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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
  • 747 View
  • 40 Download
AbstractAbstract AbstractSummary PDF
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 Articles
Homelessness and mortality: gender, age, and housing status inequity in Korea
Gum-Ryeong Park, Dawoon Jeong, Seung Won Lee, Hojoon Sohn, Young Ae Kang, Hongjo Choi
Epidemiol Health. 2024;46:e2024076.   Published online September 12, 2024
DOI: https://doi.org/10.4178/epih.e2024076
  • 16,764 View
  • 167 Download
  • 1 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
We compared mortality rates among various housing statuses within the homeless population and investigated factors contributing to their deaths, including housing status, gender, and age.
METHODS
Using a comprehensive multi-year dataset (n=15,445) curated by the National Tuberculosis Screening and Case Management Programs, matched with the 2019-2021 Vital Statistics Death Database and National Health Insurance claims data, we calculated age-standardized mortality rates and conducted survival analysis to estimate differences in mortality rates based on housing status.
RESULTS
The mortality rate among the homeless population was twice as high as that of the general population, at 1,159.6 per 100,000 compared to 645.8 per 100,000, respectively. Cancer and cardiovascular diseases were the primary causes of death. Furthermore, individuals residing in shelter facilities faced a significantly higher risk of death than those who were rough sleeping, with an adjusted hazard ratio of 1.70 (95% confidence interval, 1.37 to 2.11). This increased risk was especially pronounced in older adults and women.
CONCLUSIONS
The study highlights the urgent need for targeted interventions, as the homeless population faces significantly higher mortality rates. Older adults and women in shelter facilities are at the highest risk.
Summary
Korean summary
전체 인구의 사망률은 큰 폭으로 줄어들면서 홈리스와 전체 인구 간의 사망 불평등이 1.3배에서 1.8배로 증가했다. 특히 쪽방주민이나 거리 홈리스보다 시설 거주 홈리스의 사망 위험이 더 높았으며, 동일 조건하에서 거리 홈리스 대비 약 1.7배 높은 사망 위험을 보였다. 본 연구는 홈리스의 탈시설화를 촉진하는 정책 전환의 필요성을 시사한다.
Key Message
The mortality rate of the general population has significantly declined, leading to an increase in mortality inequality between the homeless and the general population from 1.3 to 1.8 times. In particular, the mortality risk for homeless individuals in facilities was higher than that of those living in jjokbang or on the streets. This study highlights the need for a policy shift to promote deinstitutionalization for the homeless population.

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  • Bezdomność w Polsce. Epidemiologiczne spojrzenie na przyczyny zgonów i implikacje zdrowotne (2015–2022)
    Jadwiga Duda, Igor Popiela, Karolina Dudzik, Aleksandra Adamus, Maciej Przygoda, Andrzej Kościsz, Tomasz Konopka
    Zdrowie Publiczne i Zarządzanie.2025; 23(1): 29.     CrossRef
Comparison of self-reported and accelerometer-assessed measurements of physical activity according to socio-demographic characteristics in Korean adults
Seung Won Lee, Jee-Seon Shim, Bo Mi Song, Ho Jae Lee, Hye Yoon Bae, Ji Hye Park, Hye Rin Choi, Jae Won Yang, Ji Eun Heo, So Mi Jemma Cho, Ga Bin Lee, Diana Huanan Hidalgo, Tae-Hoon Kim, Kyung Soo Chung, Hyeon Chang Kim
Epidemiol Health. 2018;40:e2018060.   Published online November 29, 2018
DOI: https://doi.org/10.4178/epih.e2018060
  • 24,362 View
  • 174 Download
  • 8 Web of Science
  • 7 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Previous studies have shown relatively low correlations between self-reported and accelerometer-assessed physical activity (PA). However, this association differs by socio-demographic factors, and this relationship has not been fully investigated in the general population. Thus, we investigated the correlation between self-reported and accelerometer-assessed PA and whether it differed by demographic and socioeconomic factors among the Korean general population.
METHODS
This cross-sectional study included 623 participants (203 men and 420 women) aged 30 to 64 years, who completed a PA questionnaire and wore a wrist-worn accelerometer on the non-dominant wrist for 7 days. We examined the agreement for metabolic equivalent task minutes per week (MET-min/wk) between the 2 measures and calculated Spearman correlation coefficients according to demographic and socioeconomic factors.
RESULTS
The kappa coefficient between tertiles of self-reported and accelerometer-assessed total MET-min/wk was 0.16 in the total population, suggesting overall poor agreement. The correlation coefficient between the 2 measurements was 0.26 (p<0.001) in the total population, and the correlation tended to decrease with increasing age (p for trend <0.001) and depression scores (p for trend <0.001).
CONCLUSIONS
We found a low correlation between self-reported and accelerometer-assessed PA among healthy Korean adults, and the correlation decreased with age and depression score. When studying PA using accelerometers and/or questionnaires, age and depression need to be considered, as should differences between self-reported and accelerometer-assessed PA.
Summary
Korean summary
역학연구에서 신체활동량 측정에 가장 많이 사용되는 설문조사와 가속도계 착용법인데, 두 가지 방법으로 측정한 신체활동량은 상관성이 그리 높지 않으며, 대상자 특성에 따라서도 일치도가 다른 것으로 보고되고 있다. 따라서, 비교적 건강한 중년의 한국 성인을 대상으로 자가설문과 가속도계 조사를 사용해 측정한 신체활동량의 관련성을 조사해보았다. 이 연구는 전향적 코호트 연구의 기반조사 결과를 이용한 단면연구로, 지역사회 거주하는 30-64세 성인 623명(남성203명, 여성 420명)을 대상으로 하였으며, 신체활동을 자가보고 설문조사와 3축 가속도계를 7일간 손목에 연속착용하여 측정하고 두 방법으로 측정한 신체활동량을 비교하였다. 전체 대상자에서 두 방법으로 측정한 신체활동량 삼분위(tertile) 값의 일치도를 조사했을 때 Kappa 통계량은 0.16 이었으며 Spearman 상관계수는 0.26 (p<0.001)이었다. 나이가 많을수록 우울증상이 많을수록 두 방법 간 일치도와 상관성이 낮아지는 경향을 보였다.

Citations

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  • A systematic review of measurement tools and senior engagement in urban nature: Health benefits and behavioral patterns analysis
    Fan Yuan, Mingze Chen
    Health & Place.2025; 91: 103410.     CrossRef
  • Historical development of accelerometry measures and methods for physical activity and sedentary behavior research worldwide: A scoping review of observational studies of adults
    Kelly R. Evenson, Elissa Scherer, Kennedy M. Peter, Carmen C. Cuthbertson, Stephanie Eckman, Zulkarnain Jaafar
    PLOS ONE.2022; 17(11): e0276890.     CrossRef
  • Physical Exercise and Undergraduate Students’ Subjective Well-Being: Mediating Roles of Basic Psychological Need Satisfaction and Sleep Quality
    Sen Lin, Liming Li, Dong Zheng, Libiao Jiang
    Behavioral Sciences.2022; 12(9): 316.     CrossRef
  • The effect of a video‐supported assessment to increase the accuracy of self‐reported physical activity
    Antje Ullrich, Lisa Voigt, Ulrike Siewert‐Markus, Christian Meyer, Marcus Dörr, Sabina Ulbricht
    Scandinavian Journal of Medicine & Science in Sports.2021; 31(5): 1059.     CrossRef
  • Association between social network structure and physical activity in middle-aged Korean adults
    So Mi Jemma Cho, Hokyou Lee, Jee-Seon Shim, Yoosik Youm, Sun Jae Jung, Dae Jung Kim, Hyeon Chang Kim
    Social Science & Medicine.2021; 282: 114112.     CrossRef
  • Objective versus Self-reported Physical Activity and Cardiovascular Disease Risk Factors
    Hoyong Sung, Jungjun Lim, Junbae Mun, Yeonsoo Kim
    The Korean Journal of Sports Medicine.2020; 38(1): 28.     CrossRef
  • Let’s Live Healthier: The Relationship between Suicidal Behavior and Physical Activity in an Age-, Gender-, and Body Mass Index-Matched Adults
    Jeong-Hui Park, Myong-Won Seo, Hyun Chul Jung, Jung-Min Lee
    International Journal of Environmental Research and Public Health.2020; 17(22): 8350.     CrossRef
Cohort Profile
Cardiovascular and Metabolic Diseases Etiology Research Center (CMERC) cohort: study protocol and results of the first 3 years of enrollment
Jee-Seon Shim, Bo Mi Song, Jung Hyun Lee, Seung Won Lee, Ji Hye Park, Dong Phil Choi, Myung Ha Lee, Kyoung Hwa Ha, Dae Jung Kim, Sungha Park, Won-Woo Lee, Hyeon Chang Kim
Epidemiol Health. 2017;39:e2017016.   Published online April 1, 2017
DOI: https://doi.org/10.4178/epih.e2017016
  • 28,955 View
  • 349 Download
  • 38 Web of Science
  • 42 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
Although the etiologies of cardiovascular disease (CVD) are widely understood, the goal of finding a globally effective solution for preventing CVD is unrealistic. Therefore, we aimed to conduct a community-based prospective study on the prevention and management of CVD in Korean adults. This study was designed to recruit 8,000 healthy adults over the course of 5 years. The baseline assessment includes a wide range of established CVD risk factors, including demographic characteristics, medical history, health behaviors, psychological conditions, body size and composition, blood pressure, the augmentation index, carotid ultrasonography, an electrocardiogram, and biochemical indicators, as well as some novel factors, such as social network characteristics, exposure to environmental pollutants, inflammatory markers, hemostatic markers, and immunosenescence markers. Annual telephone interviews and follow-up health examinations at 5-year intervals after the baseline assessment are planned to collect information on changes in health status and its determinants. Additionally, indirect follow-up using secondary data sources will be conducted to obtain information on health services utilization and death. So far, more than 6,000 adults have been enrolled during the first three and a half years, and almost all participants have been tracked by annual telephone follow-up surveys. The data have been uploaded to iCReaT, the clinical research information management system of the Korea National Institute of Health.
Summary
Korean summary
심뇌혈관 및 대사질환 원인연구센터(Cardiovascular and Metabolic Diseases Etiology Research Center)에서는 심뇌혈관질환 및 대사질환의 새로운 발병 원인을 찾고 효율적인 예방 전략을 개발하고자 코호트(CMERC cohort와 CMERC-HI cohort)를 구축하였다. 지역사회에 거주하는 만 30-64세 건강한 성인을 대상으로 하는 CMERC cohort는 2013년부터 2018년 까지 총 5년 동안 8000명 등록을 목표로 기반조사를 진행 중이며(2016년 12월 현재 6000여명 등록), 이미 알려진 다양한 위험요인 이외에 사회연결망 정보와 면역노화 관련 바이오마커 등 새로운 위험 요인에 관한 광범위한 정보가 수집되고 있다. CMERC cohort는 심뇌혈관 및 대사질환 예방연구의 기초자료로 활용되어 과학적 데이터에 근거한 예방 전략 수립에 기여하게 될 것이다.

Citations

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  • Cohort profile: Cardiovascular Metabolic Etiological Research Center COVID-19 Mental Health Survey (CC-MHS)
    Sun Jae Jung, Dongkyu Lee, Ji Su Yang, Sunghyuk Kang, Hyejin Kim, Jeong Hyun Ahn, Yunseong Heo, Jieun Noh, Changhyun Kim, Hyeon Chang Kim
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    Hope Nyavor, Emmanuel Obeng-Gyasi
    International Journal of Environmental Research and Public Health.2025; 22(10): 1551.     CrossRef
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    Cardiovascular Prevention and Pharmacotherapy.2025; 7(4): 109.     CrossRef
  • Nocturnal systolic blood pressure dipping and progression of chronic kidney disease
    Cheol Ho Park, Jong Hyun Jhee, Kyeong-Hyeon Chun, Jiwon Seo, Chan Joo Lee, Soo-Hyun Park, Jin-Taek Hwang, Seung Hyeok Han, Shin-Wook Kang, Sungha Park, Tae-Hyun Yoo
    Hypertension Research.2024; 47(1): 215.     CrossRef
  • A Prospective Sociocentric Study of 2 Entire Traditional Korean Villages: The Korean Social Life, Health, and Aging Project (KSHAP)
    Jiwon Baek, Ekaterina Baldina, Kiho Sung, Sung-Ha Lee, Nicholas A Christakis, Peter Bearman, Hyeon Chang Kim, Sang Hui Chu, Eun Lee, Yeong-Ran Park, Jeanyung Chey, Youn-Hee Choi, Dohoon Lee, Yoosik Youm
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  • Metabolic phenotyping with computed tomography deep learning for metabolic syndrome, osteoporosis and sarcopenia predicts mortality in adults
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    American Journal of Kidney Diseases.2023; 81(4): 384.     CrossRef
  • Ideal cardiovascular health metrics and the risk of nonalcoholic fatty liver disease in Korean adults
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  • Cortical and Trabecular Bone Deficit in Middle‐Aged Men Living withHIV
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  • Ultra-Processed Food Consumption and Obesity in Korean Adults
    Jee-Seon Shim, Kyoung Hwa Ha, Dae Jung Kim, Hyeon Chang Kim
    Diabetes & Metabolism Journal.2023; 47(4): 547.     CrossRef
  • Diet quality partially mediates the association between ultraprocessed food consumption and adiposity indicators
    Jee‐Seon Shim, Kyoung Hwa Ha, Dae Jung Kim, Hyeon Chang Kim
    Obesity.2023; 31(9): 2430.     CrossRef
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    Eunji Kim, Youngrong Lee, Hyeon Chang Kim
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    Ga Hye Lee, Jee Youn Lee, Jiyeon Jang, Yeon Jun Kang, Seung Ah Choi, Hyeon Chang Kim, Sungha Park, Myoung Soo Kim, Won‐Woo Lee
    Clinical & Translational Immunology.2022;[Epub]     CrossRef
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    Ye Jin Jeon, Youngrong Lee, Ji Su Yang, Young Su Park, Sun Jae Jung
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    Y. J. Jeon, S. J. Jung, H. C. Kim
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    Jong Hyun Jhee, Bo Young Nam, Chan Joo Lee, Jung Tak Park, Seung Hyeok Han, Shin‐Wook Kang, Sungha Park, Tae‐Hyun Yoo
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    Sun Jae Jung, Yongwoo Jeon, Gabin Lee, Jee-Seon Shim, Hyeon Chang Kim
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    Hye Rin Choi, Jung Hyun Lee, Hyung Keun Lee, Jong Suk Song, Hyeon Chang Kim
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  • Dose-Response Association between Smoking Cessation and Arterial Stiffness: The Cardiovascular and Metabolic Diseases Etiology Research Center (CMERC) Cohort
    Ga Bin Lee, Jee Seon Shim, Hyeon Chang Kim
    Korean Circulation Journal.2020; 50(4): 361.     CrossRef
  • Effects of cigarette smoking on blood lipids in Korean men: Cardiovascular and Metabolic Diseases Etiology Research Center cohort
    Soo Kyoung Kim, Hyeon Chang Kim, Jee-Seon Shim, Dae Jung Kim
    The Korean Journal of Internal Medicine.2020; 35(2): 369.     CrossRef
  • Residential Radon Exposure and Cigarette Smoking in Association with Lung Cancer: A Matched Case-Control Study in Korea
    Eung Joo Park, Hokyou Lee, Hyeon Chang Kim, Seung Soo Sheen, Sang Baek Koh, Ki Soo Park, Nam Han Cho, Cheol-Min Lee, Dae Ryong Kang
    International Journal of Environmental Research and Public Health.2020; 17(8): 2946.     CrossRef
  • Association between the Thigh Muscle and Insulin Resistance According to Body Mass Index in Middle-Aged Korean Adults
    Ji Eun Heo, Jee-Seon Shim, Hokyou Lee, Hyeon Chang Kim
    Diabetes & Metabolism Journal.2020; 44(3): 446.     CrossRef
  • Depressive symptoms, its sub-factors, and augmentation index: the modifying effects according to inflammatory markers
    Ye Jin Jeon, So Mi Jemma Cho, Yu Jin Lee, Hyeon Chang Kim, Sun Jae Jung
    Journal of Affective Disorders.2020; 272: 380.     CrossRef
  • Ambulatory blood pressure variability and risk of cardiovascular events, all-cause mortality, and progression of kidney disease
    Jong Hyun Jhee, Jiwon Seo, Chan Joo Lee, Jung Tak Park, Seung Hyeok Han, Shin-Wook Kang, Sungha Park, Tae-Hyun Yoo
    Journal of Hypertension.2020; 38(9): 1712.     CrossRef
  • Comparison of Computed Tomography-based Abdominal Adiposity Indexes as Predictors of Non-alcoholic Fatty Liver Disease Among Middle-aged Korean Men and Women
    Jongmin Baek, Sun Jae Jung, Jee-Seon Shim, Yong Woo Jeon, Eunsun Seo, Hyeon Chang Kim
    Journal of Preventive Medicine and Public Health.2020; 53(4): 256.     CrossRef
  • Effect of Smartphone-Based Lifestyle Coaching App on Community-Dwelling Population With Moderate Metabolic Abnormalities: Randomized Controlled Trial
    So Mi Jemma Cho, Jung Hyun Lee, Jee-Seon Shim, Hyungseon Yeom, Su Jin Lee, Yong Woo Jeon, Hyeon Chang Kim
    Journal of Medical Internet Research.2020; 22(10): e17435.     CrossRef
  • The Association of Adiponectin and Visceral Fat with Insulin Resistance and β-Cell Dysfunction
    Hyun Uk Moon, Kyoung Hwa Ha, Seung Jin Han, Hae Jin Kim, Dae Jung Kim
    Journal of Korean Medical Science.2019;[Epub]     CrossRef
  • Presence of Metabolic Syndrome Components Is Associated with Tooth Loss in Middle-Aged Adults
    Min-Jeong Cho, Youn-Hee Choi, Hyeon Chang Kim, Jee-Seon Shim, Atsuo Amano, Ji-Young Kim, Keun-Bae Song
    Yonsei Medical Journal.2019; 60(6): 554.     CrossRef
  • Cohort Profile: The Cardiovascular and Metabolic Diseases Etiology Research Center Cohort in Korea
    Jee-Seon Shim, Bo Mi Song, Jung Hyun Lee, Seung Won Lee, Ji Hye Park, Dong Phil Choi, Myung Ha Lee, Kyoung Hwa Ha, Dae Jung Kim, Sungha Park, Won-Woo Lee, Yoosik Youm, Eui-Cheol Shin, Hyeon Chang Kim
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Original Article
Admission route and use of invasive procedures during hospitalization for acute myocardial infarction: analysis of 2007-2011 National Health Insurance database
Hyungseon Yeom, Dae Ryong Kang, Seong Kyung Cho, Seung Won Lee, Dong-Ho Shin, Hyeon Chang Kim
Epidemiol Health. 2015;37:e2015022.   Published online May 1, 2015
DOI: https://doi.org/10.4178/epih/e2015022
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
The goal of this study was to investigate trends in admission to the emergency department and the use of invasive or surgical procedures during hospitalization for acute myocardial infarction (AMI) in Korea.
METHODS
The National Health Insurance (NHI) claims database between 2007 and 2011 was used. We identified all admission claims that included codes from the tenth revision of the International Classification of Diseases beginning with I21 as the primary or secondary diagnosis. Information about the admission route, admission date, discharge date, and whether coronary artery angiography, angioplasty, or bypass surgery was performed was also obtained from the NHI database.
RESULTS
Of the 513,886 relevant admission claims over the five years encompassed by this study, 295,001 discrete episodes of admission for AMI were identified by analyzing the date and length of each admission and the interval between admissions. The number of AMI admissions gradually decreased from 66,883 in 2007 to 47,656 in 2011. The number and proportion of admissions through the emergency department also decreased from 38,118 (57.0%) in 2007 to 24,001 (50.4%) in 2011. However, during the same period, admissions in which invasive or surgical procedures were performed increased from 15,342 (22.9%) to 17,505 (36.7%).
CONCLUSIONS
The reported numbers of emergency department visits and admissions for AMI decreased from 2007 to 2011. However, only a small portion of the patients underwent invasive or surgical procedures during hospitalization, although the number of admissions involving invasive or surgical procedures has increased. These findings suggest that simply counting the number of admission claims cannot provide valid information on trends in AMI occurrence.
Summary
Korean summary
급성심근경색 환자의 급성기 의료이용행태를 조사하기 위해 2007년부터 2011년까지 급성심근경색증 진단명(ICD-10 코드 I21.x)을 포함하는 입원 청구자료 513,886건을 분석하였다. 총 295,001건의 독립된 입원 에피소드를 추출하여 분석한 결과, 5년동안 전체 입원건수와 응급실 경유 입원건수는 감소한 반면, 진단 또는 치료 목적의 침습적 시술을 동반한 입원은 증가하였다. 건강보험청구자료를 이용하여 급성심근경색증 발생 규모를 파악할 때, 진단명만으로는 정확한 추계가 어려우며 관련 시술 등의 의료이용 정보를 추가하는 것이 필요할 것이다.

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