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Cohort Profile
Cohort profile: the KDCA-Tuberculosis-NHIS cohort linking tuberculosis surveillance and health insurance data in Korea
Dawoon Jeong, Jinsun Kim, Seung Won Lee, Hongjo Choi, Hojoon Sohn, Jieun Kim, Hyewon Lee, Hyeran Jeong, Seung Eun Lee, Young-joon Park, Jaiyong Kim, Eun Mi Kim, Minji Koo, Hoyeon Jang, Young Ae Kang
Epidemiol Health. 2025;47:e2025071.   Published online December 13, 2025
DOI: https://doi.org/10.4178/epih.e2025071
  • 1,267 View
  • 62 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
Despite a steady decline in incidence, tuberculosis (TB) remains a substantial public health burden in Korea, particularly among older adults. Existing national TB surveillance systems lack sufficiently comprehensive data to assess long-term outcomes and health disparities. The K-TB-N cohort integrates data from 3 national sources: the Korean Tuberculosis Surveillance System (2011-2022), the National Health Insurance Database (2010-2022), and mortality data from Statistics Korea (2010-2022). After data cleaning and linkage, the final cohort included 373,812 patients (375,440 episodes) with either drug-susceptible TB or drug- resistant TB. TB notifications declined by approximately 60% over the study period, while the median patient age continued to rise. Treatment success improved over time, accompanied by reductions in lost to follow-up. However, mortality during treatment increased, with more than half of deaths attributed to non-TB causes such as pneumonia, cancer, and cardiovascular disease. Post-treatment mortality also remained high, particularly among patients with drug-resistant TB. The K-TB-N cohort provides a comprehensive, linked dataset for advancing research on TB epidemiology, treatment outcomes, comorbidities, and health disparities. It enables evaluations of public health interventions, long-term prognosis, and strategies for post-TB care. This cohort will remain a valuable resource for shaping data-driven TB control policies in aging and high-burden settings.
Summary
Korean summary
- K-TB-N 코호트는 결핵 신고자료, 건강보험청구자료, 통계청 사망자료를 연계한 국내 최초의 전국단위 결핵 통합자료 코호트이다. - 이 코호트를 결핵 치료 성과와 치료 종료 이후 사망을 포함한 장기예후 분석이 가능하다. - 코호트에 포함된 2011-2022년 사이, 결핵 발생은 60% 감소하였고, 결핵 환자의 평균 연령은 증가하였다. 결핵 치료 중 사망율은 증가하였는데, 사망원인의 50% 이상은 비결핵성 사망이었다.
Key Message
- The K-TB-N cohort is the first national-level integrated TB cohort in South Korea that combines three distinct datasets, overcoming the limitations of single-source TB registries. - The linkage of clinical data (KTB-Surv), health insurance claims (NHID), and mortality records (Statistics Korea) allows long-term tracking of treatment outcomes and post-treatment mortality. - TB notifications declined by ~60% during the study period, while the median patient age increased. - The mortality during TB treatment rose, with over half of deaths attributed to non-TB causes.
Original Article
Associations between usual source of care characteristics and health outcomes in diabetes mellitus: a focus on medication adherence and healthy behaviors in Korea
Seung Eun Lee, Chul-Woung Kim, Ji Eun Bae, Jee Hyun Choi
Epidemiol Health. 2025;47:e2025063.   Published online December 2, 2025
DOI: https://doi.org/10.4178/epih.e2025063
  • 1,160 View
  • 56 Download
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
This study investigated the associations between usual source of care (USC) characteristics, which incorporate primary care functions, and medication adherence and healthy behaviors in Korean adults with diabetes.
METHODS
We used data from 1,543 adults with diabetes in the 2020 Korea Health Panel Survey. USC was categorized into 5 types based on whether a regular doctor was identified and whether that provider fulfilled comprehensiveness and coordination functions. Multivariable logistic regression was used to assess associations with medication adherence and healthy behaviors.
RESULTS
A significant difference in medication adherence was observed by USC type, although no significant associations emerged for healthy behaviors (smoking, drinking, exercise). Compared to the group without a USC, patients whose regular doctor fulfilled either function were 2.38 times more likely to adhere (odds ratio [OR], 2.38; 95% confidence interval [CI], 1.70 to 3.32), and those whose doctor fulfilled both functions were 1.84 times more likely to adhere (OR, 1.84; 95% CI, 1.31 to 2.59). This association was particularly strong for adherence to medication dosage, frequency, and timing.
CONCLUSIONS
The findings underscore that the functional quality of the USC, particularly the fulfillment of comprehensiveness and coordination, is crucial in improving medication adherence. Simply having a USC is insufficient. The lack of association with healthy behaviors suggests that physicians may focus more on pharmacological control, highlighting the need for multifaceted interventions.
Summary
Korean summary
본 연구는 단순히 주치의가 있는 것만으로는 당뇨병 환자의 복약 순응에 불충분하며, 일차 의료 기능을 충실히 수행하는 상용치료원만이 복약 순응과 유의한 관련이 있음을 입증했습니다. 하지만 상용치료원이 건강 행동 개선과는 관련이 없음을 확인하여, 의료진이 생활 습관 개선에는 영향을 주지 못하고 있음을 시사했습니다. 이러한 결과는 만성질환 관리를 개선하기 위해 상용치료원의 일차 의료 기능을 강화해야 한다는 정책적 근거를 제공합니다.
Key Message
This study shows that simply having a usual source of care (USC) is insufficient; only USCs that fully perform primary care functions are significantly associated with better medication adherence in diabetic patients. However, USC was not linked to improved health behaviors, suggesting providers fail to influence lifestyle changes. The findings provide policy evidence to reinforce the primary care functions of USCs to enhance chronic disease management.
Epidemiologic Investigation
Epidemiological characteristics and risk factors of suspected and confirmed mpox cases during the 2022-2023 epidemic in the Capital Region, Korea
Mingyeol Shim, Soo Hyeon Cho, Seung Eun Lee, Taeyoung Kim
Epidemiol Health. 2024;46:e2024092.   Published online November 24, 2024
DOI: https://doi.org/10.4178/epih.e2024092
  • 8,132 View
  • 140 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
This study investigated the general characteristics of laboratory-confirmed mpox patients in the Capital Region of Korea, as well as the risk factors for mpox infection, particularly focusing on the characteristics of polymerase chain reaction (PCR)-positive and PCR-negative cases.
METHODS
We investigated 160 adults, excluding 4 minors, from 164 suspected mpox patients reported in Seoul, Gyeonggi, Incheon, and Gangwon from June 21, 2022 to October 31, 2023. Data were collected via telephone and face-to-face interviews. A statistical analysis of the general characteristics of the infection was conducted using frequency analysis and logistic regression.
RESULTS
Of the 160 suspected cases of mpox, 59.3% (n=95) tested positive via mpox-PCR. Among the confirmed cases, 97.9% (n=93) were male. PCR-positive patients typically presented with genital and anal skin rashes or mucosal lesions, accompanied by pain. Additionally, 35.5% (n=33) of the male patients had human immunodeficiency virus (HIV) infections. Most confirmed cases (94.7%, 90/95) were believed to have contracted mpox through sexual contact during the maximal incubation period of 21 days prior to symptom onset, with a significant number reporting same-sex or casual contact. The most commonly collected and highest-yielding specimens from PCR-positive patients were from skin or mucosal lesions, whereas blood samples demonstrated the lowest percent positivity.
CONCLUSIONS
In the Capital Region, most PCR-positive cases were male patients in their 30s who had sexual contacts and exhibited symptoms, aligning with findings from previous studies. These results provide a foundation for the differential diagnosis concerning mpox infection and the selection of PCR-test samples in clinical settings.
Summary
Korean summary
- 대한민국 수도권의 mpox 의심환자 160명 중 59.3%(n=95)가 mpox-PCR 검사에서 양성으로 확인되었다. - 확진 환자 중 97.9%(n=93)는 남성이었고 35.5%(n=33)는 HIV에 감염되었으며 엠폭스 감염의 위험요인으로는 일회성 파트너와의 성적 접촉, 항문생식기 병변, 병변 부위의 통증이 포함되었다. - 양성 환자의 검체 특성은 피부 및 점막 병변 샘플이 가장 높은 양성률을 보였고, 혈액 샘플은 가장 낮은 양성률을 보였다.
Key Message
- Of the 160 suspected mpox cases in the Capital Region of South Korea, 59.3% (n=95) were confirmed as PCR-positive. - Among the confirmed cases, 97.9% were male and 35.5% were infected with HIV, and risk factors of mpox infection included sexual contact with casual partner, anogenital lesion, and pain on lesions. - Skin and mucosal lesion samples had the highest positivity rate, while blood samples had the lowest.

Citations

Citations to this article as recorded by  
  • The epidemiological and clinical differences between patients with mpox and patients without mpox among suspected cases during the recent global mpox outbreaks: a systematic review and meta-analysis
    Yingying Han, Xingzhao Li, Xin Wang, Zhuan Zhong
    Frontiers in Cellular and Infection Microbiology.2026;[Epub]     CrossRef
Original Article
Patterns and predictors of smoking relapse among inpatient smoking intervention participants: a 1-year follow-up study in Korea
Seung Eun Lee, Chul-Woung Kim, Hyo-Bin Im, Myungwha Jang
Epidemiol Health. 2021;43:e2021043.   Published online June 9, 2021
DOI: https://doi.org/10.4178/epih.e2021043
  • 23,448 View
  • 461 Download
  • 19 Web of Science
  • 20 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
This study aimed to identify relapse patterns in smokers who participated in an inpatient treatment program and to investigate factors related to relapse.
METHODS
The participants comprised 463 smokers who participated in an inpatient treatment operated by the Daejeon Tobacco Control Center from 2015 to 2018. Participants received high-intensity smoking cessation intervention for 5 consecutive days, including pharmacotherapy and behavioral support, and continued with follow-up for 1 year to determine whether they maintained smoking cessation after discharge from inpatient treatment. Kaplan-Meier and Cox proportional hazard models were used in the analysis.
RESULTS
Participants’ relapse rate within 1 year was 72.8%, and 59.8% of participants smoked again within 6 months after participation. A higher number of counseling sessions was significantly associated with a lower risk of relapse (hazard ratio [HR], 0.23; 95% confidence interval [CI], 0.17 to 0.32 for ≥9 vs. ≤5 counseling sessions). Conversely, higher relapse rates were significantly associated with the use of nicotine replacement therapy (NRT) (HR, 1.91; 95% CI, 1.43 to 2.55 for use vs. no use), and higher levels of baseline expired carbon monoxide (CO) (HR, 1.58; 95% CI, 1.21 to 2.06 for expired CO concentrations of 10-19 ppm vs. expired CO concentrations <10 ppm).
CONCLUSIONS
High-intensity smoking cessation interventions in hospital settings can be effective for smoking cessation in smokers with high nicotine dependence. In addition, the results suggest that for quitters to maintain long-term abstinence, they should receive regular follow-up counseling for 1 year after completing a high-intensity smoking cessation intervention.
Summary
Korean summary
• 한국은 국가금연정책의 일환으로 중증고도흡연자를 위해 고강도의 입원형 금연 중재 프로그램을 운영하고 있다. • 고강도 금연 중재를 받은 후 첫 6개월은 재흡연이 가장 빈번히 일어나는 시기였다. • 장기 금연을 유지하기 위해서는 고강도 금연 중재 후에도 1년간 지속적인 추후 상담이 이루어져야 한다.
Key Message
• South Korea operates a high-intensity inpatient treatment program for heavy smokers. • Relapse typically occurred in the first 6 months after completing the intervention. • Continuous 1 year follow-up counseling is important for long-term abstinence.

Citations

Citations to this article as recorded by  
  • Evaluation of a Community-Based Quality Improvement Smoking Cessation Program Using the Ottawa Model During COVID-19
    Salma Mahmoodianfard, Ayah Rashwan, Javad Heshmati, Terefe Gelibo, Mustafa Coja, David Sabapathy, Shamara Baidoobonso, Karen Phillips, Laura MacDonald, Laura Lee Noonan, Kerri-Anne Mullen, Hassan Mir
    CJC Open.2026;[Epub]     CrossRef
  • Prognosis after switching to electronic cigarettes following percutaneous coronary intervention: a Korean nationwide study
    Danbee Kang, Ki Hong Choi, Hyunsoo Kim, Hyejeong Park, Jihye Heo, Taek Kyu Park, Joo Myung Lee, Juhee Cho, Jeong Hoon Yang, Joo-Yong Hahn, Seung-Hyuk Choi, Hyeon-Cheol Gwon, Young Bin Song
    European Heart Journal.2025; 46(1): 84.     CrossRef
  • Comparison of Quit Rates and Predictors in Korean Inpatient and Residential Smoking Cessation Programs: A Secondary Data Analysis of Data from the National Smoking Cessation Services
    Youngmee Ahn, Soyoung Jung, Hunjae Lee, Jung-Ae Cho, Min Sohn
    Research in Community and Public Health Nursing.2025; 36: 210.     CrossRef
  • The impact of standardised tobacco packaging and warnings on relapse prevention: a longitudinal online survey in the UK
    Crawford Moodie, Daniel Jones, Catherine Best
    Tobacco Control.2025; : tc-2024-059206.     CrossRef
  • Prospective associations between smoking abstinence and anhedonia among people who seek smoking cessation treatment
    Elizabeth Moss-Alonso, Rubén Rodríguez-Cano, Carmela Martínez-Vispo, Ana López-Durán, Elisardo Becoña
    Addictive Behaviors.2025; 170: 108439.     CrossRef
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    Sidney Aki, Morgan Brown, Jerry Stitzel, Hunter Mathews
    Behavioural Brain Research.2025; 495: 115754.     CrossRef
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    Sophie Hascher, Ori Ossmy, Halley M. Pontes
    International Journal of Mental Health and Addiction.2025;[Epub]     CrossRef
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    Symen Kornelis Spoelstra, Robert C. van de Graaf, Arie Dijkstra
    Journal of Addiction Medicine.2024; 18(1): 33.     CrossRef
  • Experiences with smoking habits and the need for cessation among habitual smokers in Japan: a qualitative study based on semi-structured interviews
    Kae Shiratani, Junko Shimasawa, Mayumi Mizutani
    BMC Primary Care.2024;[Epub]     CrossRef
  • Neurobiology of Stress-Induced Nicotine Relapse
    Xinyu Wang, Yun Chen, Jing Dong, Jing Ge, Xiaoliu Liu, Jianfeng Liu
    International Journal of Molecular Sciences.2024; 25(3): 1482.     CrossRef
  • Tobacco control in Qatar from 2002 to 2022: 20 years of progress and challenges
    Mohamed Ghaith Al-Kuwari, Abdulhmeed Ahmad Al-Khenji, Wadha Ahmad Al-Baker, Mohamed Osman Bala
    Journal of Public Health Research.2024;[Epub]     CrossRef
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    Muhamad Arham Bin Hashim, Khairul Fikri Bin Sebri, Muhammad Faiz Bin Mohd Hanim, Diyana Shereen Binti Anwar, Nawwal Alwani Binti Mohd Radzi, Ahmad Farhan Bin Ahmad Fuad, Budi Aslinie Binti Md Sabri
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    Miyoko Massago, Mamoru Massago, Pedro Henrique Iora, Sanderland José Tavares Gurgel, Celso Ivam Conegero, Idalina Diair Regla Carolino, Maria Muzanila Mushi, Giane Aparecida Chaves Forato, João Vitor Perez de Souza, Thiago Augusto Hernandes Rocha, Samile
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  • Factors Related to Smoking Relapse Within Six-Months of Smoking Cessation Among Inpatients
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