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Identification of acute myocardial infarction and stroke events using the National Health Insurance Service database in Korea
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Minsung Cho, Hyeok-Hee Lee, Jang-Hyun Baek, Kyu Sun Yum, Min Kim, Jang-Whan Bae, Seung-Jun Lee, Byeong-Keuk Kim, Young Ah Kim, JiHyun Yang, Dong Wook Kim, Young Dae Kim, Haeyong Pak, Kyung Won Kim, Sohee Park, Seng Chan You, Hokyou Lee, Hyeon Chang Kim
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Epidemiol Health. 2024;46:e2024001. Published online December 26, 2023
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DOI: https://doi.org/10.4178/epih.e2024001
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 Abstract
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Abstract
OBJECTIVES
The escalating burden of cardiovascular disease (CVD) is a critical public health issue worldwide. CVD, especially acute myocardial infarction (AMI) and stroke, is the leading contributor to morbidity and mortality in Korea. We aimed to develop algorithms for identifying AMI and stroke events from the National Health Insurance Service (NHIS) database and validate these algorithms through medical record review.
METHODS We first established a concept and definition of “hospitalization episode,” taking into account the unique features of health claims-based NHIS database. We then developed first and recurrent event identification algorithms, separately for AMI and stroke, to determine whether each hospitalization episode represents a true incident case of AMI or stroke. Finally, we assessed our algorithms’ accuracy by calculating their positive predictive values (PPVs) based on medical records of algorithm-identified events.
RESULTS We developed identification algorithms for both AMI and stroke. To validate them, we conducted retrospective review of medical records for 3,140 algorithm-identified events (1,399 AMI and 1,741 stroke events) across 24 hospitals throughout Korea. The overall PPVs for the first and recurrent AMI events were around 92% and 78%, respectively, while those for the first and recurrent stroke events were around 88% and 81%, respectively.
CONCLUSIONS We successfully developed algorithms for identifying AMI and stroke events. The algorithms demonstrated high accuracy, with PPVs of approximately 90% for first events and 80% for recurrent events. These findings indicate that our algorithms hold promise as an instrumental tool for the consistent and reliable production of national CVD statistics in Korea.
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Summary
Key Message
In this study, we developed algorithms to identify acute myocardial infarction (AMI) and stroke events from the Korean National Health insurance Service database. To validate them, we conducted retrospective review of medical records across 24 hospitals throughout Korea. The overall positive predictive values for the first and recurrent AMI events were around 92% and 78%, respectively, while those for the first and recurrent stroke events were around 88% and 81%, respectively.
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Citations
Citations to this article as recorded by  - Incidence and case fatality rates of stroke in Korea, 2011-2020
Jenny Moon, Yeeun Seo, Hyeok-Hee Lee, Hokyou Lee, Fumie Kaneko, Sojung Shin, Eunji Kim, Kyu Sun Yum, Young Dae Kim, Jang-Hyun Baek, Hyeon Chang Kim
Epidemiology and Health.2023; : e2024003. CrossRef
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Incidence and case fatality of stroke in Korea, 2011-2020
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Jenny Moon, Yeeun Seo, Hyeok-Hee Lee, Hokyou Lee, Fumie Kaneko, Sojung Shin, Eunji Kim, Kyu Sun Yum, Young Dae Kim, Jang-Hyun Baek, Hyeon Chang Kim
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Epidemiol Health. 2024;46:e2024003. Published online December 26, 2023
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DOI: https://doi.org/10.4178/epih.e2024003
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Abstract
Summary
PDF
 Supplementary Material
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Abstract
OBJECTIVES
Stroke remains the second leading cause of death in Korea. This study was designed to estimate the crude, age-adjusted and age-specific incidence rates, as well as the case fatality rate of stroke, in Korea from 2011 to 2020.
METHODS We utilized data from the National Health Insurance Services from January 1, 2002 to December 31, 2020, to calculate incidence rates and 30-day and 1-year case fatality rates of stroke. Additionally, we determined sex and age-specific incidence rates and computed age-standardized incidence rates by direct standardization to the 2005 population.
RESULTS The crude incidence rate of stroke hovered around 200 (per 100,000 person-years) from 2011 to 2015, then surged to 218.4 in 2019, before marginally declining to 208.0 in 2020. Conversely, the age-standardized incidence rate consistently decreased by 25% between 2011 and 2020. When stratified by sex, the crude incidence rate increased between 2011 and 2019 for both sexes, followed by a decrease in 2020. Age-standardized incidence rates displayed a downward trend throughout the study period for both sexes. Across all age groups, the 30-day and 1-year case fatality rates of stroke consistently decreased from 2011 to 2019, only to increase in 2020.
CONCLUSIONS Despite a decrease in the age-standardized incidence rate, the total number of stroke events in Korea continues to rise due to the rapidly aging population. Moreover, 2020 witnessed a decrease in incidence but an increase in case fatality rates.
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Summary
Key Message
This nationwide study using Korean National Health Insurance System data reveals a decade-long downward trend in overall stroke incidence rates. While the crude incidence rate showed a temporary increase from 2016 to 2019 before a slight decline in 2020, the age-standardized incidence rate consistently decreased over the study period. The study emphasizes the significance of continuous monitoring and preventive strategies to address stroke as a public health concern in Korea
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