Given the scarcity of population data, few demographic analyses have been conducted on population trends in North Korea. Using the 1993 and 2008 population and housing census data, we prospectively reconstruct population change in the country during the 15 intercensal years. Reconstruction of the population trends of North Korea enables us to assess the consistency of the available demographic evidence and to assess the demographic impact of the famine in the 1990s. According to the results of the population reconstruction and our counterfactual population projections, the famine caused between 240,000 and 420,000 total excess deaths—lower than the previous estimate of 600,000–1 million; and the human costs of the deteriorating living conditions between 1993 and 2008 may be estimated as 600,000 to 850,000 total excess deaths attributable to economic decline in the post-Cold war era. The reconstructed population trends mirror the continuing deterioration of the living conditions in North Korea since the early 1990s.