{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T22:00:14Z","timestamp":1791756014042,"version":"4.3.4"},"reference-count":48,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2023,3,22]],"date-time":"2023-03-22T00:00:00Z","timestamp":1679443200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Over the last few decades, there has been growing evidence of earlier onset and progression of puberty worldwide. This population-based longitudinal cohort study aimed to analyze the change in the annual incidence rate of central precocious puberty (CPP) among Korean children over the most recent decade, using the national registry data.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Method<\/jats:title>\n<jats:p>The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) and insurance claims for gonadotropin-releasing hormone agonist (GnRHa) treatment were used to identify CPP patients who were using the Korean Health Insurance Review &amp; Assessment Service (HIRA) database between 2008 and 2020. Patients who began GnRHa therapy before the age of 9 and 10 for girls and boys, respectively, were included in the study.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 6,906 boys and 126,377 girls were diagnosed with CPP between 2008 and 2020. The annual incidence of CPP increased by 83.3 times in boys (from 1.2 to 100 per 100,000 persons) and by 15.9 times in girls (from 88.9 to 1414.7 per 100,000 persons). The age-specific annual incidence of CPP increased remarkably more in older children than in younger ones; the 2020 CPP incidence among 9-year-old boys and 8-year-old girls reached 705.2 and 7,967.3 per 100,000 persons, respectively. The annual prevalence of CPP in boys and girls increased from 2.7 to 206.5 (76.5 times) and from 141.8 to 3439.9 (24.3 times) per 100,000 persons, respectively.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Based on GnRHa treatment insurance claims, our study suggests that the annual incidence of CPP has substantially increased in Korea during the past 13 years. These findings highlight the importance of meticulous judgment by doctors in determining GnRHa treatment.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0283510","type":"journal-article","created":{"date-parts":[[2023,3,22]],"date-time":"2023-03-22T17:35:43Z","timestamp":1679506543000},"page":"e0283510","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":50,"title":["Ongoing increasing trends in central precocious puberty incidence among Korean boys and girls from 2008 to 2020"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0548-6420","authenticated-orcid":true,"given":"Sinyoung","family":"Kang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mi Jung","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung Min","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin-Sung","family":"Yuk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0413-122X","authenticated-orcid":true,"given":"Shin-Hye","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,3,22]]},"reference":[{"key":"pone.0283510.ref001","first-page":"528","volume-title":"Puberty in the female and its disorders.","author":"RL Rosenfield","year":"2021"},{"key":"pone.0283510.ref002","first-page":"2899","volume-title":"Disorders of pubertal development.","author":"Samir S. Shah","year":"2020"},{"key":"pone.0283510.ref003","first-page":"1023","volume-title":"Physiology and disorders of puberty.","author":"Shlomo Melmed","year":"2020"},{"key":"pone.0283510.ref004","doi-asserted-by":"crossref","first-page":"e195881","DOI":"10.1001\/jamapediatrics.2019.5881","article-title":"Worldwide secular trends in age at pubertal onset assessed by breast development among girls: a systematic review and meta-analysis","volume":"174","author":"C Eckert-Lind","year":"2020","journal-title":"JAMA Pediatr"},{"key":"pone.0283510.ref005","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1038\/243095a0","article-title":"Trend towards earlier menarche in London, Olso, Copenhagen, the Netherlands and Hungary","volume":"243","author":"JM Tanner","year":"1973","journal-title":"Nature"},{"key":"pone.0283510.ref006","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.jpag.2018.05.002","article-title":"age of menarche in a longitudinal US cohort","volume":"31","author":"FM Biro","year":"2018","journal-title":"J Pediatr Adolesc Gynecol"},{"key":"pone.0283510.ref007","doi-asserted-by":"crossref","first-page":"e60056","DOI":"10.1371\/journal.pone.0060056","article-title":"Trends in menarcheal age between 1955 and 2009 in the Netherlands.","volume":"8","author":"H Talma","year":"2013","journal-title":"PLOS ONE"},{"key":"pone.0283510.ref008","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/j.jadohealth.2009.07.009","article-title":"Update on age at menarche in Italy: toward the leveling off of the secular trend.","volume":"46","author":"F Rigon","year":"2010","journal-title":"J Adolesc Health."},{"key":"pone.0283510.ref009","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1111\/j.1651-2227.2008.00806.x","article-title":"Age at menarche in contemporary Greek girls: evidence for levelling\u2010off of the secular trend","volume":"97","author":"A Papadimitriou","year":"2008","journal-title":"Acta Paediatr"},{"key":"pone.0283510.ref010","doi-asserted-by":"crossref","first-page":"e406","DOI":"10.3346\/jkms.2020.35.e406","article-title":"Trend of menarcheal age among Korean girls.","volume":"35","author":"MY Seo","year":"2020","journal-title":"J Korean Med Sci"},{"key":"pone.0283510.ref011","doi-asserted-by":"crossref","first-page":"e0141844","DOI":"10.1371\/journal.pone.0141844","article-title":"A significant increase in the incidence of central precocious puberty among Korean girls from 2004 to 2010.","volume":"10","author":"SH Kim","year":"2015","journal-title":"PLOS ONE"},{"key":"pone.0283510.ref012","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1001\/jamapediatrics.2019.2315","article-title":"Secular trends in pubertal growth acceleration in Swedish boys born from 1947 to 1996","volume":"173","author":"C Ohlsson","year":"2019","journal-title":"JAMA Pediatr"},{"key":"pone.0283510.ref013","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1210\/jc.2009-1478","article-title":"Recent changes in pubertal timing in healthy Danish boys: associations with body mass index","volume":"95","author":"K S\u00f8rensen","year":"2010","journal-title":"J Clin Endocrinol Metab"},{"key":"pone.0283510.ref014","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1111\/j.1651-2227.2000.tb00356.x","article-title":"New reference for the age at childhood onset of growth and secular trend in the timing of puberty in Swedish","volume":"89","author":"YX Liu","year":"2000","journal-title":"Acta Paediatr"},{"key":"pone.0283510.ref015","doi-asserted-by":"crossref","first-page":"4305","DOI":"10.1210\/jc.2010-1025","article-title":"Central precocious puberty in children living in Spain: incidence, prevalence, and influence of adoption and immigration","volume":"95","author":"L Soriano-Guill\u00e9n","year":"2010","journal-title":"J Clin Endocrinol 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research.","volume":"11","author":"DS Kyoung","year":"2022","journal-title":"J Lipid Atheroscler"},{"key":"pone.0283510.ref019","volume-title":"The Korean Society of Pediatric Endocrinology\u2019s Clinical Guideline for the Management of Precocious Puberty.","author":"The Korean Society of Pediatric Endocrinology","year":"2022"},{"key":"pone.0283510.ref020","unstructured":"Korean Statistical Information Service. [Cited 2022 August 5]. Available from: https:\/\/kosis.kr\/eng\/statisticsList\/statisticsListIndex.do?menuId=M_01_01&vwcd=MT_ETITLE&parmTabId=M_01_01 Statistics Korea."},{"key":"pone.0283510.ref021","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1111\/j.1365-2605.2005.00575.x","article-title":"Recent data on pubertal milestones in United States children: the secular trend toward earlier development","volume":"29","author":"ME Herman\u2010Giddens","year":"2006","journal-title":"Int J Androl"},{"key":"pone.0283510.ref022","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1542\/peds.99.4.505","article-title":"Secondary sexual characteristics and menses in young girls seen in office practice: a study from the Pediatric Research in Office Settings network","volume":"99","author":"ME Herman-Giddens","year":"1997","journal-title":"Pediatrics"},{"key":"pone.0283510.ref023","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1542\/peds.104.4.936","article-title":"Reexamination of the age limit for defining when puberty is precocious in girls in the United States: implications for evaluation and treatment. Drug and Therapeutics and Executive Committees of the Lawson Wilkins Pediatric Endocrine Society","volume":"104","author":"PB Kaplowitz","year":"1999","journal-title":"Pediatrics"},{"key":"pone.0283510.ref024","doi-asserted-by":"crossref","first-page":"e70931","DOI":"10.1371\/journal.pone.0070931","article-title":"Presentation of 493 consecutive girls with idiopathic central precocious puberty: a single-center study.","volume":"8","author":"E Giabicani","year":"2013","journal-title":"PLOS ONE."},{"key":"pone.0283510.ref025","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1210\/jc.2010-2745","article-title":"Diagnostic work-up of 449 consecutive girls who were referred to be evaluated for precocious puberty","volume":"96","author":"SS Mogensen","year":"2011","journal-title":"J Clin Endocrinol Metab"},{"key":"pone.0283510.ref026","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1111\/j.1651-2227.1997.tb08602.x","article-title":"Longitudinal study of behavioral and affective patterns in girls with central precocious puberty during long-acting triptorelin therapy","volume":"86","author":"D Xhrouet\u2010Heinrichs","year":"1997","journal-title":"Acta Paediatr"},{"key":"pone.0283510.ref027","doi-asserted-by":"crossref","first-page":"e932","DOI":"10.1542\/peds.2008-2491","article-title":"Recent decline in age at breast development: the Copenhagen Puberty Study","volume":"123","author":"L Aksglaede","year":"2009","journal-title":"Pediatrics"},{"key":"pone.0283510.ref028","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1542\/peds.111.1.47","article-title":"Are pubertal changes in girls before age 8 benign","volume":"111","author":"LK Midyett","year":"2003","journal-title":"Pediatrics"},{"key":"pone.0283510.ref029","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1210\/er.2002-0019","article-title":"The timing of normal puberty and the age limits of sexual precocity: variations around the world, secular trends, and changes after migration","volume":"24","author":"AS Parent","year":"2003","journal-title":"Endocr Rev"},{"key":"pone.0283510.ref030","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1159\/000501336","article-title":"Use of gonadotropin-releasing hormone analogs in children: update by an international consortium","volume":"91","author":"KB Bangalore Krishna","year":"2019","journal-title":"Horm Res Paediatr"},{"key":"pone.0283510.ref031","doi-asserted-by":"crossref","first-page":"2090","DOI":"10.1210\/jcem.87.5.8481","article-title":"Gonadotropin-suppressive therapy in girls with early and fast puberty affects the pace of puberty but not total pubertal growth or final height","volume":"87","author":"L Lazar","year":"2002","journal-title":"J Clin Endocrinol Metab"},{"key":"pone.0283510.ref032","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1530\/EJE-18-0473","article-title":"GnRH analog is ineffective in increasing adult height in girls with puberty onset after 7 years of age: a systematic review and meta-analysis","volume":"179","author":"IA Franzini","year":"2018","journal-title":"Eur J Endocrinol"},{"key":"pone.0283510.ref033","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1210\/js.2019-00036","article-title":"Treatment of central precocious puberty.","volume":"3","author":"EA Eugster","year":"2019","journal-title":"J Endocr Soc"},{"key":"pone.0283510.ref034","first-page":"113","article-title":"Position value for relative comparison of healthcare status of Korea in 2019: Comparison with countries of the Organization for Economic Cooperation and Development","volume":"32","author":"M Park","year":"2022","journal-title":"Health Policy and Management"},{"key":"pone.0283510.ref035","doi-asserted-by":"crossref","first-page":"151","DOI":"10.5223\/pghn.2012.15.3.151","article-title":"Childhood obesity and pubertal development","volume":"15","author":"SH Kim","year":"2012","journal-title":"Pediatr Gastroenterol Hepatol Nutr"},{"key":"pone.0283510.ref036","doi-asserted-by":"crossref","first-page":"1056871","DOI":"10.3389\/fendo.2022.1056871","article-title":"Childhood obesity and central precocious puberty.","volume":"13","author":"L Shi","year":"2022","journal-title":"Front Endocrinol (Lausanne)."},{"key":"pone.0283510.ref037","first-page":"442","article-title":"Body fat mass, body fat distribution, and pubertal development: a longitudinal study of physical and hormonal sexual maturation of girls","volume":"75","author":"CM de Ridder","year":"1992","journal-title":"J Clin Endocrinol Metab"},{"key":"pone.0283510.ref038","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.tem.2009.02.004","article-title":"Childhood obesity and the timing of puberty","volume":"20","author":"ML Ahmed","year":"2009","journal-title":"Trends Endocrinol Metab"},{"key":"pone.0283510.ref039","doi-asserted-by":"crossref","first-page":"12","DOI":"10.7570\/jomes20002","article-title":"Secular trends in pediatric 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2016.","volume":"34","author":"HE Kim","year":"2019","journal-title":"J Korean Med Sci"},{"key":"pone.0283510.ref043","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1097\/MED.0000000000000377","article-title":"Endocrine disrupters and pubertal timing","volume":"25","author":"LC Greenspan","year":"2018","journal-title":"Curr Opin Endocrinol Diabetes Obes"},{"key":"pone.0283510.ref044","doi-asserted-by":"crossref","first-page":"e4","DOI":"10.35371\/aoem.2021.33.e4","article-title":"Association of phthalates and early menarche in Korean adolescent girls from Korean National Environmental Health Survey (KoNEHS) 2015\u20132017.","volume":"33","author":"O Park","year":"2021","journal-title":"Ann Occup Environ Med"},{"key":"pone.0283510.ref045","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1186\/s12902-021-00855-x","article-title":"Precocious puberty in Korean girls with and without exposure to endocrine-disrupting chemicals in toy slime: a comparative 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