PHWR Public Health Weekly Report

Chronic diseases, one of the leading causes of death worldwide, account for approximately 40 million deaths annually [1,2]. According to the World Health Organization (WHO), chronic diseases are responsible for approximately 70% of all deaths globally. Moreover, the social and economic burden of chronic diseases has been gradually increasing [2,3]. Notably, the prevalence of chronic diseases is predicted to continue increasing in the future owing to population aging and lifestyle changes [3].

In response to this situation, the World Health Assembly, in 2000, had prioritized the tracking and monitoring of the major risk factors for chronic diseases as well as the strengthening of surveillance capacities at the national level [4,,-7]. Chronic disease surveillance, a crucial component of public health, can contribute to the improvement of policy interventions aimed at reducing the mortality and morbidity of diseases by ensuring the systematic collection, analysis, and sharing of relevant data [8,9]. It plays an essential role in providing public health information and developing effective prevention programs [10,11].

In the Republic of Korea (ROK), since 2007, the Korea Disease Control and Prevention Agency (KDCA) has led the phased implementation of surveillance systems covering various life cycles, health behaviors, and diseases. Additionally, multiple surveys on various chronic diseases have been conducted through nationwide surveys, including the Korean National Health and Nutrition Examination Survey (KNHANES), Community Health Survey, and Korea Youth Risk Behavior Survey [12]. As these surveys are conducted independently by different agencies, improved coordination and data integration among the chronic disease surveillance systems is essential. Addressing this issue is crucial for developing more effective policies.

By contrast, major advanced countries, such as the United States, Canada, and the United Kingdom, have established and operated integrated and systematic chronic disease surveillance systems since the 1970s. For example, the United States has collected data annually from millions of people through the Behavioral Risk Factor Surveillance System (BRFSS) to monitor the prevalence of major chronic diseases such as obesity, diabetes, and hypertension, thereby effectively supporting national health policies. In Canada, the Canadian Chronic Disease Surveillance System (CCDSS) consistently collects and analyzes data across the country to provide a policy basis for the management and prevention of chronic diseases. It also systematically manages health levels at the local scale, particularly through cooperation with local governments. The United Kingdom’s National Health Service (NHS) conducts intensive surveillance for various chronic diseases, such as cancer, cardiovascular disease, and diabetes, and supports public health through the development of comprehensive policies and prevention programs based on available data.

The experiences of these advanced countries provide valuable insights for improving the chronic disease surveillance system in ROK. This study aimed to propose concrete measures for enhancing chronic disease surveillance systems in ROK by comparing and analyzing the approaches used in ROK and those in major advanced countries such as the United States, Canada, and the United Kingdom.

To assess the current status of chronic disease surveillance in ROK and major advanced countries (the United States, Canada, and the United Kingdom), this study collected data by reviewing the websites of the KDCA, Ministry of Health and Welfare, and Statistics Korea; reports published by each organization; and literature from the WHO.

For ROK, we examined various relevant surveys, survey agencies, the year of initial publication of each survey, publication frequency, objectives, target populations, and content. For major advanced countries, we examined the organizations in charge, surveillance systems, functions, sources, and target diseases.

1. Chronic Disease Surveillance Systems in the Republic of Korea

In ROK, the surveillance of chronic diseases and health risk behaviors officially began in the 1990s [13]. In 2007, the country introduced surveillance systems in stages by life cycle, health behaviors, and diseases to advance the national disease surveillance system [13].

The primary institutions responsible for chronic disease surveillance in the country include the KDCA, the National Health Insurance Service (NHIS), and the National Cancer Center. The survey systems include KNHANES, Community Health Survey, Korea Youth Risk Behavior Survey, Korea National Cardio-Cerebrovascular Disease Statistics, and Health Insurance Medical Use Indicators. The main characteristics of each surveillance system are summarized in Table 1 [14,15].

Table 1 Characteristics of Korea’s chronic disease investigation system

Investigation system	Investigation agency	Year of initial creation	Creation cycle	Purpose	Subject	Content
Korea National Health and Nutrition Examination Survey	Korea Disease Control and Prevention Agency	1998	1 year	To evaluate the health and nutritional status of the Korean people	192 Survey districts, 4,800 households, approximately 10,000 household members aged 1 year or older	About 500 health behaviors (smoking, drinking, physical activities), nutritional intake, chronic diseases, etc.
Community Health Survey	Korea Disease Control and Prevention Agency	2008	1 year	Production of health statistics at city/county/district level necessary for establishing health plan and community health plan	Adults aged 19 years or older among household members in the sample household	A total of 138 survey questions and 112 indicators in 19 areas
Korea National Children’s Oral Health Survey	Korea Disease Control and Prevention Agency	2000	3 years	Identify children’s oral health level, oral-related behavior, and health care utilization status	Children aged 5 and 12 years (first year of middle school)	Oral examination: a dentist educated and trained according to WHO recommended standards checks the condition of teeth and gingiva (gum). Survey: subjective oral health, oral health behavior, etc..
Korea Youth Risk Behavior Survey	Korea Disease Control and Prevention Agency	2005	1 year	Identify the status of adolescent health behavior and produce monitoring indicators	Approximately 60,000 students from nationwide 800 middle and high schools	Approximately 110 health behaviors including smoking, drinking, physical activity, diet, and others
Korea Youth Health Behavior Panel Survey	Korea Disease Control and Prevention Agency	2019	1 year	Identifying trends and related factors in health behaviors during adolescence	Approximately 5,000 student panel participants	Health behaviors including smoking, drinking, diet, physical activity, and contributing factors
Out-of-Hospital Cardiac Arrest Surveillance	Korea Disease Control and Prevention Agency	2015	1 year	Produce basic data to determine the status of SCA, actions, prognosis, and prepare strategies to improve patient survival rate	119 Ambulance team transport patient with SCA	Demographic characteristics, incident information (cause, witnessing, etc.), emergency measures (cardiopulmonary resuscitation, etc.), treatment details (procedure details, etc.), treatment results (spontaneous circulation, survival, recovery, etc.)
Korea National Hospital Discharge In-depth Injury Survey	Korea Disease Control and Prevention Agency	2005	1 year	Produce statistics on damage occurrence and epidemiological characteristics and produce basic data for establishing and evaluating damage prevention and management policies	9% of discharged patients from 250 sample hospitals with 100 beds or more, approximately 300,000 cases per year	20 general items (sex/age, disease and treatment information, etc.), 10 damage-in-depth items (intention of damage, mechanism, location of occurrence, activity, etc.)
Health Insurance Medical Use Indicators	National Health Insurance Service	2015	1 year	Provide tailored health services to local government residents and workplace workers, and support healthcare planning, evaluation, etc. to improve the health level of health insurance beneficiaries and support rational healthcare use	Health insurance beneficiaries or medical aid beneficiaries for the relevant year	Core indicators based on the sequential process encompassing the distribution of medical resources, healthcare utilization, health examinations, chronic disease management, and health outcomes
Cancer Registration Statistics Program	National Cancer Center	1980	1 year	Widely used for policy development and direction of national cancer control programs, outcome evaluation, and cancer research	Diagnosed or treated hospitalized, outpatient, or emergency cancer patients	Cancer incidence, survival, prevalence, etc.
Korea National Cardio-Cerebrovascular Disease Statistics	Korea Disease Control and Prevention Agency	2024	1 year	Improve the prevention, management, and quality of care for cardiovascular disease	Patients hospitalized with myocardial infarction (I21–I23) and stroke (I60–I61, I63–I64)	Number of incidence of myocardial infarction and stroke, incidence rate (case/100,000), fatality rate (30 days, 1 year)

WHO=World Health Organization; SCA=sudden cardiac arrest..

The national chronic disease surveillance systems in ROK include the KNHANES, Community Health Survey, and Health Insurance Medical Use Indicators. The KNHANES has been implemented by the KDCA since 1998 pursuant to Article 16 of the National Health Promotion Act [14,15]. Meanwhile, the Community Health Survey has been implemented since 2008 pursuant to Article 4 of the Regional Public Health Act [14,15]. The KDCA provides national-level statistics, covering >500 items and 250 health indicators [14,15]. By contrast, the Community Health Survey presents health statistics at the city, county, and district levels, covering 19 areas and 112 indicators [14,15]. In addition, since 2015, the NHIS has provided information on the key indicators of healthcare resource distribution, healthcare utilization, health screening, chronic disease management, and health outcomes through the Health Insurance Medical Use Indicators [16].

Chronic disease surveillance systems targeting specific age groups include the Korea National Children’s Oral Health Survey, Korea Youth Risk Behavior Survey, and Korea Youth Health Behavior Panel Survey. The Korea National Children’s Oral Health Survey has been conducted since 2000 pursuant to Article 9 of the Dental Health Act. This survey targets children aged 5–12 years and provides information on the indicators of oral examination, subjective oral health, and oral health behaviors [14,15]. The Korea Youth Risk Behavior Survey was launched in 2005 as a part of the plan to establish a national chronic disease surveillance system. This survey provides data on 110 indicators of health behaviors in middle and high school students [14,15]. Additionally, the Korea Youth Health Behavior Panel Survey, initiated in 2020, provides 178 indicators to comprehensively assess the health status of youths [14,15].

Chronic disease surveillance systems targeting specific diseases and patients include the Out-of-Hospital Cardiac Arrest Surveillance, Korea National Hospital Discharge In-depth Injury Survey, Cancer Registration Statistics Program, and Korea National Cardio-Cerebrovascular Disease Statistics. The Out-of-Hospital Cardiac Arrest Surveillance serves as a surveillance system that investigates the occurrence, survival outcomes, and treatment of acute cardiac arrests [14,15]. The Korea National Hospital Discharge In-depth Injury Survey examines data from approximately 300,000 discharged patients, obtaining information on 20 general items, including the demographic and disease characteristics of all discharged patients, and 10 specific in-depth items of patients with impairment [14,15]. The Cancer Registration Statistics Program, launched in 1980, has been monitoring the incidence, prevalence, and survival rates of cancer in ROK [17]. The Korea National Cardio-Cerebrovascular Disease Statistics project analyzes the incidence, fatality rate, and mortality of myocardial infarction and stroke using the health information and cause of death data from the NHIS [18].

Thus, the Korean surveillance on chronic diseases and health risk behaviors has been actively conducted since the 1990s, with various chronic disease surveillance systems in place for the general population, specific age groups, and specific diseases and patient groups. However, the different surveys administered by the KDCA provide raw data, indicators, and statistics separately based on the reporting agency. Additionally, the Health Insurance Medical Use Indicators and the Cancer Registration Statistics Program are managed by different agencies, underscoring the need for integrated linkages among chronic disease surveillance systems.

2. International Chronic Disease Surveillance Systems

1) United States

In the United States, the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), part of the Centers for Disease Control and Prevention, is responsible for the surveillance of chronic diseases and provides information on chronic diseases, risk factors, and health-related quality of life through a variety of sources [19]. The NCCDPHP has identified four key areas for chronic disease prevention: measuring chronic diseases or risk factors, improving environmental conditions, enhancing health systems to provide preventive services, and connecting clinical services with community programs to support chronic disease prevention and management [20]. The center also assesses chronic diseases and health risk behaviors, and monitors the progress of preventive efforts to help public health professionals and policy makers make timely and effective decisions [20].

The NCCDPHP annually generates various indicators of chronic disease surveillance and operates the BRFSS, Chronic Kidney Disease Surveillance System, Health-Related Quality of Life, and National Assisted Reproductive Technology Surveillance System [21]. Table 2 provides a summary of the characteristics of each indicator.

Table 2 Chronic disease Surveillance Indicators and Features in USA

Surveillance indicators	Features
BRFSS	The BRFSS is the world’s largest, premier system of health-related telephone surveys that collect state data about US residents regarding their health-related risk behaviors such as smoking, physical activity, and fruit and vegetable consumption; chronic health conditions; and use of preventive services.
CKD Surveillance System	The CKD Surveillance System documents the burden of CKD and its risk factors in the US population over time and monitors the progress of efforts to prevent, detect, and manage CKD.
HRQOL	HRQOL surveillance is used to identify unmet population health needs; recognize trends, disparities, and determinants of health in the population; and guide decision making and program evaluation.
NASS	NASS collects information on assistive reproductive technology treatment outcomes from all infertility clinics in the US, and publishes an annual report.
NATS	NATS was created to assess the prevalence of tobacco use, as well as the factors promoting and impeding tobacco use among adults. NATS also establishes a comprehensive framework for evaluating both the national and state-specific tobacco control programs.
NHIS	NHIS is a large-scale household interview survey that collects data on health status health care access, and progress toward achieving national health objectives.
NHANES	NHANES is designed to assess the health and nutritional status of adults and children in the US. The survey is unique in that it combines interviews and physical exams.
United States Cancer Statistics	The United States Cancer Statistics are the official government statistics on cancer. These statistics include cancer registry data from CDC’s National Program of Cancer Registries and the National Cancer Institute’s SEER, as well as mortality data from CDC’s National Center for Health Statistics. The statistics provide information on newly diagnosed cancer cases and cancer deaths for the whole US population.
NYTS	NYTS is a nationally representative cross-sectional school-based survey of public school students enrolled in grades 6–12.
PMSS	CDC uses PMSS to better understand the circumstances of pregnancy-related death so appropriate action can be taken to prevent them. Each year, CDC asks 52 reporting areas to send copies of death certificates for all women who died during pregnancy or within 1 year of pregnancy, and copies of the matching birth or fetal death certificates, if they have the ability to perform such record links. This information is summarized, and medically trained epidemiologists determine the cause and time of death related to the pregnancy.
PRAMS	PRAMS collects state-specific, population-based data on maternal attitudes and experiences before, during, and shortly after pregnancy.
US Diabetes Surveillance System	The US Diabetes Surveillance System documents the public health burden of diabetes and its complications at the national, state, and county levels. Users can instantly visualize diabetes data, identify high-risk groups, and track progress by customizing maps, charts, and tables to display trends by age, sex, and education.
WFRS	Water systems that adjust the fluoride of their water to the optimal level for decay prevention also collect data to monitor fluoridation quality. WFRS is an online tool that helps states manage the quality of their water fluoridation programs. WFRS information is also the basis for national surveillance reports that describe the percentage of the US population on community water systems who receive optimally fluoridated drinking water.
YRBSS	YRBSS was developed to monitor priority health risk behaviors that contribute markedly to the leading causes of death, disability, and social problems among youth and adults in the US.

BRFSS=Behavioral Risk Factor Surveillance System; CKD=Chronic Kidney Disease; HRQOL=Health-Related Quality of Life; NASS=National Assisted Reproductive Technology Surveillance System; NATS=National Adult Tobacco Survey; NHIS=National Health Interview Survey; NHANES=National Health and Nutrition Examination Survey; CDC=Centers for Disease Control and Prevention; SEER=Surveillance, Epidemiology, and End Results Program; NYTS=National Youth Tobacco Survey; PMSS=Pregnancy Mortality Surveillance System; PRAMS=Pregnancy Risk Assessment Monitoring System; WFRS=Water Fluoridation Reporting System; YRBSS=Youth Risk Behavior Surveillance System..

The NCCDPHP provides an interactive application and data portals that enable users to monitor the burden of chronic diseases, risk factors, and changes in population trends, and evaluate programs [22]. The application provides estimates at the national and state levels, allowing users to compare between regions; track year-to-year trends; and view estimates by gender, race, and age [22].

Thus, the United States assesses chronic diseases and risk factors by conducting various surveys, integrates the data collected, and presents an interactive application and data portals, thereby providing important foundational data for public health policy.

2) Canada

In Canada, chronic disease surveillance is undertaken through the CCDSS, which is supported by the Public Health Agency of Canada (PHAC). The PHAC established the CCDSS to assess the prevalence, incidence, and outcomes of chronic diseases in a standardized manner.

The CCDSS creates a database by linking health insurance registration records using personally identifiable information with health claims data, discharge summary records, and prescription records to identify patients with chronic diseases [23]. This system enables the standardized calculation of chronic disease incidence and prevalence based on the administrative data of all states and localities. Additionally, it provides insights into healthcare utilization and health outcomes (disease morbidity, multiple chronic diseases, disability, and mortality) [23]. In addition, the CCDSS also facilitates comparisons by geographic region and specific age group and the identification of trends over time based on the collected data [23].

The CCDSS covers a range of chronic diseases, including cardiovascular disease, chronic respiratory disease, mental illness, diabetes, musculoskeletal disorders, and neurological conditions [23]. The target population consists of patients with any chronic disease, with the timing of reporting each indicator set differently for each disease to avoid duplicate data. Data extraction is performed in each jurisdiction according to standardized analysis protocols established by the PHAC [23,24]. The data usage protocol is presented in Figure 1 [23,24].

Figure 1. Data processing and use in the Canadian Chronic Disease Surveillance System (CCDSS)
Reused from the article of Lix et al. (Int J Popul Data Sci 2018;3:433) [24].

The CCDSS generates a variety of chronic disease-related indicators each year, using various data sources, including the Health Insurance Registry; hospitalization database; physician billing claims database; prescription drug database; Canadian Cancer Registry; Canadian Health Measures Survey; Canadian Community Health Survey; Canadian Tobacco, Alcohol and Drugs Survey; Canadian Survey on Disability; and Canadian Coroner and Medical Examiner Database [25].

Through the CCDSS, the integrated chronic disease surveillance system, Canada standardizes information from various sources and provides regional comparisons and statistical surveillance data. This process helps build important foundational data for shaping public health policy.

3) United Kingdom

In the United Kingdom, chronic disease surveillance is managed by the Public Health England (PHE) and the Office for Health Improvement and Disparities (OHID). Both organizations conduct general health surveillance and report on public health-related indicators, individual diseases and risk factors, and health inequalities from a variety of sources [26,27].

The United Kingdom’s chronic disease surveillance system supports the statutory duties of the Chief Executive of PHE and local authorities. It provides information essential for developing public health policies, planning and evaluating programs, and conducting relevant research [27]. Additionally, it offers valuable data to help the public make informed decisions about their health [28].

The survey system at PHE follows the principles of the general health surveillance model and clearly shows the interconnected components necessary for effective surveillance and support. A generic model of PHE’s health surveillance is shown in Figure 2.

Figure 2. A general model for health surveillance by Public Health England
Reused from Public Health England (https://www.gov.uk/government/publications/public-health-england-approach-to-surveillance/public-health-england-approach-to-surveillance) [27].

The OHID surveillance system identifies additional indicators by conducting surveys to assess the demand for specific indicators and gathering public opinion. These indicators are then selected based on policy needs and priorities [29]. Chronic disease surveillance addresses a wide range of public health issues, including general public health, cardiovascular diseases, asthma and air pollution, birth defects, sexually transmitted diseases, alcohol use, and health behaviors [28].

The OHID produces indicators based on data collected through the surveillance system and regularly publishes Health Profile reports [29]. These reports include information on regional trends, regional variations, healthcare-related inequalities, and comparisons with other European countries. The entire United Kingdom and its 150 administrative regions are evaluated, with the collected data further broken down to the local level (the smallest unit being the regional level) [29].

The OHID’s surveillance system provides a wide range of information, including an online interactive database, monitoring reports of prevention programs, population-based health profiles, and situational analyses (including threat assessments and incidence investigation reports) [28].

Thus, the integrated surveillance systems of the United Kingdom monitor various public health issues, analyze local health status and disparities, and provide important information to the public and policy makers.

3. Summary

This study investigated the current status of chronic disease surveillance systems in ROK and major advanced countries; the results are summarized in Table 3. In ROK, the KDCA, NHIS, and National Cancer Center are primarily responsible for conducting chronic disease surveillance. In major advanced countries such as the United States, Canada, and the United Kingdom, organizations under or affiliated with the Ministry of Health are in charge of this role.

Table 3 Comprehensive chronic disease surveillance system by country

Characteristics	Korea	USA	Canada	UK
Responsible agency	Korea Disease Control and Prevention Agency	Centers for Disease Control and Prevention	Public Health Agency of Canada	PHE, OHID
Surveillance system	No unified surveillance system, but surveillance through multiple investigative systems	Organized by the NCCDPHP	CCDSS	PHE surveillance system, OHID surveillance system
Function	Creation of evidence for prevention and management of chronic diseases. Provide regular chronic disease management status. Strengthen the prevention and management of chronic diseases. Expanding the scope of support for children and young people with rare diseases. Establishment of a foundation for responding to health risks. Prevent and manage injuries and sudden cardiac arrest.	Creation of evidence for prevention and management of chronic diseases. Provide regular chronic disease management status. Improving the environment to promote healthy choices. Strengthen the medical system to provide preventive services such as health maintenance and early diagnosis. Linkage of community clinical services for prevention and management of chronic diseases.	Creation of evidence for prevention and management of chronic diseases. Provision of regular chronic disease management status. Link to local administrative base data and clinical records. Support for the development of health resource planning and health policy programs. Provides standardized analysis protocols.	Creation of evidence for prevention and management of chronic diseases. Provision of regular chronic disease management status. Link to regional administrative base data. Selection of indicators that reflect policy needs and priorities.
Resource	KNHANES, KCHS, Korea National Children’s Oral Health Survey, Korea Youth Risk Behavior Survey, KYPS, Out-of-Hospital Cardiac Arrest Surveillance, KNHDIS, Health Insurance Medical Use Indicators, Cancer Registration Statistics Program, Korea National Cardio-Cerebrovascular Disease Statistics	BRFSS, CKD Surveillance System, HRQOL, NASS, NATS, NHIS, NHANES, United States Cancer Statistics, NYTS, PMSS, PRAMS, US Diabetes Surveillance System, WFRS, YRBSS	Health insurance registry, hospitalizations database, physician billing claims database, prescription drug database, CCR, CHMS, CCHS, CTADS, CSD, CCMED	NHS, PHE, Office for National Statistics (mortality and populatoin; NOMIS), OECD, Global Burden of Disease Collaborative Network, Eurostat, National Cancer Registration and Analysis Service, WHO Tuberculosis Profiles
Target disease	CVD (ischemic heart disease such as myocardial infarction, cerebrovascular disease such as stroke, hypertension, diabetes, dyslipidemia), cancer, oral health	Diabetes, hypertension, cancer, CVD, chronic kidney disease, COPD, musculo skeletal, asthma, mental health	Diabetes, hypertension, cancer, CVD, COPD, musculo skeletal, asthma, nervous system	Diabetes, hypertension, cancer, CVD, chronic kidney disease, COPD, musculo skeletal, asthma, mental health, dementia

NCCDPHP=National Center for Chronic Disease Prevention and Health Promotion; CCDSS=Canadian Chronic Disease Surveillance System; PHE=Public Health England; OHID=Office for Health Improvement and Disparities; KNHANES=Korea National Health and Nutrition Examination Survey; KCHS=Community Health Survey; KYPS=Korea Youth Health Behavior Panel Survey; KNHDIS=Korea National Hospital Discharge In-depth Injury Survey Data; BRFSS=Behavioral Risk Factor Surveillance System; CKD=Chronic Kidney Disease; HRQOL=Health-Related Quality of Life; NASS=National Assisted Reproductive Technology Surveillance System; NATS=National Adult Tobacco Survey; NHIS=National Health Interview Survey; NHANES=National Health and Nutrition Examination Survey; NYTS=National Youth Tobacco Survey; PMSS=Pregnancy Mortality Surveillance System; PRAMS=Pregnancy Risk Assessment Monitoring System; WFRS=Water Fluoridation Reporting System; YRBSS=Youth Risk Behavior Surveillance System; CCR=Canadian Cancer Registry; CHMS=Canadian Health Measures Survey; CCHS=Canadian Community Health Survey; CTADS=Canadian Tobacco, Alcohol and Drugs Survey; CSD=Canadian Survey on Disability; CCMED=Canadian Coroner and Medical Examiner Database; NHS=National Health Service; PHE=Public Health England; NOMIS=Official Census and Labour Market Statistics; OECD=Organisation for Economic Co-operation and Development; WHO=World Health Organization; CVD=cardiovascular disease; COPD=chronic obstructive pulmonary disease..

In both ROK and major advanced countries, surveillance primarily targets diseases with high mortality and fatality rates, including cardiovascular disease, cancer, diabetes, hypertension, chronic renal disease, and chronic obstructive pulmonary disease. Additionally, major advanced countries have expanded their surveillance to include a broader range of chronic diseases, such as neurological disorders and mental illnesses.

In ROK, chronic disease surveillance is achieved by conducting various surveys and studies. However, as each organization conducts these surveys independently, a closer connection between chronic disease surveillance systems must be established. Specifically, the following measures should be considered. First, the data should be standardized. This involves improving data compatibility between different surveillance systems by standardizing the survey items, definitions, variables, and other elements used by each survey agency. To achieve this, developing and implementing a standardized data framework for chronic diseases at the national level is essential. Second, establishing an integrated data platform is necessary. Building a centralized database system that links multiple survey systems into a single platform will enable the development of an integrated system for centralized data management and analysis. This approach will facilitate real-time data sharing and analysis. Stronger cooperation between institutions is essential for effective data linkage. Data linkage requires cooperation among various stakeholders, including public and private organizations and medical institutions. To facilitate this process, we recommend the establishment of a standing committee or a national health data integration council. Strengthening these linkages would facilitate data integration and information sharing and provide consistent data for policy formulation.

Major advanced countries have established chronic disease surveillance systems that typically incorporate multiple integrated data sources, ensure continuous monitoring and rapid updates, and involve country-led data management and provision to guarantee accessibility. Chronic disease surveillance systems are operated by combining multiple data sources, including hospital medical records, insurance claims data, death records, and public data, such as national health surveys. This approach allows for tracking disease progression in patients, treatment effectiveness, and other factors based on multiple data sources. Rather than relying on single surveys, the integrated surveillance system monitors key indicators, such as the incidence and prevalence of chronic diseases, through continuous and systematic observation. Moreover, it regularly updates the data quickly to reflect the latest information. Such integrated surveillance systems are usually managed by the national government, with access granted to various healthcare and research organizations for research and policy development. Examples include the Chronic Disease Surveillance System in the United States and the NHS database in the United Kingdom. A multidisciplinary approach is essential when formulating disease management policies. Public health experts, physicians, data scientists, and other stakeholders collaborate within an integrated system to ensure effective disease management. Such integrated chronic disease surveillance systems can provide a comprehensive view of the regional and group estimates and annual trends, reflect priorities, or provide protocols for analysis based on national policy needs. Thus, establishing an integrated and consistent chronic disease surveillance system in ROK is crucial, which would provide systematic evidence for the prevention and management of chronic diseases.

In ROK, the chronic disease surveillance system relies on various surveys and studies that periodically report on the prevalence of chronic diseases and health behaviors. However, as these surveys are mostly conducted independently, integration among data sources remains lacking.

By contrast, the chronic disease surveillance systems in major advanced countries produce a variety of indicators through linkages between data sources, enabling integration and publication of in-depth reports. Additionally, they use interactive applications that allow easy access to estimates by region and group and trends by year.

To improve the Korean chronic disease surveillance system, strengthening the connection among sources is essential, by drawing on the examples of major advanced countries. It is also important to generate various indicators and establish a data portal where Korean citizens can easily access information related to chronic diseases in one place. Such an integrated chronic disease surveillance system would allow for a more comprehensive approach to the prevention, occurrence, prevalence, and management of chronic diseases. Additionally, it would provide in-depth reports regarding disease-specific interpretations and recommendations, supporting both public disease management efforts and local government work.

Ethics Statement: Not applicable.

Funding Source: This research was supported by funds (Code: 2022-11-037, 2023-11-023) from the Korea Disease Control and Prevention Agency.

Acknowledgments: None.

Conflict of Interest: The authors have no conflicts of interest to declare.

Author Contributions: Conceptualization: THK, HPH. Data curation: HSS, BGK, DHK. Funding acquisition: THK. Methodology: HSS, BGK, DHK. Supervision: THK, HPH. Writing – original draft: HSS, BGK, DHK. Writing – review & editing: THK, HPH.