Mortalities from cardiovascular disease in Korea have decreased markedly over the past three decades. The major cardiovascular and metabolic risk factors, however, remain prevalent, and their burden on health is large. The Cardiovascular and Metabolic Diseases Etiology Research Center (CMERC) planned a cohort study in order to identify novel risk factors and to develop evidence-based prevention strategies of cardiovascular and metabolic diseases. The CMERC deliberately designed two prospective cohorts, a community-based general population cohort (the CMERC cohort) and its sister cohort (a hospital-based high-risk patient cohort), covering a broad spectrum of cardiovascular and metabolic diseases. This paper describes the CMERC cohort study of community-dwelling adults aged 30 to 64 years. A total of 8097 adults completed baseline measurement between 2013 and 2018. Baseline measurements assessed socio-demographic factors, medical history, health-related behaviors, psychological health, social network and support, anthropometry, body composition, and resting blood pressure and comprised electrocardiography, carotid artery ultrasonography, fasting blood analysis, and urinalysis. Both active follow-up through an annual telephone survey and a 5-year on-site health examination survey and passive follow-up through secondary data linkage with national databases, such as national death records, have been applied. Researchers interested in collaborative research may contact the corresponding author.
Adult ; Anthropometry ; Blood Pressure ; Body Composition ; Cardiovascular Diseases ; Carotid Arteries ; Cohort Studies ; Death Certificates ; Electrocardiography ; Fasting ; Follow-Up Studies ; Humans ; Information Storage and Retrieval ; Korea ; Metabolic Diseases ; Mortality ; Prospective Studies ; Republic of Korea ; Risk Factors ; Siblings ; Telephone ; Ultrasonography ; Urinalysis

OBJECTIVE: This study was conducted to evaluate the concordance between the underlying causes of death (UCOD) on the death certificates written by three emergency physicians (EPs). We investigated errors on the death certificates committed by each EP.METHODS: This study included 106 patients issued a death certificate in the emergency department of an academic hospital. Three EPs reviewed the medical records retrospectively and completed 106 death certificates independently. The selection of the UCOD on the death certificates by each EP (EP-UCOD) was based on the general principle or selection rules. The gold standard UCOD (GS-UCOD) was determined for each patient by unanimous consent between three EPs. We also compared between the EP-UCOD and the GS-UCOD. In addition, we compared between UCODs of three EPs. The errors on the death certificates were investigated by each EP.RESULTS: The rates of concordance between EP-UCOD and the GS-UCOD were 86%, 81%, and 67% for EP-A, EP-B, and EP-C, respectively. The concordance rates between EP-A and EP-B were the highest overall percent agreement (0.783), and those between EP-A and EP-C were the lowest overall percent agreement (0.651). Although each EP had differences in the errors they committed, none of them listed the mode of dying as UCOD.CONCLUSION: This study confirmed that each EP wrote death certificates indicating different causes of death for the same decedents; however, the three EPs made fewer errors on the patients’ death certificates compared with those reported in previous studies.
Cause of Death ; Death Certificates ; Emergencies ; Emergency Medicine ; Emergency Service, Hospital ; Humans ; Medical Records ; Mortality ; Retrospective Studies

BACKGROUND: The solitary death rate in Japan is expected to continue increasing because of its growing super-aged society and the rapid growth of home care in the country. To accurately determine the actual status of solitary deaths, we used a novel analysis method of combining vital statistics and ambulatory care information in Yokohama City. METHODS: Data of persons who died at home in 2013 were obtained from death certificate notifications. We also obtained the emergency transportation records that matched the cases of these death certificate notifications. Then, we gathered information regarding age, gender, marital status, and cause of death for the matched cases. RESULTS: There were 1890 "suspected unnatural deaths," in which most solitary deaths could be included, among all citizens who died at home (n = 4847). We were able to match 1503 of these cases with emergency transportation records. These 1503 cases were divided into two groups, "solitary death" (n = 349) and "un-solitary death" (n = 1154) according to the postmortem interval until finding (PMI-f). Pearson's χ tests conducted for the two groups revealed that there were significant differences regarding the proportion of persons who were elderly, unmarried, male, and had a hepatic disease and senility. A logistic regression analysis also showed that an increased likelihood of a prolonged PMI-f was associated with males and an unmarried status with hepatic diseases. CONCLUSIONS Unmarried, male sex, and liver diseases are independent risks for solitary death in Yokohama City.
Age Distribution ; Cause of Death ; Death ; Death Certificates ; Diagnosis ; Emergency Medical Dispatch ; statistics & numerical data ; Female ; Humans ; Japan ; epidemiology ; Male ; Marital Status ; Mortality ; trends ; Risk Factors ; Sex Distribution

PURPOSE: To investigate the overall cancer risk and risk for specific cancers in rheumatoid arthritis (RA) patients in Korea by comparing cancer incidence between RA patients and the general population. MATERIALS AND METHODS: Individuals diagnosed with RA between 1996 and 2009 who underwent treatment at the Daegu Catholic University Medical Center were retrospectively examined. 1885 patients with RA were included in the analyses. Occurrence of cancer and death during follow up was ascertained by linking medical records to the Korean Central Cancer Registry and national death certificates. For comparing cancer incidence between RA patients and general population, standardized incidence ratios (SIR) were calculated. The 95% confidence intervals (CIs) of SIRs were calculated using the shortcut method introduced by Vandenbroucke. RESULTS: The total follow-up time was 10218.9 person-years. During follow up, 100 patients (31 men and 69 women) were diagnosed with cancer. Both men and women had greater risks of having malignancy, although cancer risk was greater in men. Men showed increased risks of lung cancer (SIR=5.46, 95% CI: 2.60–9.36) and leukemia (SIR=16.7, 95% CI: 1.58–47.9). Women showed increased risks of thyroid cancer (SIR=1.75, 95% CI: 1.02–2.68), cervical cancer (SIR=3.65, 95% CI: 1.65–6.42), non-Hodgkin's lymphoma (SIR=6.47, 95% CI: 2.04–13.4), and gallbladder cancer (SIR=3.87, 95% CI: 1.01–8.60). Disease-modifying anti-rheumatic drugs usage and cancer were not related: the relative risks of developing malignancy were not elevated for each medicine. CONCLUSION: The overall cancer incidence was increased in Korean men and women with RA. Increased risk of specific malignancy differed according to sex.
Academic Medical Centers ; Antirheumatic Agents ; Arthritis, Rheumatoid ; Daegu ; Death Certificates ; Female ; Follow-Up Studies ; Gallbladder Neoplasms ; Humans ; Incidence ; Korea ; Leukemia ; Lung Neoplasms ; Lymphoma, Non-Hodgkin ; Male ; Medical Records ; Methods ; Retrospective Studies ; Thyroid Neoplasms ; Uterine Cervical Neoplasms

The death certificate is a medical document that proves the death of a person and forms the basis of an administrative death report. It is a source of statistics on the cause of a person's death and the basic tool used in national health policy and health promotion activities. This study reviews the major categories of historical changes made to the Korean death certificate form over the years. During the Japanese colonial period, the death certificate form was first introduced under the Koii (public doctor) system. However, the first structurally organized form of the death certificate was based on the “National Medical Service Act” (June 26, 1955.); it was structurally very similar to the current form. Since the enactment of the “Enforcement Decree of the Medical Service Act”, the death certificate form has undergone structural changes 13 times. The changes made to the contents or format of the death certificate during its 98 revisions can be classified into eight categories: death certificate title, form language, personal information, place of death, cause of death, manner of death, information on unnatural death, and other changes (chart number, serial number, confirmation seal, etc.). The authors hope that future revisions to the Korean death certificate would make it easier to write.
Asian Continental Ancestry Group ; Cause of Death ; Death Certificates ; Health Policy ; Health Promotion ; Hope ; Humans ; Korea

In the Republic of Korea, relevant documents are submitted to forensic doctors or agencies when courts grant confiscation warrants for autopsy. If the essential data on unusual death are not submitted at the time of the autopsy, it may be difficult to properly understand the situation relating to an unusual death prior to the autopsy, thus reducing the accuracy of the autopsy. As many as 6,133 out of 6,610 autopsy data (92.8%) in the Republic of Korea in 2015 were analyzed. Most autopsy appraisal requests (99.8%) were submitted. Unusual death occurrence reports (86.0%) and command recommendations of unusual death (70.3%) were submitted in many cases. However, prosecutor commands on unusual death were submitted only in 27.8% cases, and confiscation warrants were not submitted in 7.4% cases. As for postmortem inspection and death scene investigation reports, 29.3% and 34.1% cases were submitted, respectively. In addition to the above two documents, death certificates and records of statement of a relative had significant regional variations (0.3%–80.1%, 3.1%–64.7%, 27.8%–81.3%, and 40.8%–96.8%, respectively). For postmortem inspection and death scene photos, 2.7% and 3.2% were submitted in black-and-white photographs, respectively. The authors propose a list of forensic autopsy requests including autopsy appraisal requests, unusual death occurrence reports, command recommendations of unusual deaths, prosecutor commands on unusual death, and confiscation warrants unconditionally, as an essential document reflecting the progress of investigations. We suggest that postmortem inspection reports and photos, death scene investigation reports and photos, and death certificates should be included as part of postmortem investigation data.
Autopsy ; Data Interpretation, Statistical ; Death Certificates ; Financing, Organized ; Korea ; Republic of Korea

BACKGROUND: Injury is a major public health problem and accounts for 10% of the global burden of disease. This study intends to present the temporal trend in the injury burden in Korea and to compare the burden size by injury mechanism and age group. METHODS: This study was a nationwide population-based observational study. We used two data sets, the death certificates statistics and the Korean National Hospital Discharge Survey data (2004–2012). We calculated age-standardized disability-adjusted life year (DALY) from years of life lost (YLL) and years lived with disability (YLD) and trend analysis. RESULTS: The DALYs of road injury decreased (P = 0.002), falls did not exhibit a trend (P = 0.108), and self-harm increased overall (P = 0.045). In the road injury, the YLLs decreased across all 4 age groups (0–14, 15–49, 50–79, ≥ 80) and the YLDs decreased in the 0–14-year-old group. In total, the DALYs of road injuries decreased in the 0–14-year-old group. In the fall injury, although the YLLs decreased in the over 80-year-old group, the YLDs increased in the 50–79-year-old group and the over 80-year-old group. The burden of self-harm injury was high in the age group 15 years and over, especially in the 15–49-year-old group. CONCLUSION: The leading causes of the injury burden were road injuries, falls, and self-harm. The burden of road injury and self-harm have recently shown a gradual decreasing tendency. On the other hands, that of fall injuries are continually high in the age group over 50 years of age.
Accidental Falls ; Accidents, Traffic ; Aged, 80 and over ; Dataset ; Death Certificates ; Hand ; Health Care Surveys ; Humans ; Korea* ; Observational Study ; Public Health ; Suicide

OBJECTIVE: This study investigated the most common errors on death certificates written by resident trainees of the emergency department and evaluated the effects of education on how to write a death certificate. METHODS: A casebook of 31 deaths was prepared based on actual death cases in the emergency room in 2016. Ten residents completed 31 death certificates for the death casebook without any prior notice and then received education on ‘How to write the death certificate.’ They completed the death certificates again for the same casebook after receiving the education and the number of errors on all death certificates was again determined and divided into major and minor errors. The average number of error types was compared before and after the education. RESULTS: Major errors occurred in 55% of all death certificates, but decreased to 32% after education. Minor errors decreased from 81% before education to 54% after education. The most common major error was ‘unacceptable cause of death’ (mean±standard deviation [SD], 10.2±8.2), and the most common minor error was ‘absence of time interval’ (mean±SD, 24.0±7.7), followed by ‘absence of other significant conditions’ (mean±SD, 14.6±6.1) before education. CONCLUSION: Education on ‘how to write a death certificate’ can help reduce errors on death certificates and improve the quality of death certificates.
Death Certificates ; Education* ; Emergencies* ; Emergency Service, Hospital* ; Guidelines as Topic

Although the enclosed rate of death certificates has steadily improved when domestic death notification to the government, the percent of well-certified causes of death is still 29th among the 35 Organization for Economic Cooperation and Development countries. The death certificate is a medical diagnosis how the deceased died, however, it is difficult to identify the causes of death such as cardiopulmonary arrest, unknown, and death due to old age were up to about 11%. The Statistics Korea selects the final cause of death by linking administrative records such as national health insurance records and national cancer registry data. The World Health Organization's the international statistical classification of diseases and related health problems, 10th revision, volume 2 manual, provides standard forms of death certificate and guidelines for how to write death certificates. It is necessary to provide the education materials or programs to the clinical doctors such as how differentiate the concepts of the underlying cause of death which is the basis of the death cause statistics, originating antecedent cause, main condition and the direct diagnosis of the death. Statistics on the causes of death are continuously needed to improve for the people's perception of death and to upgrade the quality of health care research and policy development.
Cause of Death ; Death Certificates ; Diagnosis ; Education ; Global Health ; Heart Arrest ; International Classification of Diseases ; Korea ; National Health Programs ; Organisation for Economic Co-Operation and Development ; Policy Making ; Quality of Health Care

Guidelines for writing death certificates have recently been released in various forms. However, the educational efforts of medical doctors do not seem to have led to significant improvements in the accuracy of death certificates. A death certificate can be considered as the process through which an individual's treatment sequence, and even life, is completed and summarized. Additionally, the decision about how to fill out a death certificate affects the amount of death compensation, the necessity of a legal investigation, and has implications for health care planning. However, the death certificate form used in Korea requires background knowledge of not only medicine, but also the legal system, which has placed a considerable burden on physicians in clinical practice. In addition to the continuous educational efforts of the community of physicians, other members of society should show appropriate appreciation and attention for the death investigation system. In the development of the system, the unique characteristics of the healthcare environment in Korea should be considered.
Autopsy ; Cause of Death ; Compensation and Redress ; Death Certificates ; Delivery of Health Care ; Forensic Medicine ; Korea ; Writing