Academic journal article Journal of Health Population and Nutrition

Trends in Pneumonia and Influenza-Associated Hospitalizations in South Korea, 2002-2005

Academic journal article Journal of Health Population and Nutrition

Trends in Pneumonia and Influenza-Associated Hospitalizations in South Korea, 2002-2005

Article excerpt


Globally, pneumonia and influenza are leading causes of morbidity and mortality (1,2). In 2005, the United Nations Children's Fund (UNICEF) and the World Health Organization (WHO) reported that an estimated 1.6 million people die of pneumococcal disease every year, including 700,000 to one million children aged less than five years (2). More than 70% of patients with pneumonia were found in Africa and Asia (3). Each year, an estimated 5-10% of adults and 20-30% of children become ill due to influenza. In addition, 250,000-500,000 deaths and 3-5 million severe influenza cases, which occur each year, are associated with seasonal epidemics of influenza (4). In the USA, there are more than 1.6 million annual hospitalizations attributable to pneumonia and influenza, of which 65% have pneumonia or influenza as the primary diagnosis (5-7). Each year in the USA, over 36,000 deaths are attributable to pneumonia and influenza.

With growing recognition of the impact of pneumonia and influenza, prevention through vaccination has been recommended for both children and adults but the vaccine uptake has been low in resource-limited countries (8,9). While available vaccines have been shown to reduce the burden of pneumonia and influenza, the choice of antimicrobial therapy is likely to diminish case fatality, duration of hospitalization, and the frequency of clinical sequelae (10-13). In South Korea, the Health Institute for Review and Assessment Service (HIRA) and the National Health Insurance Corporation (NHIC) reported that organism-unspecified pneumonia was the fifth leading cause of inpatient health-insurance claims during 2005 (14). However, as of 2010, limited epidemiologic information regarding the recent trends in pneumonia and influenza in Korea is available.

In this study, we describe the burden of hospitalizations due to pneumonia and influenza and their epidemiologic trends using national health-insurance and national mortality databases. Results of this analysis will be useful to support the development of improved public-health policies for the control of pneumonia and influenza in Korea.


The National Health Insurance Programme reimburses providers for medical services, and the national health-insurance system covers 97% of the Korean population through mandatory contributions from insured residents. An additional 3% of the Korean population is covered through the Korean Medical Aid Programme which provides healthcare to low-income households (14,15).

We accessed the national health-insurance databases from January 2002 through December 2005, which contain the patient's date of birth, sex, International Classification of Diseases, 10th Revision (ICD-10) codes for primary and secondary discharge diagnoses, dates of admission and discharge, type of hospital (primary, secondary, or tertiary), and the patient's address. Medical institutions receive medical service-fees from the Government by issuing reimbursement claims every month. For any patient with multiple hospital admissions, records were combined and considered the same disease episode if the date of admission was less than 30 days following the most recent date of discharge. To ensure confidentiality of patient information during analysis, individual national registration numbers were replaced with an unrelated unique eight-digit identification number assigned by the data-management staff of the Health Policy Research Institutes, NHIC.

For this analysis, a hospitalization was defined by admission to an inpatient facility for 24 hours or more. Records of hospitalizations due to pneumonia and influenza were included for analysis, if the ICD-10 diagnostic codes for pneumonia and influenza were listed for either the primary or the secondary diagnosis. The ICD-10 codes are a valid method for the diagnosis of pneumonia in a previous study (16). The diagnostic codes were classified based on unspecified (i. …

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