Opportunities for real-life respiratory research in Korea: The HIRA database and beyond

Background: To date, most real-life respiratory research has been conducted using databases from Europe and North America. However, over half of the World population suffering from asthma or chronic obstructive pulmonary disease (COPD) are living outside these areas, limiting generalizability of previous study results. Moreover, differences in population characteristics, health care systems and treatment availability may highly impact treatment effectiveness and drug safety. In Asia, the Korean Health Insurance Review and Assessment (HIRA) database may offer interesting opportunities. To provide an overview of the opportunities for real-life respiratory research in Korea, with a focus on the HIRA database. Methods: First, the contents and procedures of the HIRA database (http://www.hira.or.kr (http://www.hira.or.kr)) were assessed and characterized. Subsequently, its strengths and limitations were assessed. The database was compared with some other leading databases in Korea, Asia and beyond. Lastly, some examples of its application in respiratory research projects were explored, as well as the identification of potential future research opportunities. Results: The HIRA database covers the complete medical healthcare utilization data of the entire population of South Korea, that is, 50 million people, over the period 2008-2015. It provides a unique and unbiased overview of healthcare utilization and cost data (including almost all primary care, pharmacy, hospital data) on a national level. The HIRA database has been extensively described (Kim, Kim, Kim Epi Health 2014) and has been used in several previous studies including specific studies in the respiratory field, discussed elsewhere. It uses ICD-10 coding, but has no patient-reported health outcomes (such as CAT, CCQ, mMRC), lung function data or smoking status. So far, multiple reports using HIRA data have been published in high-impact respiratory journals on asthma, COPD and asthma-COPD overlap syndrome (ACOS), and more study protocols are currently in development. Notably, REG/OPRI is planning a HIRA study that will look at overall asthma treatment patterns and asthma control in real-life. Another Korean database of interest included the database of the Ajou Medical Center, a smaller, but more clinically orientated database. Conclusions: Korean databases, such as HIRA, offer interesting opportunities worth exploring for future reallife respiratory research in Asia