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Regional Variations in Coronavirus Disease 2019 Mortality in Japan: An Ecological Study

Akihisa Nakamura1, Kazuhiko Kotani1, Shuji Hatakeyama2,3

  • 1Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke, Japan.

JMA Journal
|November 9, 2023
PubMed

Insights

Regional characteristics impact COVID-19 mortality. More physicians per hospital bed and fewer long-term care facilities correlate with lower coronavirus disease 2019 (COVID-19) deaths, especially in less populated areas.

Area of Science:

  • Public Health
  • Epidemiology
  • Health Services Research

Background:

  • Coronavirus disease 2019 (COVID-19) outcomes vary geographically.
  • Regional factors like healthcare resource distribution may influence COVID-19 mortality rates.

Purpose of the Study:

  • To investigate the relationship between regional characteristics and COVID-19 mortality in Japan.
  • To assess how physician and hospital bed distribution affects COVID-19 mortality across prefectures.

Main Methods:

  • Ecological study during Japan's seventh COVID-19 wave (June-October 2022).
  • COVID-19 mortality index calculated as deaths per new cases.
  • Correlations analyzed between regional factors (population, physicians, hospital beds, long-term care facilities, aging rate) and mortality index, stratified by population size.

Main Results:

  • COVID-19 mortality negatively correlated with physicians per hospital bed (r = -0.386, p = 0.007).
  • Mortality positively correlated with long-term care facilities (r = 0.397, p = 0.006) and aging rate (r = 0.471, p = 0.001).
  • In less populated areas, mortality was lower with more physicians per hospital bed (β = -0.543, p = 0.024) and higher with increased aging rate (β = 0.434, p = 0.032).

Conclusions:

  • Healthcare resource distribution, particularly physicians and hospital beds, is linked to COVID-19 mortality.
  • Targeted improvements in healthcare systems for smaller, older populations may reduce COVID-19 mortality.
Abstract

Keywords:
COVID-19 mortalityJapanRegional characteristicsecological studyhospital bedsphysicians

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