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. 2023:45:e2023086.
doi: 10.4178/epih.e2023086. Epub 2023 Sep 17.

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

Xuan Quy Luu  1 , Kyeongmin Lee  1 , Jae Kwan Jun  2 , Mina Suh  2 , Kui Son Choi  1
Affiliations

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

Xuan Quy Luu et al. Epidemiol Health. 2023.

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.

Keywords: Colorectal cancer; Health inequities; Healthcare disparity; Mass screening.

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Conflict of interest statement

CONFLICT OF INTEREST

The authors have no conflicts of interest to declare for this study.

Figures

Figure 1.
Figure 1.
Screening rate for colorectal cancer by screening type from 2009 to 2021.
Figure 2.
Figure 2.
Absolute and relative educational inequalities in organized (A, B) and opportunistic (C, D) colorectal cancer screening from 2009 to 2021. SII, slope index of inequality; RII, relative index of inequality; CI, confidence interval.
Figure 3.
Figure 3.
Absolute and relative income inequalities in organized (A, B) and opportunistic (C, D) colorectal cancer screening from 2009 to 2021. SII, slope index of inequality; RII, relative index of inequality; CI, confidence interval.
None
See this image and copyright information in PMC

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