Epidemiology and Health

Original Articles

The delayed cancer treatment and economic inequality in Korea: results of common cancers by the time-to-surgery: Noorhee Son, Woo-Ri Lee, Dong-Woo Choi, Kyu-Tae Han; Epidemiol Health. 2025;47:e2025056. Published online September 27, 2025; DOI: https://doi.org/10.4178/epih.e2025056

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Growing concerns regarding the concentration of cancer treatment in the capital city in Korea have raised questions about equitable access to timely and optimal patient care. In this study, we evaluated the impact of time-to-surgery (TTS) on healthcare utilization and outcomes, with the goal of providing policy recommendations for effective quality assessment of cancer care.
METHODS
This retrospective cohort study analyzed data from 2011 to 2021 obtained from National Health Insurance Service claims. A generalized estimating equation and a Cox proportional hazards model were applied to assess the effects of TTS on length of stay (LOS), medical costs, and 5-year mortality among patients diagnosed with lung, liver, and colorectal cancers. Subgroup analyses were conducted based on patients’ baseline economic status.
RESULTS
Among patients who underwent surgical treatment for lung, liver, or colorectal cancer, 20.4%, 11.4%, and 11.4% experienced treatment delays, respectively. Regardless of cancer type, longer TTS was associated with prolonged LOS and higher medical costs. Moreover, patients with extended TTS demonstrated an increased risk of 5-year mortality. Disparities by income level were evident, with greater differences observed in the lower-income group.
CONCLUSIONS
This study highlights the importance of timely surgical treatment for patients with cancer, particularly in relation to income-based disparities. These findings emphasize the need to improve Korea’s concentrated cancer care delivery system to enhance healthcare efficiency and address health literacy gaps affecting treatment by income level.; Summary

Korean summary
- 수술 환자의 약 10%~20%에서 치료 지연이 발생했다. - 수술까지 대기시간이 길수록 재원일수가 늘고, 의료비용이 증가하며, 5년 사망위험이 높았다. - 소득수준에 따른 격차가 확인되었고, 저소득층에서 불리한 영향이 더 크게 나타났다.

Key Message
- Among surgical patients, approximately 10–20% experienced treatment delays. - Longer time-to-surgery (TTS) was linked to prolonged length of stay (LOS), higher medical costs, and an increased 5-year mortality risk. - Income-level disparities were evident, with more pronounced adverse differences in lower-income groups.

Social capital and regional influences: key predictors of unmet dental care needs among older adults in Korea: Ji-Yeon Lim, Ju-Mi Lee, Hae-Sung Nam; Epidemiol Health. 2025;47:e2025025. Published online May 7, 2025; DOI: https://doi.org/10.4178/epih.e2025025

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Abstract

OBJECTIVES
Access to dental services is essential for improving quality of life, and social capital plays a key role in facilitating that access. This study aimed to identify individual-level and regional-level factors, including social capital, that predict unmet dental care needs among older adults.

METHODS

We analyzed data from 59,414 older adults obtained from the 2023 Korea Community Health Survey and the Korean Statistical Information Service, employing a 2-level multilevel model. The dependent variables comprised 3 types of unmet dental care needs: overall, due to lack of acceptability, and due to economic reasons. Twelve independent variables, including social capital and other individual and regional factors, were examined.

RESULTS

The prevalence of unmet needs was 14.15% overall, 8.70% for acceptability reasons, and 4.85% for economic reasons. Lower individual social capital was associated with higher odds of unmet dental care needs, whereas regional social capital factors demonstrated no significant association. Residing in regions with higher fiscal independence ratios was related to an increased likelihood of economic unmet needs (odds ratio [OR], 1.29; 95% confidence interval [CI], 1.09 to 1.52). In contrast, a greater density of dentists per 10,000 population was inversely associated with overall and acceptability-related unmet needs (OR, 0.82 for both; 95% CI, 0.73 to 0.92 and 0.73 to 0.93, respectively).

CONCLUSIONS

Individual social capital and specific regional factors—namely, fiscal independence and density of dentists—may represent important determinants of unmet dental care needs among older adults. Policy interventions aimed at reducing unmet needs should consider these variables.

Summary

Korean summary
· 낮은 사회적 자본(이웃에 대한 낮은 신뢰, 적은 연락빈도, 배우자의 부재, 낮은 사회참여)은 노인의 미충족 치과의료경험을 증가시킨다. · 지역의 높은 재정자립도는 경제성 결여로 인한 미충족 치과의료경험을 증가시키며, 인구 1만명당 치과의사수가 높을수록 전체, 수용성 결여로 인한 미충족 치과의료경험을 감소시킨다.

Key Message
· Lower social capital (lower levels of trust in neighbors, less frequent contact, absence of a spouse, and lack of social participation) increases the risk of unmet dental care needs among older adults. · Higher regional fiscal independence increases unmet dental care needs due to economic reasons, while a greater density of dentists reduces overall unmet dental care needs and those due to lack of acceptability.

Citations

Citations to this article as recorded by

Mobility Limitations and Self-Perceived Unmet Dental Needs Among Korean Adults: A Nationwide Multilevel Analysis for Integrated Care
Han-Nah Kim, Nam-Hee Kim
International Dental Journal.2026; 76(2): 109371. CrossRef
Age Differences in Oral Function and Unmet Dental Care Among Korean Adults
Eun Gyo Son
Gerodontology.2026; 43(2): 245. CrossRef
Reimbursement rate determination for home-visit oral health care services using Time-Driven Activity-Based Costing
Bo-Ram Shin, Se-Rim Jo, Jong-Hwa Jang
Journal of Korean Academy of Oral Health.2026; 50(1): 39. CrossRef

The effect of public hospital closure on the death of long-term inpatients in Korea: Taeuk Kang, Minsung Sohn, Changwoo Shon; Epidemiol Health. 2024;46:e2024022. Published online January 17, 2024; DOI: https://doi.org/10.4178/epih.e2024022

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Abstract Summary PDF

Abstract

OBJECTIVES
This study aimed to examine the changes in health outcomes and the patterns of medical institution utilization among patients with long-term stays in public hospitals following the closure of a public medical center. It also sought to present a proposal regarding the role of public hospitals in countries with healthcare systems predominantly driven by private entities, such as Korea.

METHODS

To assess the impact of a public healthcare institution closure on health outcomes in a specific region, we utilized nationally representative health insurance claims data. A retrospective cohort study was conducted for this analysis.

RESULTS

An analysis of the medical utilization patterns of patients after the closure of Jinju Medical Center showed that 67.4% of the total medical usage was redirected to long-term care hospitals. This figure is notably high in comparison to the 20% utilization rate of nursing hospitals observed among patients from other medical facilities. These results indicate that former patients of Jinju Medical Center may have experienced limitations in accessing necessary medical services beyond nursing care. After accounting for relevant mortality factors, the analysis showed that the mortality rate in closed public hospitals was 2.47 (95% confidence interval, 0.85 to 0.96) times higher than in private hospitals.

CONCLUSIONS

The closure of public medical institutions has resulted in unmet healthcare needs, and an observed association was observed with increased mortality rates. It is essential to define the role and objectives of public medical institutions, taking into account the distribution of healthcare resources and the conditions of the population.

Summary

Korean summary
본 연구는 사회보험제도를 기반으로 하고 있는 한국의 상황에서 지방의 공공의료기관 폐쇄가 환자들의 건강에 어떠한 영향을 미쳤는지를 확인하고자 국민건강보험 청구자료를 기반으로 후향적코호트 자료를 구축하여 분석을 시행하였다. 연구결과 장기 입원 환자의 67.4%가 장기요양병원을 의료를 이용하였고, 이는 비교집단의 장기요양 이용비율인 20% 수준보다 3배 가량 높은 수치로, 의료이용에 일부 제약이 발생하였을 가능성을 시사하는 것이다. 폐업 후 1년 이내 사망률을 비교한 결과, 인근지역 내 민간병원 환자와 비교하여 공공의료기관 입원환자의 사망확률은 2.67배였고, 의료급여 수급권자들의 사망확률은 고소득 5분위에 비해 2.24배 높은 것으로 나타났다.

Key Message
Even in Korea's healthcare system with high medical accessibility, adverse health impacts have been observed due to the closure of public healthcare institutions. Systematic policy development is necessary to evaluate essential medical service provision and allocate medical resources comprehensively.

Citations

Citations to this article as recorded by

Impacts of Inner-City Hospital Closures on Access to Surgical Care in Urban Communities
Eliel N. Arrey, Anahit Mehranian, Aaron M. Alford
The American Surgeon™.2026; 92(1): 129. CrossRef

Regional disparities in the availability of cancer clinical trials in Korea: Jieun Jang, Wonyoung Choi, Sung Hoon Sim, Sokbom Kang; Epidemiol Health. 2024;46:e2024006. Published online December 11, 2023; DOI: https://doi.org/10.4178/epih.e2024006

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Unequal access to cancer clinical trials is an important issue, given the potential benefits of participation for cancer patients. We evaluated regional disparities in access to cancer clinical trials in Korea.

METHODS

From the Ministry of Food and Drug Safety database, we extracted 2,465 records of all cancer clinical trials approved between January 2012 and April 2023. To measure disparities in cancer clinical trial access, we calculated the ratio of clinical trials open to non-capital areas relative to those open to capital areas. We then analyzed temporal trends in this ratio, which we termed the trial geographical equity index (TGEI).

RESULTS

Disparities in access to cancer clinical trials, as indicated by the TGEI, did not significantly improve during the study period (regression coefficient, 0.002; p=0.59). However, for phase II/III trials sponsored by global pharmaceutical companies, the TGEI improved significantly (regression coefficient, 0.021; p<0.01). In contrast, the TGEI deteriorated for trials initiated by investigators or those testing domestically developed therapeutics (regression coefficient, -0.015; p=0.05). Furthermore, the increasing trend of TGEI for phase II/III trials sponsored by global companies began to reverse after 2019, coinciding with the outbreak of coronavirus disease 2019 (COVID-19).

CONCLUSIONS

Over the past decade, access to cancer clinical trials has improved in Korea, particularly for phase II/III trials evaluating therapeutics from global companies. However, this increase in accessibility has not extended to trials initiated by investigators or those assessing domestically developed therapeutics. Additionally, the impact of COVID-19 on disparities in clinical trial access should be closely monitored.

Summary

Korean summary
본 연구는 개시된 암 임상시험 수가 국내 수도권에 비해 비수도권에서 절대적으로 부족하고, 이러한 부족이 지난 10년간 개선되지 않았음을 보여줍니다. 다만, 글로벌 제약회사의 치료제를 검증하는 2상/3상 암 임상시험의 경우 임상시험 접근성에 대한 이러한 지역적 격차가 의미 있게 감소했으나 이러한 개선 또한 2019년 이후로는 정체되었을 수 있습니다. 상기 결과들은 임상시험 가용성의 형평성을 향상시키기 위해서는 국내 임상시험 개시 규모가 지역적 불균형을 이루고 있음에 대한 인식이 높아져야 하고, 비수도권 지역에서 임상시험 개시를 방해하는 장벽을 식별하는 데 추가적인 노력이 필요함을 강조합니다.

Key Message
The findings in this study indicate scarcity of cancer clinical trials in non-capital areas compared to that in capital areas of Korea, which has not improved over the past decade. However, this regional disparity in the access to clinical trials meaningfully decreased for phase II/III trials testing therapeutics from global pharmaceutical companies, though this progress may have stalled after 2019. This study highlights that increasing awareness of the regional imbalance in clinical trial access is vital and further efforts are needed to identify the barriers impeding the initiation of clinical trials in non-capital areas to improve the equity of availability.

Citations

Citations to this article as recorded by

Birth Weight-Dependent Regional Disparities in 28-Day and 1-Year Survival of Preterm Infants: Seoul Capital Area vs. Non-Capital Regions, South Korea, 2002–2021
Ji-Sook Kim, Jong-Yeon Kim, Hyeong-taek Woo
Children.2026; 13(2): 217. CrossRef
Impact of fragmented care on cancer outcomes among korean women with breast and cervical cancer: a focus on regional and economic disparities
Sun Jung Kim, Noorhee Son, Woo-Ri Lee, Dong-Woo Choi, Seojin Park, Kyu-Tae Han
International Journal for Equity in Health.2025;[Epub] CrossRef
Medical travel patterns for hepatocellular carcinoma treatment in South Korea: National Health Insurance data from 2013 to 2021
Sungmin Kim, Naeun Kim, Hyung-Sik Lee, Mina Kim, Hoseob Kim, Youngmin Choi
World Journal of Gastrointestinal Oncology.2025;[Epub] CrossRef

Evaluation of the accessibility and its equity of the national public-private mix program for tuberculosis in Korea: a multilevel analysis: Hyunjin Son, Changhoon Kim; Epidemiol Health. 2023;45:e2023002. Published online December 7, 2022; DOI: https://doi.org/10.4178/epih.e2023002

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
To examine the effect of individual and area-level characteristics on the probability of public-private mix (PPM) support (PPM coverage) for tuberculosis (TB).

METHODS

This study is a retrospective cohort design using TB reporting and treatment management data in Korea. We analyzed PPM coverage through multilevel logistic regression and empirical Bayesian estimation according to individual and area-level characteristics and their interaction.

RESULTS

Patients aged 0-29 years, women, of Korean nationality, treated at a general hospital, a one-time reporting, urban areas, and the lowest deprivation index (DI) showed higher PPM coverage. Due to the cross-level interaction, PPM coverage in the urban areas (slope=-0.048, p<0.001) had a higher level but a steeper negative deprivation gradient than in rural areas (slope= -0.015, p<0.001). For a general hospital, the PPM coverage in urban is high but more significantly decreased than in rural areas with the higher DI (urban: slope=-0.047, p<0.001; rural: slope=-0.031, p<0.001). For clinics and hospitals, the effect of DI did not appear in urban areas, but in rural areas, the higher the DI, the higher the PPM coverage with a slope of 0.046 (p<0.001) and 0.063 (p<0.001), respectively.

CONCLUSIONS

The PPM program created a significant disparity in PPM coverage between urban-rural areas and type of healthcare provider according to DI. Considering the high risk of TB incidence in areas with higher DI, institutional improvement and program redesign are needed to improve accessibility and equity.

Summary

Korean summary
다수준 분석을 통해 시행하여 PPM(Public-Private Mix) 사업의 주요한 평가 지표인 PPM coverage를 접근성과 형평성 관점에서 검토하였다. PPM 사업은 전반적으로 치료지원 수준을 높이는 효과가 있었지만, 도시화수준, 박탈 수준과 치료지원기관 선택의 3원 교차수준 교호작용의 결과로 지역간 PPM coverage에 지역박탈지수에 따른 큰 기울기를 가진 격차를 만들었다. 지역박탈수준이 큰 지역의 높은 결핵 발생 위험을 고려하면 효율성과 함께 형평성 수준을 향상시킬 수 있는 제도적 개선과 프로그램의 보완이 필요하다.

Key Message
This study analyzed the effect of individual and area-level characteristics on the probability of public-private mix (PPM) coverage for tuberculosis (TB) in Korea. The PPM program created a significant disparity in PPM coverage between urban-rural areas and type of healthcare provider according to deprivation index (DI). Given the high TB risk in areas with high DI, there is a need for institutional improvement and program redesign to improve accessibility and equity.

Citations

Citations to this article as recorded by

A structured approach to promote equity in spatial accessibility to TB services during private sector engagement
Y. Xiong, A.K. Millones, C.-C. Huang, E. Zavala-Abriojo, H. Campos, J. Jimenez, D.R. Jordan, L. Lecca, H.E. Jenkins, C.M. Yuen
IJTLD Open.2026; 3(4): 241. CrossRef
Impact of the private sector on spatial accessibility to chest radiography services in Lima, Peru
Y. Xiong, A.K. Millones, S. Farroñay, I. Torres, D. Acosta, D.R. Jordan, J. Jimenez, C. Wippel, H.E. Jenkins, L. Lecca, C.M. Yuen
IJTLD Open.2024; 1(3): 144. CrossRef

Spatial analysis of tuberculosis treatment outcomes in Shanghai: implications for tuberculosis control: Jing Zhang, Xin Shen, Chongguang Yang, Yue Chen, Juntao Guo, Decheng Wang, Jun Zhang, Henry Lynn, Yi Hu, Qichao Pan, Zhijie Zhang; Epidemiol Health. 2022;44:e2022045. Published online May 1, 2022; DOI: https://doi.org/10.4178/epih.e2022045

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Tuberculosis (TB) treatment outcomes are a key indicator in the assessment of TB control programs. We aimed to identify spatial factors associated with TB treatment outcomes, and to provide additional insights into TB control from a geographical perspective.

METHODS

We collected data from the electronic TB surveillance system in Shanghai, China and included pulmonary TB patients registered from January 1, 2009 to December 31, 2016. We examined the associations of physical accessibility to hospitals, an autoregression term, and random hospital effects with treatment outcomes in logistic regression models after adjusting for demographic, clinical, and treatment factors.

RESULTS

Of the 53,475 pulmonary TB patients, 49,002 (91.6%) had successful treatment outcomes. The success rate increased from 89.3% in 2009 to 94.4% in 2016. The successful treatment outcome rate varied among hospitals from 78.6% to 97.8%, and there were 12 spatial clusters of poor treatment outcomes during the 8-year study period. The best-fit model incorporated spatial factors. Both the random hospital effects and autoregression terms had significant impacts on TB treatment outcomes, ranking 6th and 10th, respectively, in terms of statistical importance among 14 factors. The number of bus stations around the home was the least important variable in the model.

CONCLUSIONS

Spatial autocorrelation and hospital effects were associated with TB treatment outcomes in Shanghai. In highly-integrated cities like Shanghai, physical accessibility was not related to treatment outcomes. Governments need to pay more attention to the mobility of patients and different success rates of treatment among hospitals.

Summary

Key Message
Tuberculosis treatment outcomes, a key indicator in the assessment of TB control programs, were associated with spatial autocorrelation and hospital effects in Shanghai; however, they were not associated with physical accessibility to hospitals.

Citations

Citations to this article as recorded by

Spatial Epidemiological Approach to Tuberculosis Treatment Outcomes in a Tertiary-Level Hospital: A Retrospective Analysis
Luis Del Moral Trinidad, Gilberto Silva Bañuelos, Esteban Gonzalez-Diaz, Melva Herrera Godina
Tropical Medicine and Infectious Disease.2026; 11(2): 57. CrossRef
Tuberculosis treatment outcomes and associated factors among patients treated at Bosaso TB Hospital, Bosaso, Somalia: A five-year retrospective study
Saaid Said Jama, Mohamed Mohamud Abdi, Rodney Adam
PLOS ONE.2025; 20(1): e0314693. CrossRef
Examining the efficacy of treatment outcomes for patients with pulmonary tuberculosis in Western China: A retrospective study in a region of high incidence
Jian Zhou, Jinlan Li, Yong Hu, Shijun Li
BMC Public Health.2025;[Epub] CrossRef
Geospatial analysis of shared risks for tuberculosis transmission in an urban cohort
Michael Asare-Baah, Tan M. Luong, Ernest Kwarteng, Charles Domotey, Nellie Arthur, Magalie Zoungrana, Sheila Mireku-Apah, Honesty Ganu, Michael Amo Omari, Adelaide Sackey, Awewura Kwara, Jane Sandra Afriyie-Mensah, Marie Nancy Séraphin
Scientific Reports.2025;[Epub] CrossRef

Prevalence and factors associated with non-use of health services in the Peruvian population with COVID-19 symptomatology: a secondary analysis of the 2020 National Household Survey: Akram Hernández-Vásquez, Fabriccio J. Visconti-Lopez, Diego Azañedo; Epidemiol Health. 2021;43:e2021084. Published online October 18, 2021; DOI: https://doi.org/10.4178/epih.e2021084

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Abstract Summary PDF

Abstract

OBJECTIVES
The objective of this study was to estimate the prevalence of non-use of health services (NUHS) and its associated factors in Peruvians with symptoms of coronavirus disease 2019 (COVID-19).

METHODS

A secondary analysis of the 2020 National Household Survey (ENAHO) was carried out. Participants over 18 years of age with any COVID-19 symptom (fever, cough, sensation of shortness of breath) in the last 4 weeks who did not visit health services were defined as exhibiting NUHS. Adjusted prevalence ratios (aPRs) were estimated to determine the factors associated with NUHS.

RESULTS

Data from 1,856 participants were analyzed; the prevalence of NUHS was 52.2% (95% confidence interval [CI], 48.0 to 56.5). Living in urban areas of the jungle (aPR, 1.61; 95% CI, 1.32 to 1.98; p<0.001) and rural areas of the jungle (aPR, 1.48; 95% CI, 1.15 to 1.90; p=0.002) was associated with a higher probability of NUHS than living in urban coastal areas. The factors associated with a lower probability of NUHS were being 50-59 years old (aPR, 0.72; 95% CI, 0.58 to 0.90) and 60 years and over (aPR, 0.74; 95% CI, 0.59 to 0.95), having a secondary educational level (aPR, 0.67; 95% CI, 0.48 to 0.93) or superior educational level (aPR, 0.67; 95% CI, 0.48 to 0.96), and having health insurance (aPR, 0.79; 95% CI, 0.68 to 0.92).

CONCLUSIONS

More than half of the participants with COVID-19 symptoms did not use health services, and NUHS was associated with the geographic and socio-demographic characteristics of the population. The formulation of health strategies and programs is required to increase the use of health services by people with COVID-19 symptoms.

Summary

Key Message
The objective of this study was to estimate the prevalence of non-use of health services (NUHS) and its associated factors in Peruvians with symptoms of coronavirus disease 2019 (COVID-19) in 2020. In the study, more than half of the participants with COVID-19 symptoms did not use health services, and NUHS was associated with the geographic and socio-demographic characteristics of the population. The formulation of health strategies and programs is required to increase the use of health services by people with COVID-19 symptoms, in the country with the highest mortality rate by this disease.

Citations

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Trends and Factors Associated with the Non-Use of Formal Health Services in Peru, 2015–2024
Miguel A. Arce-Huamani, Gustavo A. Caceres-Cuellar, Anyela Y. Guevara-Paz, Williams Carrascal-Astola, Maritza M. Ortiz-Arica, J. Smith Torres-Roman
International Journal of Environmental Research and Public Health.2026; 23(2): 183. CrossRef
Assessing health disparities faced by female paid domestic workers in Peru before, during, and after the COVID-19 pandemic
David Vera-Tudela, Maria Kathia Cárdenas, Ramón Díaz, Christopher Meaney, María Lazo-Porras, Viviana Cruzado, Archna Gupta, Janeth Tenorio-Mucha
International Journal for Equity in Health.2025;[Epub] CrossRef
Staying in or out? COVID-19-induced healthcare utilization avoidance and associated socio-demographic factors in rural India
Michael Safo Oduro, Prince Peprah, Anthony Kwame Morgan, Williams Agyemang-Duah
BMC Public Health.2023;[Epub] CrossRef
Chronic disease relapses: A cross-sectional study of the associated factors and socioeconomic inequalities during the COVID-19 pandemic in Peru
Fabriccio J. Visconti-Lopez, Akram Hernández-Vásquez, Dustin M. Solorzano-Salazar, Diego Azañedo, Ramune Jacobsen
PLOS ONE.2022; 17(9): e0274697. CrossRef
COVID-19 and drivers of excess death rate in Peru: A longitudinal ecological study
Kim N. Cajachagua-Torres, Hugo G. Quezada-Pinedo, Carlos A. Huayanay-Espinoza, Jordan A. Obeso-Manrique, Víctor A. Peña-Rodríguez, Elisa Vidal, Luis Huicho
Heliyon.2022; 8(12): e11948. CrossRef

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