Journal of Preventive Medicine and Public Health

Scoping Reviews

Reporting Quality for Comorbidity Adjustment in Studies Using Korean Health Insurance Claim Data: A Scoping Review: Kyoung-Hoon Kim; J Prev Med Public Health. 2026;59(2):123-131. Published online January 6, 2026; DOI: https://doi.org/10.3961/jpmph.25.839

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Objectives
Adjustment for comorbidity is essential in observational studies using administrative data to ensure the reproducibility and transparency of research findings. However, the reporting quality of comorbidity adjustment in studies using the National Health Insurance Claim Data (NHICD) has not yet been evaluated. This study aimed to assess the reporting quality of comorbidity adjustment in health outcome studies that used the NHICD.
Methods
We conducted a PubMed search in April 2025 using the terms “(Korea OR Korean) AND (‘health insurance claim*’ OR claims data OR NHIS OR HIRA) AND (2024).” Of the 239 retrieved studies, 82 outcome studies that exclusively used the NHICD and adjusted for comorbidities as confounding variables were included. Reporting quality was evaluated across 3 domains: (1) scope of data, (2) range of diagnostic codes, and (3) length of the look-back period.
Results
Among the 82 studies, 33 (40.2%) used ad hoc selection, 33 (40.2%) used the Charlson comorbidity index, and 13 (15.9%) applied both methods. The Elixhauser comorbidity measure was rarely used, appearing in only 3 studies. Only 3 studies explicitly described the scope of data used, and 6 reported the diagnostic code range. The look-back period was specified in 26 studies (31.7%), with 1 year being the most commonly reported duration.
Conclusions
The reporting quality of comorbidity adjustment in studies using the NHICD remains suboptimal. Transparent and standardized reporting of data scope, diagnostic code range, and look-back period is essential to improve the reproducibility and comparability of research findings.

Summary

Korean summary
건강보험 청구자료를 활용한 관찰연구에서 동반질환 보정은 연구 결과의 타당성을 확보하는 데 중요한 요소이나, 그 보고 수준은 충분히 평가되지 않았다. 본 연구는 2024년에 발표된 건강보험 청구자료 기반 연구를 대상으로 문헌검색을 수행하고, 데이터 범위, 진단코드 범위, 관찰기간 측면에서 동반질환 보정의 보고 수준을 평가하였다. 그 결과, 대부분의 연구에서 이러한 핵심 방법론적 정보가 충분히 보고되지 않았으며, 보고 방식에도 상당한 변이가 존재하였다. 이러한 결과는 연구의 재현성과 비교 가능성을 제한할 수 있음을 의미하며, 향후 행정자료 기반 연구의 신뢰성과 방법론적 정확성을 높이기 위해 표준화되고 투명한 보고가 필요함을 시사한다.

Key Message
The reporting quality of comorbidity adjustment in studies using Korean health insurance claims data remains suboptimal. Key methodological elements, including the scope of data, diagnostic code range, and look-back period, are frequently omitted or insufficiently described, limiting the reproducibility and comparability of findings. Transparent and standardized reporting of these components is essential to improve methodological rigor and support more reliable evidence generation in administrative data research.

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Psoriasis and Risk of Colorectal Cancer: A Nationwide Population-Based Cohort Study in Korea
Kyeong Min Han, Dae Myoung Yoo, Ho Suk Kang, Hyo Geun Choi, Joo-Hee Kim, Nan Young Kim, Kyueng-Whan Min, Mi Jung Kwon
Diseases.2026; 14(6): 200. CrossRef

Assessment of Epidemiological Data and Surveillance in Korea Substance Use Research: Insights and Future Directions: Meekang Sung, Vaughan W. Rees, Hannah Lee, Mohammad S. Jalali; J Prev Med Public Health. 2024;57(4):307-318. Published online June 24, 2024; DOI: https://doi.org/10.3961/jpmph.24.171

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Abstract Summary PDF Supplementary Material

Objectives
Effective data collection and surveillance of epidemiological trends are essential in confronting the growing challenges associated with substance use (SU), especially in light of emerging trends and underreporting of cases. However, research and data are scarce regarding SU and substance use disorder (SUD) in Korea.
Methods
We conducted a scoping review to identify data sources and surveillance methods used in SU research in Korea up to December 2023. This review was complemented by semi-structured consultations with experts in this area in Korea, whose feedback led to revisions of previously identified data sources and assessments.
Results
Our review identified 32 publications conducting secondary analyses on existing data to examine the epidemiology of SU and SUD in Korea. Of these, 14 studies utilized clinical databases to explore the prescription patterns of addictive substances, particularly opioids. Eleven data sources showed promise for advancing SU research; however, they face substantial limitations, including a lack of available data, missing data, the absence of key variables, the exclusion of marginalized populations not captured within the clinical system, and complexities in matching individual-level data across time points and datasets.
Conclusions
Current surveillance methods for SU in Korea face considerable challenges in accessibility, usability, and standardization. Moreover, existing data repositories may fail to capture information on populations not served by clinical or judicial systems. To systematically improve surveillance approaches, it is necessary to develop a robust and nationally representative survey, refine the use of existing clinical data, and ensure the availability of data on treatment facilities.

Summary

Key Message
- A scoping review identified eleven promising data sources for substance use research in Korea but noted substantial challenges in current surveillance methods, particularly regarding accessibility, usability, and standardization.
- Existing data repositories often miss information on marginalized populations not served by clinical or judicial systems, and suffer from data gaps, missing key variables, and complexities in matching individual-level data over time.
- To address these issues, developing a robust, nationally representative survey, refining the use of existing clinical data, and ensuring data availability from treatment facilities are essential.

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Md Imran Hossain, Dong Kee Yi, Sanghyo Kim
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Public discourse on substance use behavior as a driver of public policy: a scoping review of South Korean academic and official literature
Meekang Sung, Jihye Han, Carrie G. Wade, Vaughan W. Rees
Addiction Research & Theory.2025; 33(4): 312. CrossRef

Systematic Review

Adjusting for Confounders in Outcome Studies Using the Korea National Health Insurance Claim Database: A Review of Methods and Applications: Seung Jin Han, Kyoung Hoon Kim; J Prev Med Public Health. 2024;57(1):1-7. Published online November 16, 2023; DOI: https://doi.org/10.3961/jpmph.23.250

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Abstract Summary PDF

Objectives
Adjusting for potential confounders is crucial for producing valuable evidence in outcome studies. Although numerous studies have been published using the Korea National Health Insurance Claim Database, no study has critically reviewed the methods used to adjust for confounders. This study aimed to review these studies and suggest methods and applications to adjust for confounders.
Methods
We conducted a literature search of electronic databases, including PubMed and Embase, from January 1, 2021 to December 31, 2022. In total, 278 studies were retrieved. Eligibility criteria were published in English and outcome studies. A literature search and article screening were independently performed by 2 authors and finally, 173 of 278 studies were included.
Results
Thirty-nine studies used matching at the study design stage, and 171 adjusted for confounders using regression analysis or propensity scores at the analysis stage. Of these, 125 conducted regression analyses based on the study questions. Propensity score matching was the most common method involving propensity scores. A total of 171 studies included age and/or sex as confounders. Comorbidities and healthcare utilization, including medications and procedures, were used as confounders in 146 and 82 studies, respectively.
Conclusions
This is the first review to address the methods and applications used to adjust for confounders in recently published studies. Our results indicate that all studies adjusted for confounders with appropriate study designs and statistical methodologies; however, a thorough understanding and careful application of confounding variables are required to avoid erroneous results.

Summary

Korean summary
건강보험청구자료를 사용한 성과연구에서는 교란요인 통제가 중요하다. 최근 발표된 연구들은 연구설계와 통계 분석 과정에 적절하게 교란요인을 통제하였다. 연구의 질을 높이기 위해서는 건강보험청구자료에서 수집 가능한 교란 요인에 대한 이해와 방법론적 가이드라인이 요구된다.

Key Message
All recently published studies using Health Insurance Claims Database adjusted for confounders with appropriate study designs and statistical methodologies. The review suggests the need for careful application of confounding variables and the methodological guidance to improve the quality of outcome studies.

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Original Article

Trends in the Quality of Primary Care and Acute Care in Korea From 2008 to 2020: A Cross-sectional Study: Yeong Geun Gwon, Seung Jin Han, Kyoung Hoon Kim; J Prev Med Public Health. 2023;56(3):248-254. Published online April 12, 2023; DOI: https://doi.org/10.3961/jpmph.23.015

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Abstract Summary PDF

Objectives
Measuring the quality of care is paramount to inform policies for healthcare services. Nevertheless, little is known about the quality of primary care and acute care provided in Korea. This study investigated trends in the quality of primary care and acute care.
Methods
Case-fatality rates and avoidable hospitalization rates were used as performance indicators to assess the quality of primary care and acute care. Admission data for the period 2008 to 2020 were extracted from the National Health Insurance Claims Database. Case-fatality rates and avoidable hospitalization rates were standardized by age and sex to adjust for patients’ characteristics over time, and significant changes in the rates were identified by joinpoint regression.
Results
The average annual percent change in age-/sex-standardized case-fatality rates for acute myocardial infarction was -2.3% (95% confidence interval, -4.6 to 0.0). For hemorrhagic and ischemic stroke, the age-/sex-standardized case-fatality rates were 21.8% and 5.9%, respectively in 2020; these rates decreased since 2008 (27.1 and 8.7%, respectively). The average annual percent change in age-/sex-standardized avoidable hospitalization rates ranged from -9.4% to -3.0%, with statistically significant changes between 2008 and 2020. In 2020, the avoidable hospitalization rates decreased considerably compared with the 2019 rate because of the coronavirus disease 2019 pandemic.
Conclusions
The avoidable hospitalization rates and case-fatality rates decreased overall during the past decade, but they were relatively high compared with other countries. Strengthening primary care is an essential requirement to improve patient health outcomes in the rapidly aging Korean population.

Summary

Korean summary
본 연구에서는 급성심근경색증과 뇌졸중 치명률, 외래진료 민감질환의 예방 가능한 입원율을 사용하여 한국의 의료 질 수준을 분석하였다. 2008~2020년 동안 치명률과 예방 가능한 입원율은 감소하는 추세이다. 그러나, 예방 가능한 입원율은 다른 국가에 비해 상대적으로 높아 환자의 건강결과 향상을 위하여 일차의료 강화가 요구된다.

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Special Article

Cohort Profile: Korean Tuberculosis and Post-Tuberculosis Cohort Constructed by Linking the Korean National Tuberculosis Surveillance System and National Health Information Database: Dawoon Jeong, Hee-Yeon Kang, Jinsun Kim, Hyewon Lee, Bit-Na Yoo, Hee-Sun Kim, Hongjo Choi; J Prev Med Public Health. 2022;55(3):253-262. Published online April 22, 2022; DOI: https://doi.org/10.3961/jpmph.21.635

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Abstract Summary PDF Supplementary Material

We aimed to review the current data composition of the Korean Tuberculosis and Post-Tuberculosis Cohort, which was constructed by linking the Korean Tuberculosis Surveillance System (KNTSS; established and operated by the Korean Disease Control and Prevention Agency since 2000) and the National Health Information Database (NHID; established by the National Health Insurance Service in 2012). The following data were linked: KNTSS data pertaining to patients diagnosed with tuberculosis between 2011 and 2018, NHID data of patients with a history of tuberculosis and related diseases between 2006 and 2018, and data (obtained from the Statistics Korea database) on causes of death. Data from 300 117 tuberculosis patients (177 206 men and 122 911 women) were linked. The rate of treatment success for new cases was highest in 2015 (86.7%), with a gradual decrease thereafter. The treatment success rate for previously treated cases showed an increasing trend until 2014 (79.0%) and decreased thereafter. In total, 53 906 deaths were confirmed among tuberculosis patients included in the cohort. The Korean Tuberculosis and Post-Tuberculosis Cohort can be used to analyze different measurement variables in an integrated manner depending on the data source. Therefore, these cohort data can be used in future epidemiological studies and research on policy-effect analysis, treatment outcome analysis, and health-related behaviors such as treatment discontinuation.

Summary

Korean summary
TB Post 코호트(Korean Tuberculosis and Post-Tuberculosis Cohort)는 한국의 결핵 모니터링 및 관리에 대한 인구집단 수준에서의 새로운 근거를 마련하고자 구축한 우리나라 결핵 환자 코호트입니다. 국가 결핵감시체계의 일환으로 구축된 질병관리청의 결핵신고자료와 국민건강보험공단의 국민건강정보DB 자료, 통계청 사망원인 자료의 연계로 구축되었으며, 각 자료원이 보유한 정보를 활용하여 통합적인 결핵 환자 연구가 가능할 것으로 기대하고 있습니다. 결핵의 정책 효과 연구뿐만 아니라, 치료 성공, 실패, 중단 등 치료결과에 대한 영향 요인 및 환자들의 건강 관련 행태에 대한 역학 연구 등 향후 다양한 연구에 활용될 수 있을 것으로 기대됩니다.

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Brief Report

Citation Discovery Tools for Conducting Adaptive Meta-analyses to Update Systematic Reviews: Jong-Myon Bae, Eun Hee Kim; J Prev Med Public Health. 2016;49(2):129-133. Published online March 14, 2016; DOI: https://doi.org/10.3961/jpmph.15.074

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Abstract PDF

Objectives
The systematic review (SR) is a research methodology that aims to synthesize related evidence. Updating previously conducted SRs is necessary when new evidence has been produced, but no consensus has yet emerged on the appropriate update methodology. The authors have developed a new SR update method called ‘adaptive meta-analysis’ (AMA) using the ‘cited by’, ‘similar articles’, and ‘related articles’ citation discovery tools in the PubMed and Scopus databases. This study evaluates the usefulness of these citation discovery tools for updating SRs.
Methods
Lists were constructed by applying the citation discovery tools in the two databases to the articles analyzed by a published SR. The degree of overlap between the lists and distribution of excluded results were evaluated.
Results
The articles ultimately selected for the SR update meta-analysis were found in the lists obtained from the ‘cited by’ and ‘similar’ tools in PubMed. Most of the selected articles appeared in both the ‘cited by’ lists in Scopus and PubMed. The Scopus ‘related’ tool did not identify the appropriate articles.
Conclusions
The AMA, which involves using both citation discovery tools in PubMed, and optionally, the ‘related’ tool in Scopus, was found to be useful for updating an SR.

Summary

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Clinical Trial

The Current Status of Utilization and Demand on Cancer Information in the Faculties of Medical School in Korea.: Min Kyung Lim, Sook Kyung Park, Jeong Hee Yang, Young Sung Lee; Korean J Prev Med. 2003;36(1):39-46.

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Abstract PDF: OBJECTIVES
To investigate the availability and demand for overall cancer-related information, and to establish a basic plan for the construction of a cancer database and information system based on the research results from Korea. METHODS: Postal and telephone surveys were carried out, between August 2001 and November 2001, of 323 affiliated faculty professors from medical universities and colleges in Korea. The data were analyzed with descriptive statistical methods, with regard to the present status and demand for health and cancer-related information. RESULTS: Most (over 80%) subjects studied utilized the health-related information provided on Internet website from foreign countries, such as Medline, but similar comprehensive information system lacked in Korea. The construction of a cancer-related database of domestic research results was revealed to be in a great demand. Information on registration and statistics (52.8%), study results (48.5%) and study resources (37.4%) were the major ingredients required in the database. In constructing a database of the cancer-related research results, a full-text service, continuous updating of data, and the development of standardized user-friendly searching tool were regarded as the necessary components. The formulation of an information sharing system, regarding cancer-related clinical trials, was investigated as being quite feasible. CONCLUSION: This study demonstrated the great importance of cancer information systems, and much demand for an available cancer-related database based on Korean research results.; Summary

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