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

Sujin Kim,Jongnam Hwang

doi:10.1186/s12939-016-0319-7

Abstract

BackgroundThis 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.MethodsThree 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.ResultsThroughout 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.ConclusionOur 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-016-0319-7) contains supplementary material, which is available to authorized users.

Highlights

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 to quantify each contribution from various socio-demographic factors income-related inequalities with respect to these cancer screening services
Positive values of the Concentration Index (CI) observed consistently over time indicates that more use of cancer screening services has been concentrated among individuals with higher income for both cancers, but the degree of the CIs has slightly decreased for gastric cancer from 0.179 in 1998 to 0.132 in 2010–2012
Results from Oaxaca decomposition of the CIs reassure us that the contributor that is most responsible for decreasing inequalities is income

Summary

Introduction

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 to quantify each contribution from various socio-demographic factors income-related inequalities with respect to these cancer screening services. Cancer screening refers to the use of simple tests across a healthy population to identify individuals who have the disease [1] It contributes to considerable reduction of both clinical and financial burdens of through early detection and timely treatment for such as colorectal, cervical, and breast cancers [2,3,4]. Nationwide screening programs are closely related to overall increases in the use of cancer screening services and decreases in cancer incidence and cancer-related mortality [2]. Few studies have examined the impact of the implementation of public cancer screening programs, observing that national-level mass screening may contribute to decreasing inequality in screening participation for breast and cervical cancers [12,13,14,15,16]. Existing evidence is somewhat limited; the impact of those mass screening policies across socioeconomic status (SES) is not fully understood

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