We thank Daungsupawong et al. for their interest in our study reporting the protective effect of coronavirus disease 2019 (COVID-19) vaccination on future exacerbations of chronic obstructive pulmonary disease [1]. We agree with their concerns regarding the study’s methodology, particularly the potential for selection bias. In our study based on claims data, access to healthcare services played a critical role in the identification of exacerbations. Although we could not directly assess healthcare accessibility, this factor might be less influential in South Korea, which has the highest healthcare utilization rate among Organization for Economic Co-operation and Development (OECD) countries [2]. Nevertheless, caution is warranted when generalizing our findings to other countries with different healthcare infrastructures.
Furthermore, as suggested by the authors, the relatively small number of individuals infected with COVID-19 in our cohort might have limited the statistical power to detect significant differences. This was likely attributable to stringent public health measures implemented by the Korean government in the early phase of the pandemic, which effectively mitigated the spread of the virus [3]. Evaluating the impact of COVID-19 vaccination in countries with more lenient policies might provide further insights.
Finally, this study inherently faced limitations in generalizability due to variations in healthcare systems across countries [4]. As the authors noted, validating our findings in different settings, including Thailand, would be of great interest.
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