J Korean Med Sci.  2021 Aug;36(32):e211. 10.3346/jkms.2021.36.e211.

Trend of Disease Burden of North Korean Defectors in South Korea Using Disability-adjusted Life Years from 2010 to 2018

• Kim KA
• Jung YS
• Kim CB
• Kim KB
• Yoon SJ

• KMID: 2519225
• DOI: http://doi.org/10.3346/jkms.2021.36.e211

Abstract

Background
This study aimed to examine the disease burden of North Korean defectors in South Korea by sex, age, and disease from 2000 to 2018 and to study the changes in the disease burden over time.
Methods
Based on the incidence-based disability-adjusted life year (DALY) developed in a Korean National Burden of Disease (KNBD) study, we calculated the years of life lost (YLL), years lived with disability (YLD), and disability-adjusted life years (DALY) for approximately 22,753 North Korean defectors in South Korea whose claims data were available from the National Health Insurance Service (NHIS).
Results
In 2018, the rates of YLL, YLD, and DALY for North Korean defectors per 100,000 population was 3,763 (male 8,491; female 2,404), 37,683 (male 27,742; female 40,539), and 41,446 (male 36,233; female 42,943), respectively. Major depressive disorders constituted the highest DALY, followed by cirrhosis of the liver and low back pain. The disease burden of North Korean defectors consistently decreased from 2010 to 2018. The decrease in YLD contributed to the overall decline in DALY per 100,000 population in 2018, which decreased by 25.2% compared to that in 2010.
Conclusion
This is the first study to measure the disease burden of North Korean defectors in South Korea. Given the decreasing or substantially increasing trends in disease burden, it is necessary to establish appropriate public health policies in a timely manner, and the results of this study provide a basis for the development of customized public health and healthcare policies for North Korean defectors in South Korea.

Keyword

Disability-adjusted Life Years; Burden of Disease; Years of Life Lost; Years Lived with Disability; North Korea Defectors

Figure

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  Fig. 1 The number of North Korean defectors and deaths in the National Health Insurance System (NHIS) database and Statistics Korea database from 2010 to 2018.

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  Fig. 2 The population of North Korean defectors by sex and age group from 2010 to 2018.

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  Fig. 3 Changes of the rates by sex and year from 2010 to 2018. (A) Crude YLLs, (B) crude YLDs, (C) crude DALYs.YLL = year of life lost, YLD = year of life lived, DALY = disability-adjusted life year.

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  Fig. 4 Changes of rates of YLLS, YLDs, and DALYs per 100,000 North Korean defectors by sex and year from 2010 to 2018. (A) YLLs per 100,000 = crude YLLs/population of the year × 100,000, (B) YLDs per 100,000 = crude YLDs/population of the year × 100,000, (C) DALYs per 100,000 = crude DALYs/population of the year × 100,000.YLL = year of life lost, YLD = year of life lived, DALY = disability-adjusted life year.

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  Fig. 5 The rate of DALYs (per 100,000) of North Korean defectors by sex and age group in 2018.YLL = year of life lost, YLD = year of life lived, DALY = disability-adjusted life year.

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  Fig. 6 The rates of YLLs, YLDs, and DALYs per 100,000 North Korean defectors by top 20 causes in 2018. (A) Total. (B) Male. (C) Female.YLL = year of life lost, YLD = year of life lived, DALY = disability-adjusted life year.

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  Fig. 7 Top leading specific causes (level 3 and 4) due to premature mortality, YLDs, and DALYs for 2010, 2014, and 2018, with percentage in DALYs (per 100,000). (A) The changes in the rankings of YLLs, (B) YLDs, and (C) DALYs per 100,000 North Korean defectors in the level 3 and 4 disease group for 2010, 2014, and 2018.YLL = year of life lost, YLD = year of life lived, DALY = disability-adjusted life year.

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