in rapidly aging populations.

목차 (Table of Contents)

• Ⅰ. 연구의 배경 및 필요성 1
• Ⅱ. 대상 및 방법 4
• 1. 연구 대상 4
• 2. 연구 방법 5
• Ⅲ. 연구결과 6
• 1. 암 조사망률과 연령표준화 사망률의 추세 비교 6
• 2. 전체 암 초과사망 추이 (2020-2023) 9
• 3. 암종별 초과사망 추이 (2020-2023) 11
• 3.1 위암 초과사망 11
• 3.2. 간암 초과사망 13
• 3.3 결장, 직장암 초과사망 15
• 3.4. 췌장암 초과사망 17
• 3.5. 폐, 기관지암 초과사망 19
• 3.6. 유방암 초과사망 21
• 3.7. 혈액암 초과사망 23
• Ⅳ. 고찰 25
• Ⅴ. 참고문헌 28
• 영문초록 32