OBJECTIVES: The number of North Korea Refugees(NKRs) in South Korea is steadily increasing but previous studies on NKRs' health status have been limited. This study examines the health status of NKRs living in Sough Korea and identify how does it change according to adaptation process.

METHODS: We conducted a cross-sectional study and longitudinal study by using National-wide big data targeting all North Korean refugees(NKRs) in South Korea from 2002 to 2019. We examined healthcare expenditure, frequency of healthcare utilization, and health status outcomes such as body mass index(BMI), waist measurements, and health-related factors(smoking, alcohol consumption, and regular exercise). To compare NKRs and South Koreans, we utilized the National Health Insurance Statistical Yearbook for South Koreans, employing the same categorization as used for NKRs.

RESULTS: The results of examining the key variables are as follows. Examining the latest available data from 2019, there were 38,565 NKRs in South Korea. Females had higher healthcare utilization than males, following a similar pattern of utilization with a slight increase in the second year after entry and a decrease in the third year. Per capita healthcare expenditure increased by 4.8% annually. Male NKRs had a smoking rate of 53.2%, significantly higher (17.9 percentage points) than the 35.3% among South Koreans. The prevalence of 'mental and behavioral disorders' among NKRs was over double that of South Koreans.

CONCLUSIONS: The findings will contribute to a better understanding of the healthcare needs of this vulnerable population and inform targeted interventions to improve their overall well-being. Our findings provide empirical evidence regarding health status NKRs in South Korea. This study suggests that pamphlets, manuals of health screening program should be developed. There is a need to improve the existing data on refugee's health status, needs and access to healthcare to be able to provide optimal healthcare tailored to the needs of refugees.