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Incidence and case fatality 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
Epidemiol Health. 2024;46:e2024003.   Published online December 26, 2023
DOI: https://doi.org/10.4178/epih.e2024003
  • 24,343 View
  • 298 Download
  • 11 Web of Science
  • 10 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
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.
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

Citations

Citations to this article as recorded by  
  • Perceptions of Integrated Medical Service Among Stroke Patients in South Korea: Self-Reported Web-Based Survey Study
    Han-Gyul Lee, Woo-Sang Jung, Ho Geol Woo, Seungwon Kwon, Sung Hyuk Heo
    Journal of Multidisciplinary Healthcare.2026; Volume 19: 1.     CrossRef
  • Trends in Acute Care and Rehabilitation for First-Ever Stroke Patients: A 12-Year Perspective, the KOSCO Study
    Dae Hyun Kim, Min Kyun Sohn, Jongmin Lee, Deog Young Kim, Yong-Il Shin, Gyung-Jae Oh, Yang-Soo Lee, Min Cheol Joo, So Young Lee, Min-Keun Song, Junhee Han, Jeonghoon Ahn, Ho Seok Lee, Yun-Hee Kim, Won Hyuk Chang
    Journal of Korean Medical Science.2026;[Epub]     CrossRef
  • Effect of regular exercise on stroke prevention: an instrumental variables approach
    Wonseok Jeong
    BMC Public Health.2025;[Epub]     CrossRef
  • A Study on the Healthcare Workforce and Care for Acute Stroke: Results From the Survey of Hospitals Included in the National Acute Stroke Quality Assessment Program
    Jong Young Lee, Jun Kyeong Ko, Hak Cheol Ko, Hae-Won Koo, Hyon-Jo Kwon, Dae-Won Kim, Kangmin Kim, Myeong Jin Kim, Hoon Kim, Keun Young Park, Kuhyun Yang, Jae Sang Oh, Won Ki Yoon, Dong Hoon Lee, Ho Jun Yi, Heui Seung Lee, Jong-Kook Rhim, Dong-Kyu Jang, Yo
    Journal of Korean Medical Science.2025;[Epub]     CrossRef
  • Confidence-linked and uncertainty-based staged framework for phenotype validation using large language models
    Sumin Lee, Hyeok-Hee Lee, Hokyou Lee, Kyu Sun Yum, Jang-Hyun Baek, Jaewon Khil, Jaeyong Lee, Sojung Shin, Minsung Cho, Na Yeon Ahn, Seng Chan You, Hyeon Chang Kim
    Journal of the American Medical Informatics Association.2025; 32(8): 1320.     CrossRef
  • Association between triglyceride glucose-waist-adjusted waist index and incident stroke in Chinese adults: a prospective cohort study
    Yaqin Ye, Zhenyi He, Jingguo Wu, Junlin Wu, Yanbing Liang
    Frontiers in Nutrition.2025;[Epub]     CrossRef
  • G20 stroke burden 1990–2035: trends, projections and precision health insights
    Rongrong Chen, Xiangwen Li, Ruonan Zhao, Xufei Zhao, Lin Ma, Qi Miao, Rongqiang Zhang
    Neurological Sciences.2025; 46(11): 5863.     CrossRef
  • The Importance of Cost-Effectiveness in New Drug Approval: Stroke Burden and Tenecteplase Efficacy
    Hyuk Sung Kwon, Byung-Jo Kim
    Journal of Clinical Neurology.2025; 21(5): 363.     CrossRef
  • Clinical Practice Guideline for Stroke Rehabilitation in Korea—Part 2: Rehabilitation for Motor and Sensory Function (2024)
    Hyun Haeng Lee, Yong Wook Kim, Hyoung Seop Kim, Seung Nam Yang, Sun Im, Woo-Kyoung Yoo, Joon-Ho Shin, Min-Kyun Oh, Won-Seok Kim, Da-Sol Kim, Won Kee Chang, Seyoung Shin, Sekwang Lee, Doo Young Kim, Sung-Hwa Ko, Yeo Jun Yun, Yookyung Lee, Miyoung Choi, Suk
    Brain & Neurorehabilitation.2025;[Epub]     CrossRef
  • Explainable SHAP-XGBoost models for identifying important social factors associated with the atherosclerotic cardiovascular disease risk score using the LASSO feature selection technique
    Jungtae Choi, Jooeun Jeon, Hyoeun An, Hyeon Chang Kim
    Epidemiology and Health.2025; 47: e2025052.     CrossRef
Identification of acute myocardial infarction and stroke events using the National Health Insurance Service database in Korea
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
Epidemiol Health. 2024;46:e2024001.   Published online December 26, 2023
DOI: https://doi.org/10.4178/epih.e2024001
  • 21,616 View
  • 266 Download
  • 9 Web of Science
  • 9 Crossref
AbstractAbstract AbstractSummary PDF
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.
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.

Citations

Citations to this article as recorded by  
  • Cardiovascular Risk Among Stroke Survivors With Combustible and Electronic Cigarettes: A Nationwide Study in Korean Men
    Joonsang Yoo, Jimin Jeon, Minyoul Baik, Yun Young Choi, Jinkwon Kim
    Journal of the American Heart Association.2026;[Epub]     CrossRef
  • Blood pressure status and risk of cardiovascular disease in older adults aged 75+ without prior cardiovascular events: a nationwide cohort study
    Sangwon Choi, Kyung-Do Han, Kyung-Ho Yu, Byung-Chul Lee, Mi Sun Oh, Dae Young Cheon, Minwoo Lee
    European Journal of Preventive Cardiology.2026;[Epub]     CrossRef
  • Geographic disparities in EVT access and stroke mortality under universal health coverage in South Korea
    Jeehye Lee
    BMC Health Services Research.2026;[Epub]     CrossRef
  • Constipation and risk of death and cardiovascular events in patients on hemodialysis
    Sang Cheol Park, Juyoung Jung, Young Eun Kwon, Song In Baeg, Dong-Jin Oh, Do Hyoung Kim, Young-Ki Lee, Hye Min Choi
    Kidney Research and Clinical Practice.2025; 44(1): 155.     CrossRef
  • Body Mass Index Changes and Femur Fracture Risk in Parkinson's Disease: National Cohort Study
    Sung‐Ho Ahn, Hye Sun Lee, Jun‐Hyuk Lee
    Journal of Cachexia, Sarcopenia and Muscle.2025;[Epub]     CrossRef
  • Confidence-linked and uncertainty-based staged framework for phenotype validation using large language models
    Sumin Lee, Hyeok-Hee Lee, Hokyou Lee, Kyu Sun Yum, Jang-Hyun Baek, Jaewon Khil, Jaeyong Lee, Sojung Shin, Minsung Cho, Na Yeon Ahn, Seng Chan You, Hyeon Chang Kim
    Journal of the American Medical Informatics Association.2025; 32(8): 1320.     CrossRef
  • Cardiovascular risk across blood pressure categories defined by the 2024 ESC and 2023 ESH hypertension guidelines: insights from a Korean nationwide cohort study
    Dae young Cheon, Kyung-do Han, Yeon Jung Lee, Jeen Hwa Lee, Myung Soo Park, Sook Jin Lee, Seongwoo Han, Jae Hyuk Choi, Minwoo Lee
    European Journal of Preventive Cardiology.2025;[Epub]     CrossRef
  • Cumulative Cardiovascular Health Score Through Young Adulthood and Cardiovascular and Kidney Outcomes in Midlife
    Jong Hyun Jhee, Kyoung Hwa Ha, Dasom Son, Hyeok-Hee Lee, Eun-Jin Kim, Hyeon Chang Kim, Hokyou Lee
    JAMA Cardiology.2025; 10(11): 1207.     CrossRef
  • Incidence and case fatality 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; 46: e2024003.     CrossRef
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