Epidemiology and Health

Original Articles

Income-based disparities in the risk of distant-stage cervical cancer and 5-year mortality after the introduction of a National Cancer Screening Program in Korea: Erdenetuya Bolormaa, Seung-Ah Choe, Mia Son, Myung Ki, Domyung Paek; Epidemiol Health. 2022;44:e2022066. Published online August 11, 2022; DOI: https://doi.org/10.4178/epih.e2022066

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Abstract

OBJECTIVES
This study assessed the socioeconomic gradient in the risk of distant-stage cervical cancer (CC) at presentation and 5-year mortality for new CC patients after the introduction of a national Cancer Screening Program (NCSP) in Korea.

METHODS

All new CC cases from 2007 to 2017 were retrieved from the Korea Central Cancer Registry database linked with the National Health Information Database of the National Health Insurance Service. The age-standardized cumulative incidence of CC, adjusted odds ratios (ORs) of distant metastasis at presentation, and adjusted all-cause mortality hazard ratios (HRs) within 5 years post-diagnosis were assessed according to the income gradient.

RESULTS

The 11-year age-standardized cumulative incidence of CC ranged from 48.9 to 381.5 per 100,000 women, with the richest quintile having the highest incidence. Of 31,391 new cases, 8.6% had distant metastasis on presentation, which was most frequent among Medical Aid beneficiaries (9.9%). Distant-stage CC was more likely when the income level was lower (OR, 1.46; 95% confidence interval [CI]), 1.28 to 1.67 for the lowest compared to the richest) and among Medical Aid beneficiaries (OR, 1.50; 95% CI, 1.24 to 1.82). The 5-year mortality was greater in the lower-income quintiles and Medical Aid beneficiaries than in the richest quintile.

CONCLUSIONS

The incidence of CC was higher in the richest quintile than in the lower income quintiles, while the risk of distant-stage CC and mortality was higher for women in lower income quintiles in the context of the NCSP. A more focused approach is needed to further alleviate disparities in the timely diagnosis and treatment of CC.

Summary

Korean summary
새로이 자궁경부암을 진단받은 여성에서 소득수준에 따른 진단시 원격 전이가 있을 위험도와 진단 이후 5년 사망위험도를 연령과 체질량 지수등의 개인 수준의 위험 요인을 보정하여 구했다. 소득 수준이 낮을수록, 의료급여 환자일수록 진단시 원격 전이가 있을 위험과 5년 내 사망 위험이 높은 것으로 나타났다. 자궁경부암에 대한 전국민 대상 선별 검사가 있지만 여전히 소득 수준에 따른 자궁경부암의 적시 진단과 진단 후 생존의 불평등이 남아 있으며 이에 대한 추가 정책이 필요하다.

Key Message
This study adds empirical evidence for an income-based disparity in the cancer stage at presentation and five-year survival among cervical cancer patients even in the presence of a universal screening program.

Citations

Citations to this article as recorded by

Individual and joint effect of socioeconomic status and lifestyle factors on cancer in Korea
Chi Lan Tran, Kui Son Choi, Sun‐Young Kim, Jin‐Kyoung Oh
Cancer Medicine.2023; 12(16): 17389. CrossRef
Menopausal hormone therapy and risk of dementia: health insurance database in South Korea-based retrospective cohort study
Jin-Sung Yuk, Jin San Lee, Joong Hyun Park
Frontiers in Aging Neuroscience.2023;[Epub] CrossRef
Disparities in Cancer Incidence across Income Levels in South Korea
Su-Min Jeong, Kyu-Won Jung, Juwon Park, Nayeon Kim, Dong Wook Shin, Mina Suh
Cancers.2023; 15(24): 5898. CrossRef

A Study on the Relationship Between Smoking Habits and BMI of Adult Males.: Joo Hee Han, Myung Kim, Dae Hyu Oh, Hee Choul Ohrr; Korean J Epidemiol. 1998;20(1):39-50.

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Abstract PDF: Abstract
Smoking, obesity and diet are just a few of the multifactors which have been suggested to be associated with the risk of CHD. It is a common phenomenon that persons who stop smokin gain weight. This fear of gaining weight is often given as a reason for giving up to quit smoking. The purpose of this study is to find the effects of cessation of smoking on body weight and the difference of BMI distribution according to smoking habits. The subjects of this study were 72 techinical high school teachers in Seoul and Kyounggi-Do, 85 offical wokers of the S-Company and 81 auto industrial workers in PyoungTaek. The investigation for this study has been conducted from Oct. 27th to Oct. 31st 1997. The method was self-feported questionnaire survey which consists of general characterisics, smoking habits and its relevant questions. The questionnaires were revised after two-times of pre-tests, carried out for twenty subjects. The results are as follows ; 1. Smoking habits have significant relations with diet, exercise, drinking and the amount of daily smoking. 2. BMI among different smoking habits groups showed significant differences in following variables ; age, the interaction between exercise and smoking habits, drinking level, the interaction etween drinking level and smoking habits and the interaction between total smoking duration and smoking gabits. 3. The mean values of BMI are 23.5 in non-smoker, 23.8 in ex-smoker and 23.4 in current smoker. There are no statistically significant differencs among amoking habits. 4. The average of 2.14kg weight gain is witnessed after 6 months of the cessation of smoking. Current weight was high by 3.89kh in average compared to the pre-cessation weight(p=0.0001). 5. The odds ratio for gaining weight among ex-smokers is 8.94 in "increase or very increase" group in diet compared to those of "no change". 6. The multiple regression analysis has a significant model in current smoker(p=0.001). The mean BMI of those who were "very active" in exercise is higher than that of "inactive" or "active". The mean BMI of those who were "light or moderate ot heavy drinker" is lower than that of "non-drinker". The mean BMI of those who have the monthly income 1.5millions-1.99millions won is significantly higher than those having less than 1.5millions or more than 2.0millions won. The implication of this study could suggest that health education for smoking cessation needs new approches to minimize weight gain.; Summary

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