Skip to main content
Top
Published in: International Journal for Equity in Health 1/2016

Open Access 01-12-2016 | Research

Assessment of trends in socioeconomic inequalities in cancer screening services in Korea, 1998–2012

Authors: Sujin Kim, Jongnam Hwang

Published in: International Journal for Equity in Health | Issue 1/2016

Login to get access

Abstract

Background

This study aimed to examine how income-related inequalities in screening services for gastric and colorectal cancer in Korea have changed over the past decades, along with the implementation of the national cancer screening program, and also to quantify each contribution from various socio-demographic factors income-related inequalities with respect to these cancer screening services.

Methods

Three cycles (1998, 2005, and 2010–2012) of Korea National Health and Nutrition Examination Survey (KNHANES) were utilized. To measure income-related inequalities in the use of gastric and colorectal cancer, individuals over the age of 40 and the age of 50 were included respectively, and the Concentration Index (CI) was calculated for each cycle. To identify and quantify contribution from each socio-demographic factor, decomposition of the CIs was conducted.

Results

Throughout this study, CIs and horizontal inequity indices (HIs) steadily but consistently decreased, suggesting that inequalities and inequities in participation in gastric and colorectal cancer screening were weakened after the implementation of the national public cancer screening program. Decomposition analyses revealed that whereas decreases in inequalities mostly stemmed from income and educational levels; higher income and better education levels are still major contributors to the observed inequalities that influence participation in cancer screening services in Korea.

Conclusion

Our empirical findings suggest that, although the policy of reducing out-of-pocket payment for cancer screening may contribute to the observed decreases in inequality, it alone is not likely to completely eliminate inequality. Further research is required to identify barriers that prevent people with lower socioeconomic status from participation in cancer screening, which allows equal access for equal need.
Appendix
Available only for authorised users
Literature
1.
go back to reference WHO: National cancer control programmes- Policies and managerial guidelines. WHO ed., 2nd edition: World Health Organization 2002. WHO: National cancer control programmes- Policies and managerial guidelines. WHO ed., 2nd edition: World Health Organization 2002.
2.
go back to reference McKinnon B, Harper S, Moore S. Decomposing income-related inequality in cervical screening in 67 countries. Int J Public Health. 2011;56:139–52.CrossRefPubMed McKinnon B, Harper S, Moore S. Decomposing income-related inequality in cervical screening in 67 countries. Int J Public Health. 2011;56:139–52.CrossRefPubMed
3.
go back to reference Berrino F, De Angelis R, Sant M, Rosso S, Bielska-Lasota M, Coebergh JW, et al. Survival for eight major cancers and all cancers combined for European adults diagnosed in 1995-99: results of the EUROCARE-4 study. Lancet Oncol. 2007;8:773–83.CrossRefPubMed Berrino F, De Angelis R, Sant M, Rosso S, Bielska-Lasota M, Coebergh JW, et al. Survival for eight major cancers and all cancers combined for European adults diagnosed in 1995-99: results of the EUROCARE-4 study. Lancet Oncol. 2007;8:773–83.CrossRefPubMed
4.
go back to reference Provenzale D, Gray RN. Colorectal cancer screening and treatment: review of outcomes research. J Natl Cancer Inst Monogr 2004:45–55. Provenzale D, Gray RN. Colorectal cancer screening and treatment: review of outcomes research. J Natl Cancer Inst Monogr 2004:45–55.
5.
go back to reference Kamangar F, Dores GM, Anderson WF. Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol. 2006;24:2137–50.CrossRefPubMed Kamangar F, Dores GM, Anderson WF. Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol. 2006;24:2137–50.CrossRefPubMed
6.
go back to reference Lee H, Min BH, Lee JH, Son HJ, Kim JJ, Rhee JC, et al. Survival outcome associated with the screening interval for gastric cancer in Korea. Digestion. 2011;84:142–8.CrossRefPubMed Lee H, Min BH, Lee JH, Son HJ, Kim JJ, Rhee JC, et al. Survival outcome associated with the screening interval for gastric cancer in Korea. Digestion. 2011;84:142–8.CrossRefPubMed
7.
go back to reference Palencia L, Espelt A, Rodriguez-Sanz M, Puigpinos R, Pons-Vigues M, Pasarin MI, et al. Socio-economic inequalities in breast and cervical cancer screening practices in Europe: influence of the type of screening program. Int J Epidemiol. 2010;39:757–65.CrossRefPubMed Palencia L, Espelt A, Rodriguez-Sanz M, Puigpinos R, Pons-Vigues M, Pasarin MI, et al. Socio-economic inequalities in breast and cervical cancer screening practices in Europe: influence of the type of screening program. Int J Epidemiol. 2010;39:757–65.CrossRefPubMed
8.
go back to reference Lee K, Lim HT, Hwang SS, Chae DW, Park SM. Socio-economic disparities in behavioural risk factors for cancer and use of cancer screening services in Korean adults aged 30 years and older: the Third Korean National Health and Nutrition Examination Survey, 2005 (KNHANES III). Public Health. 2010;124:698–704.CrossRefPubMed Lee K, Lim HT, Hwang SS, Chae DW, Park SM. Socio-economic disparities in behavioural risk factors for cancer and use of cancer screening services in Korean adults aged 30 years and older: the Third Korean National Health and Nutrition Examination Survey, 2005 (KNHANES III). Public Health. 2010;124:698–704.CrossRefPubMed
9.
go back to reference Whynes DK, Frew EJ, Manghan CM, Scholefield JH, Hardcastle JD. Colorectal cancer, screening and survival: the influence of socio-economic deprivation. Public Health. 2003;117:389–95.CrossRefPubMed Whynes DK, Frew EJ, Manghan CM, Scholefield JH, Hardcastle JD. Colorectal cancer, screening and survival: the influence of socio-economic deprivation. Public Health. 2003;117:389–95.CrossRefPubMed
10.
go back to reference Hao Y, Jemal A, Zhang X, Ward EM. Trends in colorectal cancer incidence rates by age, race/ethnicity, and indices of access to medical care, 1995–2004 (United States). Cancer Causes Control. 2009;20:1855–63.CrossRefPubMed Hao Y, Jemal A, Zhang X, Ward EM. Trends in colorectal cancer incidence rates by age, race/ethnicity, and indices of access to medical care, 1995–2004 (United States). Cancer Causes Control. 2009;20:1855–63.CrossRefPubMed
11.
go back to reference Katz SJ, Hofer TP. Socioeconomic disparities in preventive care persist despite universal coverage: breast and cervical cancer screening in Ontario and the United States. JAMA. 1994;272:530–4.CrossRefPubMed Katz SJ, Hofer TP. Socioeconomic disparities in preventive care persist despite universal coverage: breast and cervical cancer screening in Ontario and the United States. JAMA. 1994;272:530–4.CrossRefPubMed
12.
go back to reference De Maio FG, Linetzky B, Ferrante D. Changes in the social gradients for Pap smears and mammograms in Argentina: evidence from the 2005 and 2009 National Risk Factor Surveys. Public Health. 2012;126:821–6.CrossRefPubMed De Maio FG, Linetzky B, Ferrante D. Changes in the social gradients for Pap smears and mammograms in Argentina: evidence from the 2005 and 2009 National Risk Factor Surveys. Public Health. 2012;126:821–6.CrossRefPubMed
13.
go back to reference Lee M, Park EC, Chang HS, Kwon JA, Yoo KB, Kim TH. Socioeconomic disparity in cervical cancer screening among Korean women: 1998–2010. BMC Public Health. 2013;13:553.PubMedCentralCrossRefPubMed Lee M, Park EC, Chang HS, Kwon JA, Yoo KB, Kim TH. Socioeconomic disparity in cervical cancer screening among Korean women: 1998–2010. BMC Public Health. 2013;13:553.PubMedCentralCrossRefPubMed
14.
go back to reference Puddu M, Demarest S, Tafforeau J. Does a national screening programme reduce socioeconomic inequalities in mammography use? Int J Public Health. 2009;54:61–8.CrossRefPubMed Puddu M, Demarest S, Tafforeau J. Does a national screening programme reduce socioeconomic inequalities in mammography use? Int J Public Health. 2009;54:61–8.CrossRefPubMed
15.
go back to reference Puigpinos-Riera R, Serral G, Pons-Vigues M, Palencia L, Rodriguez-Sanz M, Borrell C. Evolution of inequalities in breast and cervical cancer screening in Barcelona: population surveys 1992, 2001, and 2006. J Womens Health. 2011;20:1721–7.CrossRef Puigpinos-Riera R, Serral G, Pons-Vigues M, Palencia L, Rodriguez-Sanz M, Borrell C. Evolution of inequalities in breast and cervical cancer screening in Barcelona: population surveys 1992, 2001, and 2006. J Womens Health. 2011;20:1721–7.CrossRef
16.
go back to reference Tabuchi T, Hoshino T, Nakayama T, Ito Y, Ioka A, Miyashiro I, et al. Does removal of out-of-pocket costs for cervical and breast cancer screening work? A quasi-experimental study to evaluate the impact on attendance, attendance inequality and average cost per uptake of a Japanese government intervention. Int J Cancer. 2013;133:972–83.CrossRefPubMed Tabuchi T, Hoshino T, Nakayama T, Ito Y, Ioka A, Miyashiro I, et al. Does removal of out-of-pocket costs for cervical and breast cancer screening work? A quasi-experimental study to evaluate the impact on attendance, attendance inequality and average cost per uptake of a Japanese government intervention. Int J Cancer. 2013;133:972–83.CrossRefPubMed
17.
go back to reference Korea Ministry of Health and Welfare. National cancer screening programmes guidelines. Seoul: Ministry of Health and Welfare; 2006. Korea Ministry of Health and Welfare. National cancer screening programmes guidelines. Seoul: Ministry of Health and Welfare; 2006.
18.
go back to reference Suh M, Choi KS, Lee YY, Jun JK. Trends in cancer screening rates among korean men and women: results from the Korean National Cancer Screening Survey, 2004–2012. Cancer Res Treat. 2013;45:86–94.PubMedCentralCrossRefPubMed Suh M, Choi KS, Lee YY, Jun JK. Trends in cancer screening rates among korean men and women: results from the Korean National Cancer Screening Survey, 2004–2012. Cancer Res Treat. 2013;45:86–94.PubMedCentralCrossRefPubMed
19.
go back to reference Choi KS, Jun JK, Lee HY, Hahm MI, Oh JH, Park EC. Increasing uptake of colorectal cancer screening in Korea: a population-based study. BMC Public Health. 2010;10:265.PubMedCentralCrossRefPubMed Choi KS, Jun JK, Lee HY, Hahm MI, Oh JH, Park EC. Increasing uptake of colorectal cancer screening in Korea: a population-based study. BMC Public Health. 2010;10:265.PubMedCentralCrossRefPubMed
20.
go back to reference Korea Ministry of Health and Welfare. Trend in the uptake of cancer screening: adults over the age of 19. Seoul: Korea Ministry of Health and Welfare; 2013. Korea Ministry of Health and Welfare. Trend in the uptake of cancer screening: adults over the age of 19. Seoul: Korea Ministry of Health and Welfare; 2013.
21.
go back to reference Kweon S, Kim Y, Jang M-j, Kim Y, Kim K, Choi S, et al. Data resource profile: the Korea National Health and Nutrition Examination Survey (KNHANES). Int J of Epidemiology. 2014;43:69–77.CrossRef Kweon S, Kim Y, Jang M-j, Kim Y, Kim K, Choi S, et al. Data resource profile: the Korea National Health and Nutrition Examination Survey (KNHANES). Int J of Epidemiology. 2014;43:69–77.CrossRef
22.
go back to reference Korea Centres for Disease and Control and Prevention (KCDC): The fifth Korea National Health and Nutrition Examination Survey Data User Guide. KCDC 2012. Korea Centres for Disease and Control and Prevention (KCDC): The fifth Korea National Health and Nutrition Examination Survey Data User Guide. KCDC 2012.
23.
go back to reference Wagstaff A, van Doorslaer E, Watanabe N. On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam. J Econom. 2003;112:207–23.CrossRef Wagstaff A, van Doorslaer E, Watanabe N. On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam. J Econom. 2003;112:207–23.CrossRef
24.
go back to reference van Doorslaer E, Masseria C, Koolman X, the OECD Health Equity Research Group. Inequalities in access to medical care by income in developed countries. CMAJ. 2006;174:177–83.PubMedCentralCrossRefPubMed van Doorslaer E, Masseria C, Koolman X, the OECD Health Equity Research Group. Inequalities in access to medical care by income in developed countries. CMAJ. 2006;174:177–83.PubMedCentralCrossRefPubMed
25.
go back to reference Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36(1):1–10.CrossRefPubMed Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36(1):1–10.CrossRefPubMed
26.
go back to reference Heo J, Hwang J. Income-related Inequalitiesin cancer screening in Korea: using Concentration Index (CI) and decomposition of CI. Health Soc Welfare Rev. 2014;34:59–81.CrossRef Heo J, Hwang J. Income-related Inequalitiesin cancer screening in Korea: using Concentration Index (CI) and decomposition of CI. Health Soc Welfare Rev. 2014;34:59–81.CrossRef
27.
go back to reference Solmi F, Von Wagner C, Kobayashi LC, Raine R, Wardle J, Morris S. Decomposing socio-economic inequality in colorectal cancer screening uptake in England. Soc Sci Med. 2015;134:76–86.CrossRefPubMed Solmi F, Von Wagner C, Kobayashi LC, Raine R, Wardle J, Morris S. Decomposing socio-economic inequality in colorectal cancer screening uptake in England. Soc Sci Med. 2015;134:76–86.CrossRefPubMed
28.
go back to reference O’Donnell O, van Dooslaer E, Wagstaff A, Lindelow M. Analyzing Health Equity Using Household Survey Data : A Guide to Techniques and Their Impementation. Washington, DC: The World Bank; 2008. O’Donnell O, van Dooslaer E, Wagstaff A, Lindelow M. Analyzing Health Equity Using Household Survey Data : A Guide to Techniques and Their Impementation. Washington, DC: The World Bank; 2008.
29.
go back to reference Haper SL, Lynch J. Methods for measuring cancer disparities : using data relevant to healthy people 2010 cancer-related objectives. Bethesda, MD: National Cancer Institute; 2005. Haper SL, Lynch J. Methods for measuring cancer disparities : using data relevant to healthy people 2010 cancer-related objectives. Bethesda, MD: National Cancer Institute; 2005.
30.
go back to reference O’Donnell O, van Dooslaer E, Wagstaff A, Lindelow M. Chapter 8. The Concentration Index. In: Analyzing Health Equity Using Household Survey Data : A Guide to Techniques and Their Impementation. Washington, DC: The World Bank; 2008. p. 95–108. O’Donnell O, van Dooslaer E, Wagstaff A, Lindelow M. Chapter 8. The Concentration Index. In: Analyzing Health Equity Using Household Survey Data : A Guide to Techniques and Their Impementation. Washington, DC: The World Bank; 2008. p. 95–108.
31.
32.
go back to reference Wagstaff A. The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality. Health Econ. 2005;14:429–32.CrossRefPubMed Wagstaff A. The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality. Health Econ. 2005;14:429–32.CrossRefPubMed
33.
go back to reference Devaux M. Income-related inequalities and inequities in health care services utilisation in 18 selected OECD countries. Eur J Health Econ. 2015;16:21–33.CrossRefPubMed Devaux M. Income-related inequalities and inequities in health care services utilisation in 18 selected OECD countries. Eur J Health Econ. 2015;16:21–33.CrossRefPubMed
34.
go back to reference Hajizadeh M, Karen Campbell M, Sarma S. Socioeconomic inequalities in adult obesity risk in Canada: trends and decomposition analyses. Eur J Health Econ. 2014;15:203–21.CrossRefPubMed Hajizadeh M, Karen Campbell M, Sarma S. Socioeconomic inequalities in adult obesity risk in Canada: trends and decomposition analyses. Eur J Health Econ. 2014;15:203–21.CrossRefPubMed
35.
go back to reference O’Donnell O, van Doorslear E, Wagstaff A, Lindelow M. Chapter 15. Measuring and explaining inequity in health service delivery. In: Analyzing Health Equity Using Household Survey Data : A Guide to Techniques and Their Impementation. Washington, DC: The World Bank; 2008. p. 177–86. O’Donnell O, van Doorslear E, Wagstaff A, Lindelow M. Chapter 15. Measuring and explaining inequity in health service delivery. In: Analyzing Health Equity Using Household Survey Data : A Guide to Techniques and Their Impementation. Washington, DC: The World Bank; 2008. p. 177–86.
37.
go back to reference Hwang J, Rudnisky C, Bowen S, Johnson JA. Income-related inequalities in visual impairment and eye screening services in patients with type 2 diabetes. J Public Health. 2015. doi:10.1093/pubmed/fdv185. Hwang J, Rudnisky C, Bowen S, Johnson JA. Income-related inequalities in visual impairment and eye screening services in patients with type 2 diabetes. J Public Health. 2015. doi:10.​1093/​pubmed/​fdv185.
38.
go back to reference Kwon S. Thirty years of national health insurance in South Korea: lessons for achieving universal health care coverage. Health Policy Plan. 2009;24:63–71.CrossRefPubMed Kwon S. Thirty years of national health insurance in South Korea: lessons for achieving universal health care coverage. Health Policy Plan. 2009;24:63–71.CrossRefPubMed
39.
go back to reference Devaux M, De Looper M. Income-related inequalities in health service utilisation in 19 OECD countries, 2008–2009. OECD Health Working Papers No. 58, OECD Publishng 2012. Devaux M, De Looper M. Income-related inequalities in health service utilisation in 19 OECD countries, 2008–2009. OECD Health Working Papers No. 58, OECD Publishng 2012.
40.
go back to reference von Wagner C, Baio G, Raine R, Snowball J, Morris S, Atkin W, et al. Inequalities in participation in an organized national colorectal cancer screening programme: results from the first 2.6 million invitations in England. Int J Epidemiol. 2011;40:712–8.CrossRef von Wagner C, Baio G, Raine R, Snowball J, Morris S, Atkin W, et al. Inequalities in participation in an organized national colorectal cancer screening programme: results from the first 2.6 million invitations in England. Int J Epidemiol. 2011;40:712–8.CrossRef
42.
go back to reference Carrieri V, Wuebker A. Assessing inequalities in preventive care use in Europe. Health Policy. 2013;113:247–57.CrossRefPubMed Carrieri V, Wuebker A. Assessing inequalities in preventive care use in Europe. Health Policy. 2013;113:247–57.CrossRefPubMed
43.
go back to reference Sabates R, Feinstein L. The role of education in the uptake of preventative health care: the case of cervical screening in Britain. Soc Sci Med. 2006;62:2998–3010.CrossRefPubMed Sabates R, Feinstein L. The role of education in the uptake of preventative health care: the case of cervical screening in Britain. Soc Sci Med. 2006;62:2998–3010.CrossRefPubMed
44.
go back to reference Wardle J, McCaffery K, Nadel M, Atkin W. Socioeconomic differences in cancer screening participation: comparing cognitive and psychosocial explanations. Soc Sci Med. 2004;59:249–61.CrossRefPubMed Wardle J, McCaffery K, Nadel M, Atkin W. Socioeconomic differences in cancer screening participation: comparing cognitive and psychosocial explanations. Soc Sci Med. 2004;59:249–61.CrossRefPubMed
45.
go back to reference Stimpson JP, Pagan JA, Chen LW. Reducing racial and ethnic disparities in colorectal cancer screening is likely to require more than access to care. Health Aff. 2012;31:2747–54.CrossRef Stimpson JP, Pagan JA, Chen LW. Reducing racial and ethnic disparities in colorectal cancer screening is likely to require more than access to care. Health Aff. 2012;31:2747–54.CrossRef
46.
go back to reference Finney Rutten LJ, Nelson DE, Meissner HI. Examination of population-wide trends in barriers to cancer screening from a diffusion of innovation perspective (1987–2000). Prev Med. 2004;38:258–68.CrossRefPubMed Finney Rutten LJ, Nelson DE, Meissner HI. Examination of population-wide trends in barriers to cancer screening from a diffusion of innovation perspective (1987–2000). Prev Med. 2004;38:258–68.CrossRefPubMed
47.
go back to reference Peipins LA, Soman A, Berkowitz Z, White MC. The lack of paid sick leave as a barrier to cancer screening and medical care-seeking: results from the National Health Interview Survey. BMC Public Health. 2012;12:520.PubMedCentralCrossRefPubMed Peipins LA, Soman A, Berkowitz Z, White MC. The lack of paid sick leave as a barrier to cancer screening and medical care-seeking: results from the National Health Interview Survey. BMC Public Health. 2012;12:520.PubMedCentralCrossRefPubMed
48.
go back to reference Kim S, Kwon S, Subramanina SV. Has the National Cancer Screening Program reduced income inequalities in screening attendance in South Korea? Cancer Causes Control. 2015;26:1617–25.CrossRefPubMed Kim S, Kwon S, Subramanina SV. Has the National Cancer Screening Program reduced income inequalities in screening attendance in South Korea? Cancer Causes Control. 2015;26:1617–25.CrossRefPubMed
49.
go back to reference Rakowski W, Meissner H, Vernon SW, Breen N, Rimer B, Clark MA. Correlates of repeat and recent mammography for women ages 45 to 75 in the 2002 to 2003 Health Information National Trends Survey (HINTS 2003). Cancer Epidemiol Biomarkers Prev. 2006;15:2093–101.CrossRefPubMed Rakowski W, Meissner H, Vernon SW, Breen N, Rimer B, Clark MA. Correlates of repeat and recent mammography for women ages 45 to 75 in the 2002 to 2003 Health Information National Trends Survey (HINTS 2003). Cancer Epidemiol Biomarkers Prev. 2006;15:2093–101.CrossRefPubMed
50.
go back to reference Rutten LJ, Squiers L, Hesse B. Cancer-related information seeking: hints from the 2003 Health Information National Trends Survey (HINTS). J Health Commun. 2006;11 Suppl 1:147–56.CrossRefPubMed Rutten LJ, Squiers L, Hesse B. Cancer-related information seeking: hints from the 2003 Health Information National Trends Survey (HINTS). J Health Commun. 2006;11 Suppl 1:147–56.CrossRefPubMed
51.
go back to reference Bao Y, Fox SA, Escarce JJ. Socioeconomic and racial/ethnic differences in the discussion of cancer screening: “between-” versus “within-” physician differences. Health Serv Res. 2007;42:950–70.PubMedCentralCrossRefPubMed Bao Y, Fox SA, Escarce JJ. Socioeconomic and racial/ethnic differences in the discussion of cancer screening: “between-” versus “within-” physician differences. Health Serv Res. 2007;42:950–70.PubMedCentralCrossRefPubMed
52.
go back to reference Tefft N, Kageleiry A. State-level unemployment and the utilization of preventive medical services. Health Ser Res. 2014;49:186–205.CrossRef Tefft N, Kageleiry A. State-level unemployment and the utilization of preventive medical services. Health Ser Res. 2014;49:186–205.CrossRef
54.
go back to reference Pace LE, Keating NL. A systematic assessment of benefits and risks to guide breast cancer screening decisions. JAMA. 2014;311:1327–35.CrossRefPubMed Pace LE, Keating NL. A systematic assessment of benefits and risks to guide breast cancer screening decisions. JAMA. 2014;311:1327–35.CrossRefPubMed
Metadata
Title
Assessment of trends in socioeconomic inequalities in cancer screening services in Korea, 1998–2012
Authors
Sujin Kim
Jongnam Hwang
Publication date
01-12-2016
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2016
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-016-0319-7

Other articles of this Issue 1/2016

International Journal for Equity in Health 1/2016 Go to the issue