Background Sixty-five percent of children worldwide lack access to surgical care, the majority of whom live in low-income and middle-income countries (LMICs). Developing surgical infrastructure requires information on surgical need; however, this information is often limited in LMICs. North Korea (Democratic People’s Republic of Korea, DPRK) has a low amount of publicly available data. Here, we analyzed available modeled data to understand the causes of pediatric deaths due to conditions treatable with surgery in DPRK. Methods We used World Bank data and models from the Institute for Health Metrics and Evaluation to identify causes of pediatric deaths affecting pediatric patients (age <20 years). We compared mortality of disease between DPRK and countries with similar economic status. Results Between 1990 and 2019, the number of overall pediatric deaths has decreased. In 2019, 32.2% of all pediatric deaths in DPRK were caused by surgical conditions. The leading categories of surgical conditions were injuries (53.9%), congenital conditions (34.2%), tumors (8.8%), and abdominal conditions (3.2%). DPRK has a lower relative rate of pediatric deaths compared with other LMICs with similar gross domestic product per capita. However, it has a higher relative rate of pediatric deaths due to conditions requiring treatment with surgery. Transport injuries contribute significantly to the high rate of pediatric deaths in DPRK. Conclusions Although DPRK may be allocating overall resources toward pediatric healthcare more efficiently than economic peers, DPRK may benefit from improvement in pediatric surgical capacity. Improved availability of data and close international collaboration could be potential solutions to bridge this gap. Data are available in a public, open access repository.

中文翻译：

---

了解朝鲜的儿科手术需求：模型分析

背景 全世界 65% 的儿童无法获得外科护理，其中大多数生活在低收入和中等收入国家 (LMIC)。发展外科基础设施需要有关外科手术需求的信息；然而，这些信息在中低收入国家通常是有限的。朝鲜（朝鲜民主主义人民共和国，DPRK）的公开数据量很少。在这里，我们分析了现有的模型数据，以了解朝鲜因可手术治疗的疾病而导致儿童死亡的原因。方法 我们使用世界银行的数据和健康指标与评估研究所的模型来确定影响儿科患者（年龄 <20 岁）的儿科死亡原因。我们比较了朝鲜和经济状况相似国家的疾病死亡率。结果 1990 年至 2019 年间，儿童死亡总数有所下降。2019年，朝鲜所有儿科死亡中32.2%是由手术条件造成的。手术病症的主要类别是损伤（53.9%）、先天性疾病（34.2%）、肿瘤（8.8%）和腹部疾病（3.2%）。与人均国内生产总值相似的其他中低收入国家相比，朝鲜的儿科死亡率相对较低。然而，由于需要手术治疗的情况，儿童死亡率相对较高。交通伤害是朝鲜儿童死亡率高的一个重要原因。结论 尽管朝鲜可能比其他经济体更有效地将总体资源分配给儿科医疗保健，但朝鲜可能会受益于儿科手术能力的提高。提高数据可用性和密切国际合作可能是弥补这一差距的潜在解决方案。数据可在公共、开放访问存储库中获取。