有组织和机会性乳腺癌筛查中的社会经济不平等：2009-2021年韩国国家癌症筛查调查结果

IF 2.2 4区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Epidemiology and Health Pub Date : 2025-05-30 DOI:10.4178/epih.e2025031

Yejin Ha, Xuan Quy Luu, Woorim Kim, Jae Kwan Jun, Mina Suh, Kui Son Choi

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引用次数: 0

摘要

目的：自韩国引入国家癌症筛查计划（NCSP）以来，乳腺癌筛查率有所提高。然而，目前尚不清楚社会经济不平等是否有所改善，特别是根据筛查类型。本研究调查了按教育和收入水平分层的有组织（政府主导）和机会主义（个人发起）筛查中的不平等现象。方法：数据来自韩国国家癌症筛查调查，从2009年到2021年每年进行一次，除2009年外，每年约有1700名妇女参与。趋势分析采用连接点回归计算平均年百分比变化（AAPCs）。采用不平等斜率指数（SII）和相对不平等指数（RII）评估社会经济不平等。结果：组织筛查率由2009年的42.0%上升至2021年的60.2% (AAPC, 1.9；95%可信区间[CI]， 0.7-3.4)，而机会性筛查率从13.3%下降到11.2% (AAPC, -5.4；95% CI, -8.7 ~ -2.3)。在组织筛查中，受教育程度越低的个体参与度越高，导致不平等指数为负(SII, -5.37%；RII, 0.80)。没有发现显著的收入不平等(SII, 1.60；RII, 1.07)。然而，机会性筛查在教育方面表现出显著的不平等(SII, 5.37%；RII, 1.92)和收入(SII, 5.90%；RII, 1.96)，在更有利的群体中，参与率更高。结论：NCSP提高了乳腺癌筛查率，减少了有组织筛查中与收入相关的不平等。然而，在机会性筛查中，教育和收入方面的不平等仍然存在。为减少筛查不公平现象，需要采取政策措施进一步推动国家健康保障计划，包括提高项目质量和为后续检查提供资金支持。

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

Objectives: Breast cancer screening rates have increased since the introduction of the National Cancer Screening Program (NCSP) in Korea. However, it remains unclear whether socioeconomic inequalities have improved, particularly according to screening type. This study investigated inequalities in organized (government-led) and opportunistic (individually initiated) screening, stratified by education and income levels.

Methods: Data were obtained from the Korean National Cancer Screening Survey, conducted annually from 2009 to 2021, involving approximately 1,700 women each year except in 2009. Trends were analyzed using joinpoint regression to calculate average annual percent changes (AAPCs). Socioeconomic inequalities were assessed using the slope index of inequality (SII) and relative index of inequality (RII).

Results: Organized screening rates increased from 42.0% in 2009 to 60.2% in 2021 (AAPC, 1.9; 95% confidence interval [CI], 0.7-3.4), whereas opportunistic screening rates declined from 13.3% to 11.2% (AAPC, -5.4; 95% CI, -8.7 to -2.3). For organized screening, individuals with lower education levels exhibited higher participation, resulting in negative inequality indices (SII, -5.37%; RII, 0.80). No significant income-based inequality was found (SII, 1.60; RII, 1.07). However, opportunistic screening demonstrated significant inequalities by both education (SII, 5.37%; RII, 1.92) and income (SII, 5.90%; RII, 1.96), with higher participation rates among more advantaged groups.

Conclusion: The NCSP has improved breast cancer screening rates and reduced income-related inequality in organized screening. However, educational and income-based inequalities persist in opportunistic screening. To reduce screening inequities, policy efforts are needed to further promote the NCSP, including improving program quality and providing financial support for follow-up examinations.

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来源期刊

Epidemiology and Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

6.30

自引率

2.60%

发文量

106

审稿时长

4 weeks

期刊介绍： Epidemiology and Health (epiH) is an electronic journal publishing papers in all areas of epidemiology and public health. It is indexed on PubMed Central and the scope is wide-ranging: including descriptive, analytical and molecular epidemiology; primary preventive measures; screening approaches and secondary prevention; clinical epidemiology; and all aspects of communicable and non-communicable diseases prevention. The epiH publishes original research, and also welcomes review articles and meta-analyses, cohort profiles and data profiles, epidemic and case investigations, descriptions and applications of new methods, and discussions of research theory or public health policy. We give special consideration to papers from developing countries.