Association Between Changes in Socioeconomic Status Before and After Human Immunodeficiency Virus Infection Diagnosis and Mortality Rates in Korea

Clinical Snapshot

Key Findings

• P Value: Statistically significant (p-values not specified)

• Effect Size: HR 1.66 for NHI to MA transition; HR 1.74 for remaining on MA

• Primary Outcome: All-cause mortality

• Nnt Or Sensitivity: 66% and 74% increased mortality risk for socioeconomic decline groups

• Confidence Interval: 95% CI 1.39-1.97 and 1.40-2.18 respectively

Clinical Application

Findings applicable to healthcare systems with universal coverage and social safety nets Highly relevant to Australian HIV care given Medicare system similarities and PBS coverage for antiretroviral therapy. May inform targeted social work interventions and financial counselling services in HIV clinics People living with HIV, particularly those experiencing socioeconomic decline post-diagnosis

Abstract

BACKGROUND: This study investigated changes in medical insurance status as a surrogate marker of socioeconomic status after human immunodeficiency virus (HIV) infection, and their association with mortality among people living with HIV in Korea. METHODS: This study included 13,112 individuals newly diagnosed with HIV between 2004 and 2018, identified from the claims data of the National Health Insurance System-National Health Information Database. Participants' medical insurance status was categorized into National Health Insurance (NHI) and medical aid (MA). Using the Cox proportional hazards model, the association between mortality and changes in medical insurance status before and after HIV infection diagnosis was assessed using hazard ratios (HRs) and confidence intervals (CIs). RESULTS: The insurance coverage rates before HIV diagnosis were 95.1% and 4.9% for NHI and MA recipients, respectively. After diagnosis, the insurance coverage rates were 13.4% and 86.6% for MA and NHI recipients, respectively, demonstrating a threefold increase in the proportion of MA recipients. The conversion rate from NHI to MA was highest in the 35-44 and 45-54-year age groups at HIV infection diagnosis (32.9% and 29.4%, respectively). Compared with NHI recipients, the HR was significantly higher among individuals that transitioned from NHI to MA (HR, 1.66; 95% CI, 1.39-1.97) and individuals that remained on MA (HR, 1.74; 95% CI, 1.40-2.18), suggesting a higher mortality rate in these groups. CONCLUSION: In Korea, where highly active antiretroviral therapy is essentially free of charge, a significant association was observed between a decline in medical insurance status following HIV diagnosis and increased mortality.

References

1. 1.Jang, Y., Kim, T., Seong, H., Kim, J. H., Kim, S.-W., Kim, Y. J., Nguyen, T. H. T., & Park, B. (2026). Association between changes in socioeconomic status before and after human immunodeficiency virus infection diagnosis and mortality rates in Korea. Journal of Korean Medical Science, 41, e128. https://doi.org/10.3346/jkms.2026.41.e128