Disparities in Liver Cancer Screening Among People with Disabilities: A National Database Study in Korea

Abstract

Background: Using the linked administrative database in Korea, we sought to investigate 1) whether there are disparities in liver cancer screening according to degree and type of disability and 2) temporal trends in liver cancer screening among people with disabilities. Methods: We linked national disability registration data with national cancer screening data. We analyzed age-standardized participation rates for each year during the 2006-2015 period according to presence, type, and severity of disability. We also examined factors associated with liver cancer screening by multivariate logistic regression using the most current data (2014-2015). Findings: The age- and sex-adjusted screening rate for liver cancer in people with disabilities increased from 25.7% in 2006 to 49.6% in 2015 (change: +23.9%); however, during the same period, screening rate among people without disabilities increased from 24.9 to 54.5% (change: +29.6%). As a result, disparities in liver cancer screening increased over time. The screening participation rate among people with disabilities was 12% lower than among people without disabilities (adjusted OR [aOR] 0.88, 95% confidence interval [CI], 0.87-0.89). Screening rates were markedly lower among people with severe disabilities (aOR 0.71, 95% CI 0.70-0.72) and people with renal disease (aOR 0.43, 95% CI 0.41-0.45), brain injuries (aOR 0.60, 95% CI 0.58-0.62), ostomy problems (aOR 0.60, 95% CI 0.53-0.68), and intellectual disabilities (aOR 0.69, 95% CI 0.66-0.73). Interpretation: Despite the availability of a national liver cancer screening program, a marked disparity was found in liver cancer screening participation, especially among people with severe disabilities, renal disease, or brain-related or mental disabilities. Funding Statement: This work was supported by the R&D grant (No. 2016007) on rehabilitation by Korea National Rehabilitation Center Research Institute, Ministry of Health & Welfare, and the National Research Foundation of Korea(NRF) grant funded by the Ministry of Education (No.2016R1D1A3B03931142) and by the Korea government(MSIT) (No. 2019R1H1A2080180, 2019R1A2C1087507) and by the Ministry of Science, ICT, & Future Planning (No. 2016R1A2B4011045). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Our study was approved by the Institutional Review Board of Chungbuk National University (CBNU-201708-BM-501-01).