Income Disparities in Cancer Screening: A Cross-Sectional Study of the Korean National Health and Nutrition Examination Survey, 2013–2019

Rajaguru, Vasuki; Kim, Tae Hyun; Shin, Jaeyong; Lee, Sang Kyu

doi:10.3389/fpubh.2022.820643

Cited by 9 publications

(12 citation statements)

References 28 publications

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“…44 However, the lower income group showed a higher cancer-specific mortality rate for most cancers, which could result from poorer access to screening and appropriate treatment, leading to a higher proportion of late-stage cases. 45,46 We found that individuals with unhealthy lifestyles had poorer health outcomes, as in previous studies. 27,28 Multiple unhealthy behaviors (including smoking, alcohol drinking, physical inactivity, unhealthy diet, abnormal sleep duration, and television viewing time) were found to be strongly associated with CVDs and all-cause mortality 28 ; in addition, healthy lifestyle (non-smoking, non-drinking, physical activity, maintaining a healthy diet, and a waist-to-hip ratio <0.90 for men and <0.85 for women) reduced liver cancer risk by 43% in the Chinese.…”

Section: Discussionsupporting

confidence: 81%

Individual and joint effect of socioeconomic status and lifestyle factors on cancer in Korea

Tran,

Choi,

Kim

et al. 2023

Cancer Medicine

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BackgroundThere is limited evidence on the individual and joint effect of socioeconomic status (SES) and unhealthy lifestyle on cancer. Therefore, this study aimed to examine the effects of these factors on cancer incidence and mortality.MethodsIn this population‐based cohort study, income was used as the proxy of SES. A combined unhealthy lifestyle score was obtained using data on smoking, alcohol consumption, physical activity, and body mass index. Hazard ratios were estimated using a Cox proportional hazards model.ResultsThe study included data on 8,353,169 participants (median follow‐up period, 17 years). Although the association between low income and cancer incidence varied depending on cancer type, low income consistently increased the risk of cancer‐related death with a social gradient. Unhealthy behaviors increased the risk of cancer incidence and mortality, except for thyroid and breast cancer in women and prostate cancer in men. Compared with the wealthiest and healthiest individuals, the poorest and unhealthiest men and women showed 2.1‐fold (2.05–2.14) and 1.36‐fold (1.31–1.41) higher risk of cancer‐related death, respectively. The joint effect was most robust for lung, liver, head, and neck cancers in men and liver and cervical cancers in women; further, the effect was stronger with cancer‐specific mortality than with incidence.ConclusionIn conclusion, income and combined healthy lifestyle behaviors have individual and joint effects on cancer incidence and mortality. The effect varies by cancer type and sex.

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Section: Discussionsupporting

confidence: 81%

Individual and joint effect of socioeconomic status and lifestyle factors on cancer in Korea

Tran,

Choi,

Kim

et al. 2023

Cancer Medicine

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“…This finding reflects disparities in cancer screening participation among people from lower income communities. [28][29][30][31] Other studies in a range of populations have found similar associations between stage at diagnosis for cancers with screening programs and SES, particularly for colorectal cancer 20,32,33 and breast cancer. 20,34,35 These disparities exist even in countries with publicly funded health coverage because financial concerns may affect when and whether individuals with lower incomes access health services.…”

Section: Discussionmentioning

confidence: 73%

The association between neighborhood‐level income and cancer stage at diagnosis and survival in Alberta

Ruan,

Heer,

Warkentin

et al. 2023

Cancer

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BackgroundSocioeconomic status (SES) is associated with a range of health outcomes, including cancer diagnosis and survival. However, the evidence for this association is inconsistent between countries with and without single‐payer health care systems. In this study, the relationships between neighborhood‐level income, cancer stage at diagnosis, and cancer‐specific mortality in Alberta, Canada, were evaluated.MethodsThe Alberta Cancer Registry was used to identify all primary cancer diagnoses between 2010 and 2020. Average neighborhood income was determined by linking the Canadian census to postal codes and was categorized into quintiles on the basis of income distribution in Alberta. Multivariable multinomial logistic regression was used to model the association between income quintile and stage at diagnosis, and the Fine–Gray proportional subdistribution hazards model was used to estimate the association between SES and cancer‐specific mortality.ResultsOut of the 143,818 patients with cancer included in the study, those in lower income quintiles were significantly more likely to be diagnosed at stage III (odds ratio [OR], 1.07; 95% CI [confidence interval], 1.06–1.09) or IV (OR, 1.12; 95% CI, 1.11–1.14) after adjusting for age and sex. Lower income quintiles also had significantly worse cancer‐specific survival for breast, colorectal, liver, lung, non‐Hodgkin lymphoma, oral cavity, pancreas, and prostate cancers.ConclusionsDisparities were observed in cancer outcomes across neighborhood‐level income groups in Alberta, which demonstrates that health inequities by SES exist in countries with single‐payer health care systems. Further research is needed to better understand the underlying causes and to develop strategies to mitigate these disparities.

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“…Finally, the study population was included in the national cancer screening program. Considering the different characteristics of people who underwent cancer screening and those who did not receive cancer screening, the results based on participants in the national cancer screening program would be affected by selection bias 35 . However, when we compared cancer incidence rates in our study population with the Korean national cancer statistics, the incidence rates were comparable, suggesting minimal selection bias.…”

Section: Discussionmentioning

confidence: 90%

Increased risk of pancreatic, thyroid, prostate and breast cancers in men with a family history of breast cancer: A population‐based study

Song

Jung

Tran

et al. 2023

Intl Journal of Cancer

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The association between a family history of breast cancer (FHBC) in female first‐degree relatives (FDRs) and cancer risk in men has not been evaluated. This study aimed to compare the risks of overall and site‐specific cancers in men with and without FHBC. A population‐based study was conducted with 3 329 106 men aged ≥40 years who underwent national cancer screening between 2013 and 2014. Men with and without FHBC in their female FDRs were age‐matched in a 1:4 ratio. Men without FHBC were defined as those without a family history of any cancer type in their FDRs. Data from 69 124 men with FHBC and 276 496 men without FHBC were analyzed. The mean follow‐up period was 4.7 ± 0.9 years. Men with an FHBC in any FDR (mother or sister) had a higher risk of pancreatic, thyroid, prostate and breast cancers than those without an FHBC (adjusted hazard ratios [aHRs] (95% confidence interval [CI]): 1.35 (1.07‐1.70), 1.33 (1.12‐1.56), 1.28 (1.13‐1.44) and 3.03 (1.130‐8.17), respectively). Although an FHBC in any one of the FDRs was not associated with overall cancer risk, FHBC in both mother and sibling was a significant risk factor for overall cancer (aHR: 1.69, 95% CI:1.11‐2.57) and increased the risk of thyroid cancer by 3.41‐fold (95% CI: 1.10‐10.61). FHBC in the mother or sister was a significant risk factor for pancreatic, thyroid, prostate and breast cancers in men; therefore, men with FHBC may require more careful BRCA1/2 mutation‐related cancer surveillance.

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Income Disparities in Cancer Screening: A Cross-Sectional Study of the Korean National Health and Nutrition Examination Survey, 2013–2019

Cited by 9 publications

References 28 publications

Individual and joint effect of socioeconomic status and lifestyle factors on cancer in Korea

Individual and joint effect of socioeconomic status and lifestyle factors on cancer in Korea

The association between neighborhood‐level income and cancer stage at diagnosis and survival in Alberta

Increased risk of pancreatic, thyroid, prostate and breast cancers in men with a family history of breast cancer: A population‐based study

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