본문 바로가기
KERD
논문KCI 등재

Socioeconomic inequality in organized and opportunistic screening for colorectal cancer: results from the Korean National Cancer Screening Survey, 2009-2021

Lee Kyeongmin|Choi Kui Son|Suh Mina|Jun Jae Kwan|Luu Xuan Quy
한국역학회 (Korean Society of Epidemiology)|2023.01|Epidemiology and Health|제45권 |pp. 1-10|DOI 10.4178/epih.e2023086

2

조회

0

다운로드

0

인용

0

참고문헌

키워드

Mass screeningColorectal cancerHealth inequitiesHealthcare disparity

초록

OBJECTIVES: This study aimed to investigate socioeconomic status (SES)-based inequality in colorectal cancer (CRC) screening in Korea. We assessed whether the rates of opportunistic and organized CRC screening differed according to income and education levels. METHODS: We analyzed data from the Korean National Cancer Screening Survey of 27,654 cancer-free individuals, aged 50-74 years, from 2009 to 2021. The weighted cancer screening rates with trends were estimated with the average annual percentage change using joinpoint regression. Inequality was calculated in both relative and absolute terms, based on a Poisson regression model. RESULTS: The organized screening rate increased significantly from 22.1% in 2009 to 53.1% in 2020 and 50.6% in 2021, with an average annual change of 8.6% (95% confidence interval [CI], 4.9 to 12.5). In contrast, no significant trend was observed for opportunistic screening. The SES inequality in opportunistic screening uptake was indicated by a slope index of inequality (SII) of 9.74% (95% CI, 6.36 to 13.12), relative index of inequality (RII) of 2.18 (95% CI, 1.75 to 2.70) in terms of education level; and an SII of 7.03% (95% CI, 4.09 to 9.98), RII of 1.81 (95% CI, 1.41 to 2.31) in terms of measured income. Although there was an increasing trend in income inequality, no significant SES inequalities were observed in the overall estimates for organized screening. CONCLUSIONS: Organized CRC screening is effective in improving the participation rate, regardless of SES. However, significant inequalities were found in opportunistic screening, suggesting room for improvement in the overall equity of CRC screening.

Abstract

OBJECTIVES: This study aimed to investigate socioeconomic status (SES)-based inequality in colorectal cancer (CRC) screening in Korea. We assessed whether the rates of opportunistic and organized CRC screening differed according to income and education levels. METHODS: We analyzed data from the Korean National Cancer Screening Survey of 27,654 cancer-free individuals, aged 50-74 years, from 2009 to 2021. The weighted cancer screening rates with trends were estimated with the average annual percentage change using joinpoint regression. Inequality was calculated in both relative and absolute terms, based on a Poisson regression model. RESULTS: The organized screening rate increased significantly from 22.1% in 2009 to 53.1% in 2020 and 50.6% in 2021, with an average annual change of 8.6% (95% confidence interval [CI], 4.9 to 12.5). In contrast, no significant trend was observed for opportunistic screening. The SES inequality in opportunistic screening uptake was indicated by a slope index of inequality (SII) of 9.74% (95% CI, 6.36 to 13.12), relative index of inequality (RII) of 2.18 (95% CI, 1.75 to 2.70) in terms of education level; and an SII of 7.03% (95% CI, 4.09 to 9.98), RII of 1.81 (95% CI, 1.41 to 2.31) in terms of measured income. Although there was an increasing trend in income inequality, no significant SES inequalities were observed in the overall estimates for organized screening. CONCLUSIONS: Organized CRC screening is effective in improving the participation rate, regardless of SES. However, significant inequalities were found in opportunistic screening, suggesting room for improvement in the overall equity of CRC screening.

참고문헌 (32)

  1. Sung H, "Global cancer statistics 2020 : GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries", CA Cancer J Clin, 71, pp.209~249 (2021)
  2. Xi Y, "Global colorectal cancer burden in 2020 and projections to 2040", Transl Oncol, 14, pp.101174~ (2021)
  3. Carethers JM, "Causes of socioeconomic disparities in colorectal cancer and intervention framework and strategies", Gastroenterology, 158, pp.354~367 (2020)
  4. 홍세리, "Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2018", Cancer Research and Treatment, 53(2), pp.301~315 (2021), 대한암학회[DOI]
  5. Bray F, "Global cancer statistics 2018 : GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries", CA Cancer J Clin, 68, pp.394~424 (2018)
  6. Khil H, "Time trends of colorectal cancer incidence and associated lifestyle factors in South Korea", Sci Rep, 11, pp.2413~ (2021)
  7. Van Hal G, "Editorial : social inequality in cancer screening", Front Public Health, 10, pp.854659~ (2022)
  8. Vaccarella S, "Reducing social inequalities in cancer: evidence and priorities for research", pp.71~89 (2019), International Agency for Research on Cancer
  9. Hoeck S, "Do socioeconomic factors play a role in nonadherence to follow-up colonoscopy after a positive faecal immunochemical test in the Flemish colorectal cancer screening programme?", Eur J Cancer Prev, 29, pp.119~126 (2020)
  10. Hurtado JL, "Social inequalities in a population based colorectal cancer screening programme in the Basque Country", BMC Public Health, 15, pp.1021~ (2015)
  11. Tran Thi Xuan Mai, "Socioeconomic Inequalities in Colorectal Cancer Screening in Korea, 2005–2015: After the Introduction of the National Cancer Screening Program", Yonsei Medical Journal, 59(9), pp.1034~1040 (2018), 연세대학교의과대학[DOI]
  12. von Wagner C, "Inequalities in colorectal cancer screening participation in the first round of the national screening programme in England", Br J Cancer, 101(Suppl 2), pp.S60~S63 (2009)
  13. 홍세리, "Trends in Cancer Screening Rates among Korean Men and Women: Results of the Korean National Cancer Screening Survey, 2004–2018", Cancer Research and Treatment, 53(2), pp.330~338 (2021), 대한암학회[DOI]
  14. Suh M, "Socioeconomic disparities in colorectal cancer screening in Korea: a nationwide cross-sectional study", Medicine(Baltimore), 94, pp.e1368~ (2015)
  15. Lee K, "Intentions to undergo primary screening with colonoscopy under the National Cancer Screening Program in Korea", PLoS One, 16, pp.e0247252~ (2021)
  16. Nhung Cam Bui, "Stages of Adoption for Fecal Occult Blood Test and Colonoscopy Tests for Colorectal Cancer Screening in Korea", Cancer Research and Treatment, 50(2), pp.416~427 (2018), 대한암학회
  17. Luu XQ, "Effect of colorectal cancer screening on long-term survival of colorectal cancer patients : results of the Korea National Cancer Screening Program", Int J Cancer, 150, pp.1958~1967 (2022)
  18. 서민아, "Trends in Cancer Screening Rates among Korean Men and Women: Results of the Korean National Cancer Screening Survey, 2004-2013", Cancer Research and Treatment, 48(1), pp.1~10 (2016), 대한암학회[DOI]
  19. Kim HJ, "Permutation tests for joinpoint regression with applications to cancer rates", Stat Med, 19, pp.335~351 (2000)
  20. Clegg LX, "Estimating average annual per cent change in trend analysis", Stat Med, 28, pp.3670~3682 (2009)
  21. Oakes JM, "Methods in social epidemiology", pp.91~130 (2017), John Wiley & Sons
  22. "RIIGEN: Stata module to generate variables to compute the relative index of inequality" (2013)[URL]
  23. Moreno-Betancur M, "Relative index of inequality and slope index of inequality : a structured regression framework for estimation", Epidemiology, 26, pp.518~527 (2015)
  24. Bozhar H, "Socio-economic inequality of utilization of cancer testing in Europe : a cross-sectional study", Prev Med Rep, 26, pp.101733~ (2022)
  25. Kim S, "Assessment of trends in socioeconomic inequalities in cancer screening services in Korea, 1998-2012", Int J Equity Health, 15, pp.30~ (2016)
  26. Doubeni CA, "Framework and strategies to eliminate disparities in colorectal cancer screening outcomes", Annu Rev Med, 72, pp.383~398 (2021)
  27. Lee K, "Impact of COVID-19 on cancer screening in South Korea", Sci Rep, 12, pp.11380~ (2022)
  28. Luu Xuan Quy, "The Classification Capability of Asia Pacific Colorectal Screening Score in Korea: An analysis of the Cancer Screenee Cohort", Epidemiology and Health, 43, pp.1~10 (2021), 한국역학회[DOI]
  29. Pilonis ND, "Participation in competing strategies for colorectal cancer screening : a randomized health services study(PICCOLINO Study)", Gastroenterology, 160, pp.1097~1105 (2021)
  30. Kortlever T, "Future of colorectal cancer screening : from one-size-fits-all to tailor-made", Front Gastroenterol, 1, pp.906052~ (2022)
  31. Hoffmeister M, "Validity of self-reported endoscopies of the large bowel and implications for estimates of colorectal cancer risk", Am J Epidemiol, 166, pp.130~136 (2007)
  32. Yukyung Shin, "Increase in Potential Low-value Magnetic Resonance Imaging Utilization Due to Out-of-pocket Payment Reduction Across Income Groups in Korea: An Experimental Vignette Study", 예방의학회지, 55(4), pp.389~397 (2022), 대한예방의학회

관련 논문AI추천

Socioeconomic Inequalities in Colorectal Cancer Screening in Korea, 2005–2015: After the Introduction of the National Cancer Screening Program김열, 기모란, 박보영, 서미나, 오진경, 이윤영, 이은영, 전재관, 조현순, 최귀선, 최은지, Tran Thi Xuan Mai연세대학교의과대학 · Yonsei Medical Journal2018 · 제59권 제9호Trends of Colorectal Cancer Screening Rates in Korea: Korean National Cancer Screening Survey 2005–2020최귀선, Jun Jae Kwan, Lee Yun Yeong, Park Bomi, Shin Hye Young, Song Soo Yeon, Suh Mina거트앤리버 소화기연관학회협의회 · Gut and Liver2022 · 제16권 제6호Socioeconomic Inequalities in Stomach Cancer Screening in Korea, 2005–2015: After the Introduction of the National Cancer Screening Program김열, 기모란, 박보영, 서미나, 오진경, 이윤영, 이은영, 전재관, 조현순, 최귀선, 최은지, Tran Thi Xuan Mai연세대학교의과대학 · Yonsei Medical Journal2018 · 제59권 제8호Socioeconomic inequality in organized and opportunistic screening for breast cancer: results from the Korean National Cancer Screening Survey, 2009-2021Choi Kui Son, Ha Yejin, Jun Jae Kwan, Kim Woorim, Luu Xuan Quy, Suh Mina한국역학회 · Epidemiology and Health2025 · 제47권 Trends in Cancer-screening Rates in Korea: Findings from the National Cancer Screening Survey, 2004–2023김열, 강은교, 김태희, 서민아, 이선화, 이현지, 전재관, 최귀선, 최창균대한암학회 · Cancer Research and Treatment2025 · 제57권 제1호Association between Socioeconomic Status and Cancer Screening in Koreans over 40 Years in Age Based on the 2010–2012 Korean National Health and Nutrition Examination SurveyHee-Taik Kang, Jin-Young Kim대한가정의학회 · Korean Journal of Family Medicine2016 · 제37권 제5호

이 간행물의 다른 논문 (102건)

Changes in health behaviors and obesity of Korean adolescents before and during the COVID-19 pandemic: a special report using the Korea Youth Risk Behavior SurveyChoi Sunhye, Oh Kyungwon, 오창모, Kim Yangha, Yang Ji Eunpp. 1-8Korea Seroprevalence Study of Monitoring of SARS-COV-2 Antibody Retention and Transmission (K-SEROSMART): findings from national representative sample황태윤, 오경재, 홍영습, Kim Su Young, 이계오, 윤규현, 김정애, 이혁민, 신민호, 이순영, 이원영, 김동현, 박재현, 이훈재, 조성일, 남해성, 이무식, Lee June-Woo, Kim Sung Soon, 설로마, Kim Byoungguk, 이중정, 오창모, Jung Sun Jae, 오성수, Yim Hyeon Woo, 한미아, 김유미, 조희숙, Lee Ju-Hyung, Jung Jaehun, Kim Ah-Ra, Han Jina, Baek Hye Jin, Noh Eunbi, Ryu Sukhyun, 박노례, Jung Eunok, Kim Sang Il, Hwang Yoo-Sung, Oh Sangcheol, Kim Migyeong, Yu Byengchul, Kim Keonyeop, Hwangbo Young, Lee Joongyub, Kim Hyeongsu, Kang Gilwon, Ryu So Yeon, Park Soon-Woo, Kim Sang Kyu, Park Ki Soo, Kwon Jun-wook, Jang Eun Young, Nam Jeonghyunpp. 1-13Genetically determined alcohol consumption and cancer risk in Korea지선하, 정금지, 백지우, Shin Sang Yoppp. 1-7Self-reported adverse events after 2 doses of COVID-19 vaccine in Korea고미정, 김형준, 황인섭, Kwon Yunhyung, Kim Seontae, Seo Soon-Young, Cho Enhi, Yeon-Kyeng Leepp. 1-7Detecting mpox infection in the early epidemic: an epidemiologic investigation of the third and fourth cases in KoreaChoi Jihyun, Choi Yunsang, Kim Jong Mu, 박숙경, Kim Taeyoung, Park Eonjoo, Eun Juk Suk, Lee Eun-young, Mun Ji Won, Lee Sinyoung, Yeom Hansol, Kim Eun Kyoung, Ha Jinhopp. 1-7
원문 보기