Disagreement on estimating cause of death under tuberculosis treatment between the national tuberculosis registry and statistics data in South Korea, 2011–2020

Background: Disagreement persists regarding the cause of death in patients with tuberculosis (TB) between the national TB registry and vital registration statistics. This study investigated the disagreement and contributing factors between TB-related and non-TB-related deaths using an integrated nat...

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Main Authors: Chiwook Chung, Seung Won Lee, Dawoon Jeong, Hongjo Choi, Hojoon Sohn, Doosoo Jeon, Young Ae Kang
Format: Article
Language:English
Published: Elsevier 2025-05-01
Series:Journal of Infection and Public Health
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Online Access:http://www.sciencedirect.com/science/article/pii/S1876034125000723
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author Chiwook Chung
Seung Won Lee
Dawoon Jeong
Hongjo Choi
Hojoon Sohn
Doosoo Jeon
Young Ae Kang
author_facet Chiwook Chung
Seung Won Lee
Dawoon Jeong
Hongjo Choi
Hojoon Sohn
Doosoo Jeon
Young Ae Kang
author_sort Chiwook Chung
collection DOAJ
description Background: Disagreement persists regarding the cause of death in patients with tuberculosis (TB) between the national TB registry and vital registration statistics. This study investigated the disagreement and contributing factors between TB-related and non-TB-related deaths using an integrated national TB database in South Korea. Methods: We identified a sub-set cohort of 29,033 patients with drug-susceptible TB registered between 2011 and 2020 who died during TB treatment. The cause of death was identified by the Korean National Tuberculosis Surveillance System (KNTSS) and Statistics Korea database. We performed a multinomial logistic regression to identify factors associated with the cause of death. Results: The participants’ median age was 79 years (interquartile range, 70–85 years), with males comprising 63.2 %. Among the 29,033 deaths, 12,937 (44.6 %) and 6028 (20.8 %) were classified as TB-related deaths in Statistics Korea and KNTSS, respectively. The overall agreement rate for the cause of death between the two databases was 0.72 (95 % confidence interval, 0.71–0.72), increasing from 0.69 in 2011–0.77 in 2020. Among discrepant cases, 92.2 % (7545/8181) were classified as non-TB-related in KNTSS but as TB-related in Statistics Korea. Over the study period, the proportion of individuals classified as non-TB-related deaths in both databases and the agreement rate increased. In the multinomial analysis, age, sputum acid-fast bacilli smear, Charlson comorbidity index, and comorbidities, such as cancer and end-stage renal disease, showed distinguishing features across the cause of death groups. Conclusions: Substantial disagreement on the cause of death persists between the national TB registry and vital registration statistics, though this decreased during the study period. Most disagreement likely indicates an underestimation of TB-related deaths in the TB registry. Age, sputum smear, and comorbidities were identifiable characteristics across groups that may influence the cause of death coding process.
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spelling doaj-art-666a6ce8d3a14183bc9946a3f65b99d72025-08-20T02:15:51ZengElsevierJournal of Infection and Public Health1876-03412025-05-0118510272310.1016/j.jiph.2025.102723Disagreement on estimating cause of death under tuberculosis treatment between the national tuberculosis registry and statistics data in South Korea, 2011–2020Chiwook Chung0Seung Won Lee1Dawoon Jeong2Hongjo Choi3Hojoon Sohn4Doosoo Jeon5Young Ae Kang6Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of KoreaInstitute for Immunology and Immunological Disease, Yonsei University College of Medicine, Seoul, Republic of KoreaDepartment of Preventive Medicine, Seoul National University, Seoul, Republic of KoreaDivision of Health Policy and Management, College of Health Science, Korea University, Seoul, Republic of KoreaDepartment of Preventive Medicine, Seoul National University, Seoul, Republic of Korea; Department of Human Systems Medicine, Seoul National University, Seoul, Republic of Korea; Institute of Health Policy and Management, Seoul National University, Seoul, Republic of KoreaDepartment of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea; Correspondence to: Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of KoreaInstitute for Immunology and Immunological Disease, Yonsei University College of Medicine, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Correspondence to: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Institute for Immunology and Immunological Disease, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of KoreaBackground: Disagreement persists regarding the cause of death in patients with tuberculosis (TB) between the national TB registry and vital registration statistics. This study investigated the disagreement and contributing factors between TB-related and non-TB-related deaths using an integrated national TB database in South Korea. Methods: We identified a sub-set cohort of 29,033 patients with drug-susceptible TB registered between 2011 and 2020 who died during TB treatment. The cause of death was identified by the Korean National Tuberculosis Surveillance System (KNTSS) and Statistics Korea database. We performed a multinomial logistic regression to identify factors associated with the cause of death. Results: The participants’ median age was 79 years (interquartile range, 70–85 years), with males comprising 63.2 %. Among the 29,033 deaths, 12,937 (44.6 %) and 6028 (20.8 %) were classified as TB-related deaths in Statistics Korea and KNTSS, respectively. The overall agreement rate for the cause of death between the two databases was 0.72 (95 % confidence interval, 0.71–0.72), increasing from 0.69 in 2011–0.77 in 2020. Among discrepant cases, 92.2 % (7545/8181) were classified as non-TB-related in KNTSS but as TB-related in Statistics Korea. Over the study period, the proportion of individuals classified as non-TB-related deaths in both databases and the agreement rate increased. In the multinomial analysis, age, sputum acid-fast bacilli smear, Charlson comorbidity index, and comorbidities, such as cancer and end-stage renal disease, showed distinguishing features across the cause of death groups. Conclusions: Substantial disagreement on the cause of death persists between the national TB registry and vital registration statistics, though this decreased during the study period. Most disagreement likely indicates an underestimation of TB-related deaths in the TB registry. Age, sputum smear, and comorbidities were identifiable characteristics across groups that may influence the cause of death coding process.http://www.sciencedirect.com/science/article/pii/S1876034125000723TuberculosisCause of deathNational tuberculosis registryVital registration statistics
spellingShingle Chiwook Chung
Seung Won Lee
Dawoon Jeong
Hongjo Choi
Hojoon Sohn
Doosoo Jeon
Young Ae Kang
Disagreement on estimating cause of death under tuberculosis treatment between the national tuberculosis registry and statistics data in South Korea, 2011–2020
Journal of Infection and Public Health
Tuberculosis
Cause of death
National tuberculosis registry
Vital registration statistics
title Disagreement on estimating cause of death under tuberculosis treatment between the national tuberculosis registry and statistics data in South Korea, 2011–2020
title_full Disagreement on estimating cause of death under tuberculosis treatment between the national tuberculosis registry and statistics data in South Korea, 2011–2020
title_fullStr Disagreement on estimating cause of death under tuberculosis treatment between the national tuberculosis registry and statistics data in South Korea, 2011–2020
title_full_unstemmed Disagreement on estimating cause of death under tuberculosis treatment between the national tuberculosis registry and statistics data in South Korea, 2011–2020
title_short Disagreement on estimating cause of death under tuberculosis treatment between the national tuberculosis registry and statistics data in South Korea, 2011–2020
title_sort disagreement on estimating cause of death under tuberculosis treatment between the national tuberculosis registry and statistics data in south korea 2011 2020
topic Tuberculosis
Cause of death
National tuberculosis registry
Vital registration statistics
url http://www.sciencedirect.com/science/article/pii/S1876034125000723
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