Jang Inho, Han Heesang, Lee Seungcheol, Jeong Hyeongyeong, Lee Rugyeom, Kang Yedham, Oh In-Hwan, Lee Seung Heon
College of Medicine, Korea University, Seoul, Republic of Korea.
Department of Preventive Medicine, Kyeong Hee University School of Medicine, Seoul, Republic of Korea.
Front Public Health. 2025 May 30;13:1545628. doi: 10.3389/fpubh.2025.1545628. eCollection 2025.
North and South Korea have taken different approaches to tuberculosis (TB) epidemic control after the Korean War. This study aimed to compare TB epidemiology in North Korean defectors (NKDs) based on South Korean National Health Insurance (NHIS) data and assess its implications for understanding TB prevalence in North Korea.
We used the NHIS claims data from 2007 to 2019 to evaluate TB epidemics in NKD and the age-and-sex matched South Korean control group. The number of participants was 35,620 for defectors and 107,016 for the control group.
The prevalence of TB among NKDs decreased from 466/100,000 persons in 2010 to 95/100,000 persons in 2019, while the North Korean TB prevalence as per the World Health Organization (WHO) report remained approximately 500/100,000 persons. The NKD TB prevalence was 3-7 times higher than that in the South Korean population. Additionally, the distribution of TB cases in NKDs showed distinct age-related patterns, with peaks in the 25-34 and 65 + age groups. The proportion of extrapulmonary TB in NKDs was 36-46%, similar to South Korean patterns. The estimated and reported multidrug-resistant TB rates in NKDs were higher than in the control group, highlighting potential underreporting in North Korean data.
There were large gaps in TB prevalence between NKD and native North Korean residents and between the estimated and reported TB burden within North Korea. These findings underscore the need for targeted TB control strategies that address both health system disparities and the integration of NKDs into local healthcare services.
朝鲜战争后，朝鲜和韩国在结核病（TB）疫情控制方面采取了不同的方法。本研究旨在基于韩国国民健康保险（NHIS）数据比较朝鲜叛逃者（NKD）中的结核病流行病学情况，并评估其对了解朝鲜结核病患病率的意义。
我们使用了2007年至2019年的NHIS理赔数据，以评估NKD和年龄及性别匹配的韩国对照组中的结核病疫情。叛逃者的参与者人数为35620人，对照组为107016人。
NKD中的结核病患病率从2010年的466/10万人降至2019年的95/10万人，而根据世界卫生组织（WHO）报告，朝鲜的结核病患病率仍约为500/10万人。NKD的结核病患病率比韩国人口高3至7倍。此外，NKD中结核病病例的分布呈现出明显的年龄相关模式，在25-34岁和65岁以上年龄组出现高峰。NKD中肺外结核病的比例为36-46%，与韩国模式相似。NKD中估计和报告的耐多药结核病率高于对照组，这突出了朝鲜数据中可能存在的报告不足问题。
NKD与朝鲜本土居民之间以及朝鲜境内估计和报告的结核病负担之间存在很大差距。这些发现强调了需要制定有针对性的结核病控制策略，以解决卫生系统差异以及将NKD纳入当地医疗服务的问题。
