Journal of Preventive Medicine and Public Health

The Korean Society for Preventive Medicine (대한예방의학회)
권호 표지

Trend of Socioeconomic Inequality in Participation in Cervical Cancer Screening among Korean Women

자궁경부암 검진 수검률의 불평등 추이

  • Jang, Soong-Nang (Institute of Health and Environment, Seoul National University) ;
  • Cho, Sung-Il (Graduate School of Public Health, Seoul National University) ;
  • Hwang, Seung-Sik (National Cancer Control Research Institute, Division of Cancer Prevention) ;
  • JungChoi, Kyung-Hee (Department of Occupational and Environmental Medicine, KyungHee Medical Center) ;
  • Im, So-Young (Department of Public Administration, College of Social Sciences, Ewha Womans University) ;
  • Lee, Ji-Ae (Graduate School of Public Health, Seoul National University) ;
  • KangKim, Min-Ah (Department of Public Administration, College of Social Sciences, Ewha Womans University)
  • 장숙랑 (서울대학교 보건환경연구소) ;
  • 조성일 (서울대학교 보건대학원) ;
  • 황승식 (국립암센터 국가암관리사업단 암예방사업부) ;
  • 정최경희 (경희의료원 산업의학과) ;
  • 임소영 (국립암센터 국가암관리사업단 암예방사업부) ;
  • 이지애 (서울대학교 보건대학원) ;
  • 강민아 (이화여자대학교 행정학과)
  • Published : 2007.11.30
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Abstract

Objectives : While cervical cancer is one of the leading cancers among women worldwide, there are a number of effective early detection tests available. However, the participation rates in cervical cancer screening among Korean women remain low. After the nationwide efforts in 1988 and thereafter to encourage participation in cervical cancer screening, few studies have investigated the effects of socioeconomic inequality on participation in cervical cancer screening. The purpose of this study was to investigate 1) the level of socioeconomic disparities in receiving cervical cancer screening by age group and 2) if there was an improvement in reducing these disparities between 1995 and 2001. Methods : Using data from the Korean National Health Status, Health Behavior and Belief Survey in 1995, the Korean National Health and Nutrition Examination Surveys from 1998 and 2001 (sample sizes of 2,297, 3,738, and 3,283), age-standardized participation rates were calculated according to education level, equivalized household income, and job status. Odds ratios and the relative inequality index (RII) were also calculated after controlling for age. Results : Women with lower education levels were less likely to attend the screening test, and the disparities by education level were most pronounced among women aged 60 years and older. The RIIs among women 60 years and older were 3.64, 4.46, and 8.64 in 1995, 1998, and 2001, respectively. Higher rates of participation were reported among those in the highest income category, which was more notable among the middle aged women (40s and 50s). An inconsistent trend in the rate of participation in cervical cancer screening by occupational level was found. Conclusions : Indicators of socioeconomic position seem to have varying impacts on the inequalities in the rates of participation in cervical cancer screening according to age group. These results demonstrate the need for more aggressive and age-based interventions and policy programs to eliminate the remaining inequalities.

Keywords

References

  1. Korea National Statistic Office. Annual report of the cause of death statistics 2005. [cited 2007 Sep 25]; Available from: URL:http://www.kosis.kr (Korean)
  2. Korea Central Cancer Registry, Ministry of Health and Welfare. 2002 Annual Report of the Korea Central Cancer Registry (Based on Registered Data from 139 Hospitals). Korea Central Cancer Registry; 2003. p. 46 (Korean)
  3. Ministry of Health and Welfare. Cancer Incidence in Korea (1999-2001). Ministry of Health and Welfare; 2005. p. 37 (Korean)
  4. Bradley CJ, Given CW, Roberts CR. Health care disparities and cervical cancer. Am J Public Health 2004; 94(12): 2098-2103 https://doi.org/10.2105/AJPH.94.12.2098
  5. Selvin E, Brett KM. Breast and cervical cancer screening: Sociodemographic predictors among white, black, and hispanic women. Am J public Health 2003; 93(4): 618-623 https://doi.org/10.2105/AJPH.93.4.618
  6. Fukuda Y, Nakamura K, Takano T. Reduced likelihood of cancer screening among women in urban areas and with low socio-economic status: A multilevel analysis in Japan. Public Health 2005; 119(10): 875-884 https://doi.org/10.1016/j.puhe.2005.03.013
  7. Coughlin SS, Uhler RJ. Breast and cervical cancer screening practices among hispanic women in the United States and Puerto Rico, 1998-1999. Prev Med 2002; 34(2): 242-251
  8. Maxwell CJ, Bancej CM, Snider J, Vik SA. Factors important in promoting cervical cancer screening among Canadian women: Findings from the 1996-97 national population health survey. Can J Public Health 2001; 92(2): 127-133
  9. Siahpush M, Singh GK. Sociodemographic predictors of pap test receipt currency and knowledge among Australian women. Prev Med 2002; 35(4): 362-368 https://doi.org/10.1006/pmed.2002.1086
  10. Rutton LJF, Nelson DE, Meissner HI. Examination of population-wide trends in barriers to cancer screening from a diffusion of innovation perspective (1987-2000). Prev Med 2004; 38(3): 258-268 https://doi.org/10.1016/j.ypmed.2003.10.011
  11. Baker D, Middleton E. Cervical screening and health inequality in England in the 1990s. J Epidemiol Community Health 2003; 57(6): 417-423 https://doi.org/10.1136/jech.57.6.417
  12. Choi KS, Lee DH, Jung KY, Son J, Jang TW, Kim YK, Shin HR. Factors associated with cervical cancer screening in Busan, Korea. J Prev Med Public Health 2004; 37(2): 166-173 (Korean)
  13. Kim JH. Barrier factors to pap smear screening test utilization in Korea. Health Soc Sci 1998; 4(1): 55-73 (Korean)
  14. Cheon KS, Jun TH, Jeong TH, Hwang HH, Sung S, Kim YS. A comparison of cervicar cancer screening rate and recognition between urban and rural area. Korean J Health Promot Dis Prev 2002; 2(1): 34-44 (Korean)
  15. Park CY, Kim JW. The Change of Poverty and Income Inequality Level during Economic Crisis and Counter Policies in Korea. Korea Institute for Health and Social Affairs; 1999 (Korean)
  16. Jung JH, Hwang DS, Lee BH, Choi KS. Current Status of Income Inequality and Poverty and Counter Policies in Korea. Korea Labor Institute; 2002 (Korean)
  17. Khang YH, Kim HR. Socioeconomic Mortality Inequality in Korea: Mortality Follow-up of the 1998 National Health and Nutrition Examination Survey(NHANES) Data. J Prev Med Public Health 2006; 39(2): 115-122 (Korean)
  18. Mackenbach JP, Kunst AE. Measuring the magnitude of socio-economic inequalities in health: An overview of available measures illustrated with two examples from Europe. Soc Sci Med 1997; 44(6): 757-771 https://doi.org/10.1016/S0277-9536(96)00073-1
  19. Wardle J, McCaffery K, Nadel M, Atkin W. Socioeconomic differences in cancer screening participation: Comparing cognitive and psychosocial explanation. Soc Sci Med 2004; 59(2): 249-261 https://doi.org/10.1016/j.socscimed.2003.10.030
  20. Chun EJ, Jang SN, Cho SI, Cho YT, Moon OR. Disparities in the participation of Health Examination by Socio-economic Position among adult Seoul residents. J Prev Med Public Health 2007; 40(5): 313-320 (Korean) https://doi.org/10.3961/jpmph.2007.40.4.313
  21. Eaker S, Adami H, Sparen P. Reasons women do not attend screening for cervical cancer: A population-based study in Sweden. Prev Med 2001; 32(6): 482-491 https://doi.org/10.1006/pmed.2001.0844
  22. Maxwell AE, Bastani R, Warda US. Demographic predictors of cancer screening among Filipino and Korean immigrants in the United States. Am J Prev Med 2000; 18(1): 62-68 https://doi.org/10.1016/S0749-3797(99)00110-5
  23. O'Malley AS, Forrest CB, Mandelblatt J. Adherence of low-income women to cancer screening recommendations. J Gen Intern Med 2002; 17(2): 144-154 https://doi.org/10.1046/j.1525-1497.2002.10431.x
  24. Sawaya GF, Grady D, Kerlikowske K, Valleur JL, Barnabel VM, Bass K, Snyder TE, Picker JH, Agawal SK, Mandelblatt JM. The positive predictive value of cervical smears in previously screened postmenopausal women: The Heart and Estrogen/progestin Replacement Study(HERS). Ann Intern Med 2000; 133(12): 942-950 https://doi.org/10.7326/0003-4819-133-12-200012190-00009
  25. Mandelblatt JS, Gold K, O'Malley A, Taylor K, Cagney K, Hopkins JS, Kerner J. Breast and cervix cancer screening among multiethnic women: role of age, health, and source of care. Prev Med 1999; 28(4): 418-425 https://doi.org/10.1006/pmed.1998.0446
  26. McPhee SJ, Nguyen TT, Shema SJ, Nguyen B, Somkin C, Vo P, Pasick R. Validation of recall of breast and cervical cancer screening by women in an ethnically diverse population. Prev Med 2002; 35(5): 463-473 https://doi.org/10.1006/pmed.2002.1096
  27. Gordon HP, Hiatt RA, Lampert DI. Concordance or self-reported data and medical record audit for six cancer screening procedures. J Natl Cancer Ins 1993; 85(7): 566-570 https://doi.org/10.1093/jnci/85.7.566