Trends and patterns of North Korea’s disease burden from 1990 to 2019: Results from Global Burden of Disease study 2019

Abstract

Background Evidence for the trends and patterns of disease burden in North Korea is limited, and in-depth analysis based on several health outcomes for a better understanding remains challenging. Therefore, we aimed to investigate the trends and patterns of disease burden in North Korea between 1990 and 2019. Methods We used data from the Global Burden of Diseases (GBD) 2019 study to analyze the North Korean disease burden in comparison with four groups: global, South Korea, low-sociodemographic index (SDI) countries, Central and Eastern Europe, and Central Asia (former socialist countries). We also examined changes in the disease burden between 1990 and 2019 by disease category and age group. Findings In 2019, in North Korea, death rates and disability-adjusted life years (DALYs) rates were reduced by 22.2% and 30.7%, respectively, compared to 1990. The rates showed similar trends and patterns to that in former socialist countries. However, these reductions were lower than those of the global rates and rates in low-SDI countries and South Korea. Death rates and DALY rates for under five years dramatically decreased by more than 78%, similar to the trend in South Korea. In contrast, the decline in the death rates and DALY rates of adults was less than those worldwide and in low-SDI countries and South Korea. The burden of diseases among those aged ≥30 years increased largely due to the persistently high burden of non-communicable diseases (NCDs). Cardiovascular diseases, neoplasms, and chronic respiratory diseases were the leading causes of the disease burden in both 1990 and 2019. Interpretation North Korea’s disease burden patterns and trends show clear improvements over the past 30 years but suggest that the current challenges of NCDs in the country are very serious. NCDs should be no longer neglected and should be prioritized in public health agendas in North Korea.

Changes in contributions of age- and cause-specific mortality to the widening life expectancy gap between North and South Korea, 1990–2019: An analysis of the Global Burden of Disease Study 2019

“…Regarding the healthcare system in North Korea, the management of chronic diseases is neglected in North Korea as the government of North Korea has allotted only one research agenda on non-communicable diseases, i.e., mental health, and seven communicable disease-oriented policy agendas among 16 priorities in the Medium Term Strategic Plan 2016–2020 ( Park et al, 2019 ). This is similar to the healthcare system and policy in low- and middle-income countries ( Geneau et al, 2010 ), but demographic trends and population and disease burden composition paradoxically seem to be rather close to those of high-income and upper-middle-income countries ( Hong & Kim, 2021 ; E. H. Lee et al, 2022 ) (see Supplementary Appendix 9 ), which implies that an inadequate response to non-communicable diseases may cause a considerable disease burden. Insufficient healthcare system for management of chronic diseases and poor living conditions may lead to lower gains in life expectancy in North Korea than in South Korea after 2000.…”

“…Since the 2000s, North Korea's death rates attributable to nutritional deficiencies have decreased, and life expectancy has increased, but the gap in life expectancy between the two Koreas has continued to widen. This is because South Korea has steadily reduced mortality from chronic diseases, particularly in the middle-aged and older age group, while North Korea has not (E. H. Lee et al, 2022 ).…”

“…( Institute for Health Metrics and Evaluation, 2022 ) This suggests that the burden of chronic disease in North Korea is quite large and poorly managed. People with poor living conditions may have priorities of trying to achieve economic growth and are less likely to manage their health when faced with an economic crisis, resulting in low quality of life and chronic diseases associated with risky health behaviours, such as smoking and drinking (E. H. Lee et al, 2022 ). Moreover, the level of chronic malnutrition increased with increasing age.…”

Mid-Term Strategic Plan for the Public Health and Medical Care Cooperation in the Korean Peninsula

“…The gap between South and North Korean residents in life expectancy and the burden of disease is well-documented. 4 5 6 7 All in all, these circumstances should not be neglected in order to guarantee the right to health of North Korean residents and the well-being of the unified community.…”