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Trends and all-cause mortality associated with multimorbidity of non-communicable diseases among adults in the United States, 1999-2018: a retrospective cohort study
Mengzi Sun, Ling Wang, Xuhan Wang, Li Tong, Lina Jin, Bo Li
Epidemiol Health. 2023;45:e2023023.   Published online February 14, 2023
DOI: https://doi.org/10.4178/epih.e2023023
  • 4,000 View
  • 110 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Multimorbidity of non-communicable diseases (NCDs) has brought enormous challenges to public health, becoming a major medical burden. However, the patterns, temporal trends, and all-cause mortality associated with NCD multimorbidity over time have not been well described in the United States.
METHODS
All adult participants were sourced from nationally representative data from the National Health and Nutrition Examination Survey. In total, 55,081 participants were included in trend analysis, and 38,977 participants were included in Cox regression.
RESULTS
The 5 NCDs with the largest increases over the study period were diabetes, osteoporosis, obesity, liver conditions, and cancer. The estimated prevalence of multimorbidity increased with age, especially for middle-aged participants with 5 or more NCDs; in general, the prevalence of NCD multimorbidity was higher among females than males. Participants with 5 or more NCDs were at 4.49 times the risk of all-cause mortality of participants without any diseases. Significant interactions were found between multimorbidity and age group (p for interaction <0.001), race/ethnicity (p for interaction<0.001), and educational attainment (p for interaction=0.010).
CONCLUSIONS
The prevalence of multiple NCDs significantly increased from 1999 to 2018. Those with 5 or more NCDs had the highest risk of all-cause mortality, especially among the young population. The data reported by this study could serve as a reference for additional NCD research.
Summary
Key Message
This study included a series-cross sectional study and a retrospective cohort study, utilizing nationally representative data from the National Health and Nutrition Examination Survey (NHANES). Multimorbidity of non-communicable diseases (NCDs) has brought enormous challenges to public health, becoming a major medical burden. This study aimed to explore the patterns, temporal trends, and all-cause mortality of multimorbidity of NCDs in the United States from 1999 to 2018, by gender-specific and age-specific. The data reported by this study could serve as a reference for additional NCD research.
Perceived usefulness of COVID-19 tools for contact tracing among contact tracers in Korea
Seonyeong Gong, Jong Youn Moon, Jaehun Jung
Epidemiol Health. 2022;44:e2022106.   Published online November 15, 2022
DOI: https://doi.org/10.4178/epih.e2022106
  • 3,495 View
  • 86 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
In Korea, contact tracing for coronavirus disease 2019 is conducted using information from credit card records, handwritten visitor logs, KI-Pass (QR code), and the Safe Call system after an interview. We investigated the usefulness of these tools for contact tracing.
METHODS
An anonymous survey was conducted for 2 months (July to September 2021) among contact tracers throughout Korea. The questionnaire consisted of 4 parts: (1) demographic characteristics; (2) the usefulness of each tool for contact tracing; (3) the order in which information was checked during contact tracing; and (4) the match rate between tools for contact tracing, screening test rate, response rate, and helpfulness (rated on a Likert scale).
RESULTS
In total, 190 individuals completed the survey. When asked to rate the usefulness of each tool for contact tracing on a Likert scale, most respondents (86.3%) provided positive responses for credit card records, while the most common responses for handwritten visitor logs were negative. The highest percentage of positive responses for helpfulness was found for KI-Pass (91.1%), followed in descending order by credit card records (82.6%), Safe Call (78.2%), and handwritten visitor logs (22.1%).
CONCLUSIONS
Over 80% of participants provided positive responses for credit card records, KI-Pass, and Safe Call data, while approximately 50% provided negative responses regarding the usefulness of handwritten visitor logs. Our findings highlight the need to unify systems for post-interview contact tracing to increase their convenience for contact tracers, as well as the need to improve tools utilizing handwritten visitor logs for digitally vulnerable groups.
Summary
Korean summary
본 연구는 국내 역학조사 담당자들을 대상으로 시행한 설문조사를 중심으로 면담조사 후 추가적으로 실시하는 다양한 접촉자 추적 방법의 유용성에 대한 분석을 목표로 한다. 응답자 중 약 80% 이상이 카드결제기록, KI-Pass, GPS 및 CCTV 정보의 유용성에 대해 긍정적으로 응답하였다. 반면 약 50%는 수기명부의 유용성에 대해 부정적으로 응답하였다. 본 연구의 결과는 역학조사관과 사용자 모두의 편의를 위해 역학조사 방법의 일원화가 필요할 뿐만 아니라 디지털 취약 계층을 위해 수기명부를 대체할 수 있는 시스템의 필요성을 시사한다.
Key Message
We conducted an anonymous online survey to assess the usefulness of tools for contact tracing for COVID-19 in Korea. Over 80% of participants provided positive responses regarding the usefulness of credit card records, KI-Pass, and Safe Call data, while approximately 50% provided negative responses regarding the usefulness of handwritten visitor logs. Our findings highlight the need to unify contact tracing systems to increase their convenience for contact tracers.
COVID-19: Systematic Review
Mental health outcomes of quarantine and isolation for infection prevention: a systematic umbrella review of the global evidence
Md Mahbub Hossain, Abida Sultana, Neetu Purohit
Epidemiol Health. 2020;42:e2020038.   Published online June 2, 2020
DOI: https://doi.org/10.4178/epih.e2020038
  • 38,234 View
  • 1,479 Download
  • 380 Web of Science
  • 266 Crossref
AbstractAbstract PDFSupplementary Material
Abstract
Objectives
Transmission of infectious diseases is often prevented by quarantine and isolation of the populations at risk. These approaches restrict the mobility, social interactions, and daily activities of the affected individuals. In recent coronavirus disease 2019 (COVID-19) pandemic, quarantine and isolation are being adopted in many contexts, which necessitates an evaluation of global evidence on how such measures impact the mental health outcomes among populations. This umbrella review aimed to synthesize the available evidence on mental health outcomes of quarantine and isolation for preventing infectious diseases.
Methods
We searched nine major databases and additional sources and included articles if they were systematically conducted reviews, published as peer-reviewed journal articles, and reported mental health outcomes of quarantine or isolation in any population.
Results
Among 1,364 citations, only eight reviews met our criteria. Most of the primary studies in those reviews were conducted in high-income nations and in hospital settings. These articles reported a high burden of mental health problems among patients, informal caregivers, and healthcare providers who experienced quarantine or isolation. Prevalent mental health problems among the affected individuals include depression, anxiety, mood disorders, psychological distress, posttraumatic stress disorder, insomnia, fear, stigmatization, low self-esteem, lack of self-control, and other adverse mental health outcomes.
Conclusions
This umbrella review found severe mental health problems among individuals and populations who have undergone quarantine and isolation in different contexts. This evidence necessitates multipronged interventions including policy measures for strengthening mental health services globally and promoting psychosocial wellbeing among high-risk populations.
Summary

Citations

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  • ՀԱՄԱՎԱՐԱԿԻ ԸՆԹԱՑՔՈՒՄ ԱՆՁԻ ՀՈԳԵԲԱՆԱԿԱՆ ԱՆՎՏԱՆԳՈՒԹՅՈՒՆԸ ԵՒ ՀՈԳԵԿԱՆ ԱՌՈՂՋՈՒԹՅՈՒՆԸ. ՏԵՍԱԿԱՆ ԱՍՊԵԿՏ / A PERSON’S PSYCHOLOGICAL SAFETY AND MENTALHEALTH DURING A PANDEMIC: THE THEORETICAL ASPECT
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Original Articles
Associations between chronic conditions and oral health services utilization in older Peruvian adults: a pooled analysis of the Demographic and Health Survey 2015-2017
Diego Azañedo, Diego Chambergo-Michilot, Akram Hernández-Vásquez
Epidemiol Health. 2020;42:e2020023.   Published online April 9, 2020
DOI: https://doi.org/10.4178/epih.e2020023
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AbstractAbstract PDF
Abstract
OBJECTIVES
This study was conducted to investigate the associations between chronic conditions (CCs) and oral health services utilization (OHSU) within the previous 6 months in older Peruvian adults (defined as those 60 years of age or more according to Peruvian law).
METHODS
An analytical cross-sectional study was performed based on the 2015-2017 Peruvian Demographic and Family Health Survey. Pooled data from 13,699 older adults were analyzed. A logistic regression model was used to analyze the associations between OHSU (dependent variable) and CCs (independent variables). Tobacco consumption, obesity, educational level, age, sex, welfare quintile, area of residence, having health insurance, and natural region of residence were included as covariates in the analysis.
RESULTS
The frequency of OHSU in older adults was 18.5% (95% confidence interval [CI], 17.8 to 19.3). The highest percentage point (%p) differences with regards to OHSU were found between the extreme categories of educational level (higher education vs. none or elementary school: +24.8%p) and welfare quintile (richest vs. poorest: +24.0%p). In the crude model, OHSU was associated with diabetes (odds ratio [OR], 1.46; 95% CI, 1.26 to 1.69), but this association disappeared after adjustment for covariates. Meanwhile, depression decreased the likelihood of OHSU (OR, 0.82; 95% CI, 0.72 to 0.95) in the adjusted model.
CONCLUSIONS
The frequency of OHSU was low in older Peruvian adults. Regarding CCs, we found that depression independently decreased the likelihood of OHSU in the adjusted model. Our results may be useful for the development of policies aimed at achieving greater OHSU in older adults with CCs, especially in those with depression.
Summary
Epidemiological characteristics of HIV infected Korean: Korea HIV/AIDS Cohort Study
Yunsu Choi, Bo Youl Choi, Soo Min Kim, Sang Il Kim, June Kim, Jun Young Choi, Shin-Woo Kim, Joon Young Song, Youn Jeong Kim, Dae Won Park, Hyo Youl Kim, Hee-Jung Choi, Mee-Kyung Kee, Young Hyun Shin, Myeongsu Yoo
Epidemiol Health. 2019;41:e2019037.   Published online September 3, 2019
DOI: https://doi.org/10.4178/epih.e2019037
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  • 20 Web of Science
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
To manage evidence-based diseases, it is important to identify the characteristics of patients in each country.
METHODS
The Korea HIV/AIDS Cohort Study seeks to identify the epidemiological characteristics of 1,442 Korean individuals with human immunodeficiency virus (HIV) infection (12% of Korean individuals with HIV infection in 2017) who visited 21 university hospitals nationwide. The descriptive statistics were presented using the Korea HIV/AIDS cohort data (2006-2016).
RESULTS
Men accounted for 93.3% of the total number of respondents, and approximately 55.8% of respondents reported having an acute infection symptom. According to the transmission route, infection caused by sexual contact accounted for 94.4%, of which 60.4% were caused by sexual contact with the same sex or both males and females. Participants repeatedly answered the survey to decrease depression and anxiety scores. Of the total participants, 89.1% received antiretroviral therapy (ART). In the initial ART, 95.3% of patients were treated based on the recommendation. The median CD4 T-cell count at the time of diagnosis was 229.5 and improved to 331 after the initial ART. Of the patients, 16.6% and 9.4% had tuberculosis and syphilis, respectively, and 26.7% had pneumocystis pneumonia. In the medical history, sexually transmitted infectious diseases showed the highest prevalence, followed by endocrine diseases. The main reasons for termination were loss to follow-up (29.9%) and withdrawal of consent (18.7%).
CONCLUSIONS
Early diagnosis and ART should be performed at an appropriate time to prevent the development of new infection.
Summary
Korean summary
국내 감염인은 대부분 성 접촉으로 인해 감염되었고, 감염인의 약 90%가 치료를 경험하였다. 하지만 여전히 결핵, 매독, 주폐포자충 폐렴 등과 같은 HIV 관련 질환의 유병률이 높았고, 치료를 통해 수명이 연장되어 노화 혹은 치료 약제 부작용과 관련된 HIV 비 관련 만성 질환의 유병률도 높았다. 향후 감염인의 HIV/AIDS 비 관련 질환에 대한 연구 및 사망 원인 등에 대한 후속 연구가 필요하겠다.

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Cohort Profile
Korea HIV/AIDS Cohort Study: study design and baseline characteristics
Bo Youl Choi, Jun Yong Choi, Sang Hoon Han, Sang Il Kim, Mee-Kyung Kee, Min Ja Kim, Shin-Woo Kim, Sung Soon Kim, Yu-Mi Kim, Nam Su Ku, Jin-Soo Lee, Joo-Shil Lee, Yunsu Choi, Kyong Sil Park, Joon Young Song, Jun Hee Woo, Moon Won Kang, June Kim
Epidemiol Health. 2018;40:e2018023.   Published online June 6, 2018
DOI: https://doi.org/10.4178/epih.e2018023
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  • 15 Web of Science
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
The number of persons infected by HIV/AIDS has consistently increased in Korea since the first case of HIV/AIDS infection in 1985 and reached 15,208 by 2016. About 1,100 new patients with HIV/ AIDS infections have emerged every year since 2013. In Korea, the Korea HIV/AIDS Cohort Study was established for the evidenced-based prevention, treatment, and effective management of patients infected with human immunodeficiency virus (HIV) in December 2006. This study monitored 1,438 patients, who accounted for about 10% of all patients with HIV/AIDS in Korea, for 10 years with the following aims: (1) to develop an administrative system for the establishment of a HIV/AIDS cohort-based study; (2) to standardize methodologies and the case report forms; and (3) to standardize multi-cohort data and develop a data cleaning method. This study aims to monitor at least 1,000 patients (excluding those for whom investigation had been completed) per year (estimated number of patients who can be monitored by January 2018: 939). By December 2016, the sex distribution was 93.3% for men, and 6.7% for women (gender ratio, 13.9:1.0), and 98.9% of all participants were Korean. More than 50.0% of the participants were confirmed as HIV positive after 2006. This study reports competitive, long-term research that aimed to develop policies for the prevention of chronic infectious diseases for patients with HIV. The data collected over the last decade will be used to develop indices for HIV treatment and health promotion.
Summary
Korean summary
세계적으로 HIV 감염인은 감소하고 있으나, 한국의 HIV 감염은 증가하여 2013년 이후 매년 1,000명이 넘는 신규 감염인이 보고되고 있다. HIV/AIDS 코호트 연구진은 2006년부터 HIV 감염인과 AIDS 환자를 대상으로 6개월 간격의 반복 조사를 시행하여 역학과 임상 자료를 수집하여 데이터베이스를 구축하고, 생물검체를 채취하여 인체자원은행에 보관하여, HIV/AIDS의 발생 기전을 구명하고, 자연사를 파악하며, 예방과 진단, 치료, 관리 방법을 개발하기 위한 기초와 임상, 역학 연구에 활용하고 있다.

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Perspective
The direction of restructuring of a Korea field epidemiology training program through questionnaire survey among communicable disease response staff in Korea
Moo Sik Lee, Kwan Lee, Jee-Hyuk Park, Jee-Young Hong, Min-Young Jang, Byoung-Hak Jeon, Sang-Yun Cho, Sun-Ja Choi, JeongIk Hong
Epidemiol Health. 2017;39:e2017032.   Published online July 24, 2017
DOI: https://doi.org/10.4178/epih.e2017032
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
We used a survey about the need for an educational training of infectious disease response staff in Korea Centers for Disease Control and Prevention (KCDC) and officer in metropolitan cities and provincial government to conduct field epidemiological investigation. The survey was conducted from January 25 to March 15, 2016. A total of 173 participants were selected from four different groups as follows: 27 clinical specialists, 22 Epidemic Intelligence Service (EIS) officers, 82 KCDC staff, and 42 local health department officials. Results revealed that 83% of KCDC staff and 95% of local health department officials agreed on the need for educational training to strengthen capability of personnel to conduct epidemic research and investigation. The level of their need for training was relatively high, while self-confidence levels of individuals to conduct epidemic research and investigation was low. It was concluded that there was a need to develop training programs to enhance the ability of public health officials, EIS officers, KCDC staff, and local health department personnel to conduct epidemic research and investigation.
Summary
Korean summary
2015년 한국의 메르스 유행후 한국의 감염병 대응인력을 대상으로 한 조사분석을 통하여 역학조사관 교육 개편의 필요성을 확인하고, 세부 교육과정, 방법 및 내용 등 포괄적인 교육강화 및 개선방안을 모색하여 향후 역학조사관 신규 교육프로그램의 개발과 역량강화 방안을 제시하였다.

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MERS-Epidemiologic Investigation
Surveillance operation for the 141st confirmed case of Middle East Respiratory Syndrome coronavirus in response to the patient’s prior travel to Jeju Island
Jong-Myon Bae
Epidemiol Health. 2015;37:e2015035.   Published online August 7, 2015
DOI: https://doi.org/10.4178/epih/e2015035
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  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
The provincial government of Jeju, South Korea, was notified that a 42-year-old man infected with the Middle East Respiratory Syndrome (MERS) coronavirus had gone sightseeing in Jeju Island. Although the visiting period might be interpreted as the incubation period of MERS, the province decided to conduct active surveillance to prevent a worst-case scenario. Based on the channel of movement of the patient, healthy isolation and active monitoring were conducted for persons who came in contact with the patient. During the active surveillance, none of the 56 persons in self-isolation and 123 persons under active monitoring became infected. This fact supports that MERS is not contagious during the incubation period.
Summary
Korean summary
141번 MERS 양성확진자에 대한 역학조사를 통해 잠복기간에 제주도를 여행한 것이 확인되었다. 이에 제주도 MERS 방역본부는 최악의 경우를 염두에 두고, 밀접접촉자 56명과 일상접촉자 123명을 각각 자택격리와 능동모니터링 대상자로 조치하였다. 잠복기 14일을 기준으로 감시체계를 운영하였지만, 양성감염자는 전무하였다. 이는 MERS의 잠복기 동안에는 감염력이 없다는 근거가 된다.

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  • Sources of Infection Among Confirmed Cases of COVID-19 in Jeju Province, Korea
    Moonkyong Hwang, Jong-Myon Bae
    Journal of Preventive Medicine and Public Health.2021; 54(4): 245.     CrossRef
  • A database of geopositioned Middle East Respiratory Syndrome Coronavirus occurrences
    Rebecca E. Ramshaw, Ian D. Letourneau, Amy Y. Hong, Julia Hon, Julia D. Morgan, Joshua C. P. Osborne, Shreya Shirude, Maria D. Van Kerkhove, Simon I. Hay, David M. Pigott
    Scientific Data.2019;[Epub]     CrossRef
Original Articles
The Burden of Premature Mortality in Hamadan Province in 2006 and 2010 Using Standard Expected Years of Potential Life Lost: A Population-based Study
Jalal Poorolajal, Nader Esmailnasab, Jamal Ahmadzadeh, Tahereh Azizi Motlagh
Epidemiol Health. 2012;34:e2012005.   Published online August 31, 2012
DOI: https://doi.org/10.4178/epih/e2012005
  • 15,917 View
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AbstractAbstract PDF
Abstract
<sec><title>OBJECTIVES</title><p>Examining the premature death rate represents the first step in estimating the overall burden of disease, reflecting a full picture of how different causes affect population health and providing a way of monitoring and evaluating population health. The present study was conducted to assess the burden of premature mortality in Hamadan Province, Iran in 2006 and 2010.</p></sec><sec><title>METHODS</title><p>To calculate years of potential life lost (YPLL), the dataset was categorized into 5-year age groups based on each person's age at death. Then the age groups were subtracted from the relevant age-based life table produced by the World Health Organization in 2009. The YPLL for each individual were then added together to yield the total YPLL for all individuals in the population who died in a particular year. Finally, we calculated the YPLL for all sex-, age-, and cause-specific mortality rates and reported them as percentages.</p></sec><sec><title>RESULTS</title><p>We analyzed 18,786 deaths, 9,127 of which occurred in 2006 and 9,659 in 2010. Mortality rates were higher in men than women for all age groups both in 2006 and 2010. In addition, age-specific mortality rates in both genders for all age groups were higher in 2010 than in 2006. The percentage of YPLL from ischemic heart diseases, cerebrovascular diseases, transport accidents, and intentional self-harm were among the greatest sources of premature death.</p></sec><sec><title>CONCLUSION</title><p>The results of the present survey indicate that the eight major causes of premature death in both 2006 and 2010 were non-communicable diseases, especially ischemic heart diseases, cerebrovascular diseases, transport accidents, and intentional self-harm. Furthermore, our findings indicate a change in the role of non-communicable diseases in premature mortality in recent years.</p></sec>
Summary

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Perspectives of Communicable Disease Surveillance in Korea.
Hyun Sul Lim
Korean J Epidemiol. 2006;28(1):28-35.
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AbstractAbstract PDF
Abstract
Environmental and climatic changes and the mobility of ever-increasing numbers of people increase the risks for the emergence and reemergence of infectious diseases. Since communicable disease trends change rapidly, many nations have developed individualized communicable disease surveillance systems. In Korea, notification of the incidence of communicable diseases has been the most important form of surveillance since 1954. In addition, the government has established various surveillance systems since the late 1990s. Current problem areas of surveillance systems are the low reporting rate, a lack of representativeness, a lack of participation, and poor utilization. The government has not fully evaluated these systems. For many diseases, it is of critical importance to maintain the confidentiality of surveillance data. Issues of confidentiality are critical and must be considered in order to obtain valid data and protect those surveyed. In the future, we have to improve the reporting rate, enhance collaborations with veterinarians and gain the full support from the governmental departments of agriculture and defense. Surveillance systems should be evaluated regularly. The most dynamic and important part of surveillance is the feedback mechanism. To develop positive feedback, we must disseminate the collected and analyzed information and give reimbursement to the reporters. We have to built close partnerships with governmental agencies, international organizations, research institutes, private health corporations, and academia.
Summary
Surveillance System for Communicable Disease in Korea.
Ok Park
Korean J Epidemiol. 2006;28(1):22-27.
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AbstractAbstract PDF
Abstract
Korea has experienced sporadic cases or outbreaks of emerging and reemerging infectious diseases since the 1980s. Confirmed outbreaks have included leptospirosis and legionellosis in 1984, HIV infection in 1985, enterohemorrhagic E-coli infection in 1998, staphylococcus aureus infection with decreased vancomycin susceptibility in 1999, brucellosis in 2002, and botulism in 2003. Korea has also suffered from reemerging diseases such as vivax malaria along the Demilitarized Zone (DMZ) since 1993. Owing to globalization, imported cases of diarrheal diseases, malaria, and dengue have been increasing. In addition, the overall incidence of acute infectious diseases such as shigellosis, scrub typhus, and mumps, which had been decreasing since 1970 until the late 1990s, began to increase again after the late 1990s. The range of emerging and reemerging diseases poses serious public health threats to the public. The Korean government has been striving to build capacity to detect and respond to these infectious disease threats in a timely manner since the late 1990s. For this, the government revised the Communicable Disease Prevention Law, reorganized the government structure for communicable disease control, and developed human resources through field epidemiology and various other training programs. SARS and highly pathogenic avian influenza provided momentum to accelerate these endeavors. Korea has thus far achieved significant improvements in the field of infectious disease surveillance. There are, however, gaps that need to be addressed including insufficient capacity for disease surveillance and response for emerging infectious disease at the local government level, inadequate operation of various surveillance systems, insufficient integration among surveillance systems, and low participation rate for notification among physicians. Therefore, the Korean government plans to improve infectious disease surveillance by implementing the following procedures: establishment of a web-based reporting system, integration of EDI and laboratory surveillance systems, extension of the electronic reporting system to the private sector, continuous development of human resources to build capacity, and enhancement of collaboration with the private sector.
Summary
Incorrect Disease Coding in Medical Insurance Claims and the Effect of Official Intervention: Based on Medical Insurance Claims of 6 Notifiable Acute Communicable Diseases.
Yong Mun Park, Kwang Ho Meng, Euichul Shin, Kidong Park, Won Chul Lee, Sukil Kim, Jung Hee Jang
Korean J Epidemiol. 1999;21(2):142-150.
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AbstractAbstract PDF
Abstract
BACKGROUND
Because of their large size and excellent computerized records of illness and services rendered, the importance of national insurance program is getting much attentions from the public health researchers and the national and local health authorities. In reality, however, most health records from medical insurance program suffer very much from inaccurate disease coding, and therefore, they are practically in no use.
METHODS
Pattern of incorrect disease coding of 6 Notifiable Acute Communicable Diseases that believed not to have been occurred in Korea lately was reviewed. The reasons of such incorrect codings in different level of medical institutions were studied. This study also attempted to see how an official intervention asking the medical institutions to correct their coding behavior works by comparing the frequencies of incorrect disease coding before and after the intervention.
RESULTS
Study results showed that more incorrect disease codings came from clinics than hospitals, and non-physician personnel in clinics and hospitals seemed to be responsible for most of the incorrect disease codings. Most frequent diseases coded incorrectly such as cholera and poliomyelitis were the ones that physicians and non-physician personnel in the clinics and hospitals had been familiar with for a long time period.
CONCLUSION
Even a simple official intervention asking the clinics and hospitals to correct their coding behavior was very effective : total number of incorrect disease codings before intervention (398 cases from 144 institutions) dramatically decreased (14 cases from 8 institutions) after intervention. Significant decrease in incorrect disease coding was found more in small institutions such as clinics and public health facilities than large institutions.
Summary

Epidemiol Health : Epidemiology and Health