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4 "Healthcare disparities"
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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
  • 5,620 View
  • 126 Download
AbstractAbstract AbstractSummary PDFSupplementary 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.
Decentralized pandemic response and health equity: an analysis of socioeconomic disparities in COVID-19 mortality in Japan
Hasan Jamil, Aminu Abubakar Kende, Shuhei Nomura, Fumiya Inoue, Takao Suzuki, Stuart Gilmour
Epidemiol Health. 2025;47:e2025049.   Published online August 28, 2025
DOI: https://doi.org/10.4178/epih.e2025049
  • 8,976 View
  • 109 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Global data often link greater socioeconomic deprivation to higher coronavirus disease 2019 (COVID-19) mortality. However, whether decentralized governance can mitigate this disparity by enabling tailored, equitable local responses remains unclear. We assessed whether Japan’s decentralized pandemic response moderated the association between area-level socioeconomic deprivation and COVID-19 mortality across municipalities.
METHODS
We analyzed 20,760 COVID-19 deaths from all Japanese municipalities during 2020-2021. We computed standardized mortality ratios using national age-specific and sex-specific rates to derive expected counts. We then fit a Bayesian spatial Poisson regression model with the log of expected counts as an offset to estimate smoothed relative risks (RRs). The Area Deprivation Index (ADI) represented the primary predictor; structured and unstructured random effects captured spatial correlation and residual variability.
RESULTS
Mapping of smoothed RRs, categorized into quintiles, revealed higher mortality risk in northern, central, and western municipalities, with lower risk in southern and scattered central regions. Contradicting global trends, deprivation and COVID-19 mortality demonstrated an inverse association (ADI coefficient, -0.095; 95% credible interval, -0.173 to -0.018), indicating that more deprived municipalities exhibited lower RRs for COVID-19 mortality (9.1% reduction per 1-unit increase in ADI).
CONCLUSIONS
The inverse relationship between area deprivation and COVID-19 mortality in Japan contrasts with global patterns. Although Japan’s decentralized health system ensured equitable access to COVID-19 treatment, lower mortality in more deprived areas likely reflects additional protective factors, including population density patterns and community-specific adaptations. These findings underscore the complex interplay between socioeconomic conditions and health outcomes during global health emergencies.
Summary
Key Message
Japan exhibited an inverse COVID-19 mortality pattern: 9% lower risk per unit increase in area deprivation, contrasting with patterns elsewhere. This occurred where universal healthcare access and decentralized public health infrastructure operated in a geographic context of rural, lower-density deprived areas. The convergence of health system characteristics, population distribution, and social factors likely produced this divergence from typical pandemic inequities.
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
  • 17,412 View
  • 106 Download
  • 3 Web of Science
  • 4 Crossref
AbstractAbstract AbstractSummary PDFSupplementary 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
  • Implementation of decentralized clinical trials in Korea from a resource-based perspective
    Ki Young Huh, Gaeun Kang, Kye Hun Kim
    Translational and Clinical Pharmacology.2026; 34(2): 100.     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
Trends and disparities in avoidable, treatable, and preventable mortalities in South Korea, 2001-2020: comparison of capital and non-capital areas
Sang Jun Eun
Epidemiol Health. 2022;44:e2022067.   Published online August 16, 2022
DOI: https://doi.org/10.4178/epih.e2022067
  • 29,598 View
  • 366 Download
  • 19 Web of Science
  • 20 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study aimed to describe the regional avoidable mortality trends in Korea and examine the trends in avoidable mortality disparities between the Seoul Capital Area and non-Seoul-Capital areas, thereby exploring the underlying reasons for the trend changes.
METHODS
Age-standardized mortality rates from avoidable causes between 2001-2020 were calculated by region. Regional disparities in avoidable mortality were quantified on both absolute and relative scales. Trends and disparities in avoidable mortality were analyzed using joinpoint regression models.
RESULTS
Avoidable, treatable, and preventable mortalities in Korea decreased at different rates over time by region. The largest decreases were in the non-Seoul-Capital non-metropolitan area for avoidable and preventable mortality rates and the non-Seoul- Capital metropolitan area for treatable mortality rates, despite the largest decline being in the Seoul Capital Area prior to around 2009. Absolute and relative regional disparities in avoidable and preventable mortalities generally decreased. Relative disparities in treatable mortality between areas widened. Regional disparities in all types of mortalities tended to improve after around 2009, especially among males. In females, disparities in avoidable, treatable, and preventable mortalities between areas improved less or even worsened.
CONCLUSIONS
Trends and disparities in avoidable mortality across areas in Korea seem to have varied under the influence of diverse social changes. Enhancing health services to underserved areas and strengthening gender-oriented policies are needed to reduce regional disparities in avoidable mortality.
Summary
Korean summary
2001년부터 2020년까지 회피가능, 예방가능 사망률의 수도권과 비수도권 대도시, 비수도권 비대도시 지역 간 절대적, 상대적 격차는 대체로 감소했지만, 치료가능 사망률의 상대적 격차는 커졌다. 회피가능, 치료가능, 예방가능 사망률의 지역 간 격차는 2009년경 이후에 특히 남성에서 개선됐지만, 여성의 경우 덜 개선되거나 오히려 악화되기도 했다.
Key Message
Regional disparities in avoidable, treatable, and preventable mortalities tended to improve after around 2009, especially among males, but, in females, disparities in all types of mortalities between areas improved less or even worsened.

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
  • Spatial Inequality, Community Social Capital, and Age-Differentiated Health Vulnerabilities Among the Elderly in South Korea: A Hierarchical Linear Modeling Approach
    Yoonjin Lee
    Healthcare.2026; 14(11): 1538.     CrossRef
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    Yujin Lee, Dong-Uk Kim
    Pediatric Emergency Medicine Journal.2026; 13(3): 93.     CrossRef
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    Younggyu Ko, Jung-Hyun Lee
    Journal of Epidemiology and Community Health.2026; : jech-2026-226623.     CrossRef
  • Is avoidable diabetes-related hospitalization in older patients with type 2 diabetes mellitus associated with increased health expenditure?: A nationwide retrospective cohort study in South Korea
    Woo-Ri Lee, Gyeong-Min Lee, Noorhee Son, Kyu-Tae Han, Sungyoun Chun, Yehrhee Son, Ki-Bong Yoo
    Preventive Medicine Reports.2025; 49: 102946.     CrossRef
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    Hajae Jeon, Jeahyung Lee, Jieun Jang, Mingee Choi, Junbok Lee, Jaeyong Shin
    Journal of Medical Internet Research.2025; 27: e65304.     CrossRef
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    Eunji Kim, Heeyeun Yoon
    Sustainable Cities and Society.2025; 132: 106810.     CrossRef
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    Kyungsik Kim, Ho Kyung Sung, Kyung-Shin Lee, Eunyoung Kim, Hansu Shin, Hye Sook Min
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    Youngsoo Kim, Dougho Park, Haemin Kim, Dahyeon Koo, Sukkyoung Lee, Yejin Min, Daeyoung Hong, Mun-Chul Kim
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    Jieun Jang, Wonyoung Choi, Sung Hoon Sim, Sokbom Kang
    Epidemiology and Health.2023; 46: e2024006.     CrossRef
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