• Asian Pacific Journal of Cancer Prevention
• /
• v.16 no.17
• /
• pp.7401-7407
• /
• 2015

Cervical cancer continues to be a serious public health problem in the developing world, including China. Because of its large population with geographical and socioeconomic inequities, China has a high burden of cervical cancer and important disparities among different regions. In this review, we first present an overview of the cervical cancer incidence and mortality over time, and focus on diversity and disparity in access to care for various subpopulations across geographical regions and socioeconomic strata in China. Then, we describe population-based cervical cancer screening in China, and in particular implementation of the National Cervical Cancer Screening Program in Rural Areas (NACCSPRA) and the challenges that this program faces. These include low screening coverage, shortage of qualified health care personnel and limited funds. To improve prevention of cervical cancer and obtain better cancer outcomes, the Chinese government needs to urgently consider the following key factors: reducing disparities in health care access, collecting accurate and broadly representative data in cancer registries, expanding target population size and increasing allocation of government funding for training of personnel, improving health education for women, enhancing quality control of screening services and improving a system to increase follow up for women with positive results.

• Asian Pacific Journal of Cancer Prevention
• /
• v.17 no.1
• /
• pp.347-352
• /
• 2016

Background: This study used receiver operating characteristic curve to analyze Surveillance, Epidemiology and End Results (SEER) adenosquamous carcinoma data to identify predictive models and potential disparities in outcome. Materials and Methods: This study analyzed socio-economic, staging and treatment factors available in the SEER database for adenosquamous carcinoma. For the risk modeling, each factor was fitted by a generalized linear model to predict the cause specific survival. An area under the receiver operating characteristic curve (ROC) was computed. Similar strata were combined to construct the most parsimonious models. Results: A total of 20,712 patients diagnosed from 1973 to 2009 were included in this study. The mean follow up time (S.D.) was 54.2 (78.4) months. Some 2/3 of the patients were female. The mean (S.D.) age was 63 (13.8) years. SEER stage was the most predictive factor of outcome (ROC area of 0.71). 13.9% of the patients were un-staged and had risk of cause specific death of 61.3% that was higher than the 45.3% risk for the regional disease and lower than the 70.3% for metastatic disease. Sex, site, radiotherapy, and surgery had ROC areas of about 0.55-0.65. Rural residence and race contributed to socioeconomic disparity for treatment outcome. Radiotherapy was underused even with localized and regional stages when the intent was curative. This under use was most pronounced in older patients. Conclusions: Anatomic stage was predictive and useful in treatment selection. Under-staging may have contributed to poor outcome.

• Journal of Preventive Medicine and Public Health
• /
• v.55 no.4
• /
• pp.371-378
• /
• 2022

Objectives: No studies have examined the association between preterm birth rates and socioeconomic factors in Japan using nationwide statistical data. We analyzed the association between preterm birth rates and household occupation using Vital Statistics data. Methods: Aggregated Vital Statistics data from Japan from 2007 to 2019 were obtained from the Ministry of Health, Labour and Welfare. From the data, the number of births according to year, age group, gestational period, number of pregnancies, and household occupation were used in this study. Crude preterm birth rates and preterm birth rates adjusted by maternal age according to household occupation were calculated for each year. Poisson regression analysis was conducted to evaluate the association between household occupation and preterm births. Results: Unemployed households had the highest preterm birth rate, and households with an occupation classification of "full-time worker 2" (an employee at a large company, civil servant, or board member) had the lowest preterm birth rate throughout each period. Poisson regression analysis revealed that unemployed households were statistically significantly associated with a high preterm birth risk. In contrast, the preterm birth rate adjusted by maternal age remained stable throughout each period regardless of household occupation, and preterm birth rates were found not to have increased in recent years in Japan. Conclusions: Unemployed households had higher preterm birth rates than other household occupations. Further studies investigating the characteristics of unemployed households are needed to identify the reasons for this disparity.

• The Korean Journal of Health Service Management
• /
• v.6 no.4
• /
• pp.13-25
• /
• 2012

There is growing evidence that substance use such as tobacco or alcohol consumption influences health disparity among adolescents. Previous research papers have shown an inconsistency in the relationship between socio-economic status (SES) and substance use in adolescents. However, little is known about socio-economic differences in unhealthy behaviors among Korean adolescents. The purpose of the present study is to explore associations between SES and substance use in Korean adolescents. The analysis was performed using data from the 2009 Korean Youth Risk Behavior Web-based Survey (YRBS), which included a nationally representative sample of middle and high school students. Drinking/heavy drinking and smoking/daily smoking behavior indices were used for dependent variables, and perceived economic status, family affluence score, parents' education were used for independent variables. Chi-square test were used to compare tobacco and alcohol consumption among 3 SES groups. Logistic regression models were used to identify statistically significant socio-economic factors after adjusting other covariates. Higher perceived economic status and higher family affluence were associated with higher rates of smoking, daily smoking, drinking, and heavy drinking, while lower level of parents' education was related to higher use of tobacco and alcohol. Socio-economic status significantly influences health behaviors in adolescents, and it may consequently affect health disparity in their adulthood. Therefore, there is a need of continuous monitoring and follow-up research of health disparity among adolescents.

• Journal of the Korean Regional Science Association
• /
• v.36 no.3
• /
• pp.3-16
• /
• 2020

The causes and effects of intra-urban spatial inequality have received much scholarly attention. However, the effects of urban spatial inequality on resident perceptions and the mechanisms through which it is sustained and reproduced remain mostly unknown. This study aimed to investigate whether regional deprivation, the relative socioeconomic standing of a region, affects the residents' perceptions of upward social mobility. By employing the ordinal logistic multilevel model to analyze nested data collected from Seoul, South Korea, this study found that the regional deprivation has a significant negative effect on residents' perception of upward social mobility. The results of this study suggest that one way in which spatial inequality is sustained and reproduced is by the effects of regional deprivation, having negative impacts on the aspirations and socioeconomic activities of residents. This study is expected to provide meaningful implications for planning and policy aimed to combat spatial inequality.

• Journal of dental hygiene science
• /
• v.14 no.2
• /
• pp.207-213
• /
• 2014

How to eliminate health disparity to ensure health equity is one of major issues that are handled across the world. The purpose of this study was to examine any possible differences in self-rated oral health state according to socioeconomic status and the relationship between the two based on the data of the 5th National Health & Nutrition Examination Survey of 2010~2012. As for differences in self-rated oral health state according to sociodemographic characteristics, the women considered themselves to be in poorer oral health than the men. The older respondents found themselves to be in poorer oral health, and there was a tendency that the respondents who were less educated and whose household income was smaller rated their own health as worse. When a logistic regression analysis was made to determine influential factors for self-rated oral health status, the women perceived they were in better oral health than the men did, and the better-educated respondents were more likely to consider themselves healthier. Concerning disparities in self-rated health state according to income level, there were broader differences in that regard according to an increase of income. The findings of the study illustrated that there was oral health inequity according to social stratum. It's required to make a nationwide effort to promote national oral health, and appropriate support should especially be provided for disadvantaged people at the same time in order to get rid of the gap in oral health among different social classes, as there is a yawning gap between them and the other classes.

• Asian Pacific Journal of Cancer Prevention
• /
• v.14 no.4
• /
• pp.2259-2263
• /
• 2013

Background: Public use National Health and Nutrition Examination Survey (NHANES III) and NHANES III linked mortality data were here applied to investigate the association between health insurance coverage and all cause and all cancer mortality in adults. Patients and Methods: NHANES III household adult, laboratory and mortality data were merged. Only patients examined in the mobile examination center (MEC) were included in this study. The sampling weight employed was WTPFEX6, SDPPSU6 being used for the probability sampling unit and SDPSTRA6 to designate the strata for the survey analysis. All cause and all cancer mortalities were used as binary outcomes. The effect of health insurance coverage status on all cause and all cancer mortalities were analyzed with potential socioeconomic, behavioral and health status confounders. Results: There were 2398 sample persons included in this study. The mean age was 40 years and the mean (S.E.) follow up was 171.85 (3.12) person months from the MEC examination. For all cause mortality, the odds ratios (significant p-values) of the covariates were: age, 1.0095 (0.000); no health insurance coverage (using subjects with health insurance), 1.71 (0.092); black race (using non-Hispanic white subjects as the reference group) 1.43, (0.083); Mexican-Americans, 0.60 (0.089); DMPPIR, 0.82, (0.000); and drinking hard liquor, 1.014 (0.007). For all cancer mortality, the odds ratio (significant p-values) of the covariates were: age, 1.0072 (0.00); no health insurance coverage, using with health coverage as the reference group, 2.91 (0.002); black race, using non-Hispanic whites as the reference group, 1.64 (0.047); Mexican Americans, 0.33 (0.008) and smoking, 1.017 (0.118). Conclusion: There was a 70% increase in risk of all cause death and almost 300% of all cancer death for people without any health insurance coverage.

• Asian Pacific Journal of Cancer Prevention
• /
• v.16 no.18
• /
• pp.8541-8551
• /
• 2016

Background: The coverage of breast and cervical cancer screening has only slightly increased in the past decade in Thailand, and these cancers remain leading causes of death among women. This study identified socioeconomic and contextual factors contributing to the variation in screening uptake and coverage. Materials and Methods: Secondary data from two nationally representative household surveys, the Health and Welfare Survey (HWS) 2007 and the Reproductive Health Survey (RHS) 2009 conducted by the National Statistical Office were used. The study samples comprised 26,951 women aged 30-59 in the 2009 RHS, and 14,619 women aged 35 years and older in the 2007 HWS were analyzed. Households of women were grouped into wealth quintiles, by asset index derived from Principal components analysis. Descriptive and logistic regression analyses were performed. Results: Screening rates for cervical and breast cancers increased between 2007 and 2009. Education and health insurance coverage including wealth were factors contributing to screening uptake. Lower or non-educated and poor women had lower uptake of screenings, as were young, unmarried, and non-Buddhist women. Coverage of the Civil Servant Medical Benefit Scheme increased the propensity of having both screenings, while the universal coverage scheme increased the probability of cervical screening among the poor. Lack of awareness and knowledge contributed to non-use of both screenings. Women were put off from screening, especially Muslim women on cervical screening, because of embarrassment, fear of pain and other reasons. Conclusions: Although cervical screening is covered by the benefit package of three main public health insurance schemes, free of charge to all eligible women, the low coverage of cervical screening should be addressed by increasing awareness and strengthening the supply side. As mammography was not cost effective and not covered by any scheme, awareness and practice of breast self examination and effective clinical breast examination are recommended. Removal of cultural barriers is essential.

• Journal of Preventive Medicine and Public Health
• /
• v.55 no.1
• /
• pp.68-79
• /
• 2022

Objectives: This study investigated associations between ethnicity and malaria awareness in East Nusa Tenggara Province (ENTP), Indonesia. Methods: A community-based cross-sectional study was conducted upon 1503 adults recruited by multi-stage cluster random sampling. A malaria awareness questionnaire was used to collect data, according to which participants were classified as aware or unaware of malaria. Logistic regression was applied to quantify the strength of associations of factors with malaria awareness. Results: The participation rate in this study was high (99.5%). The participants were distributed relatively evenly among the Manggarai, Atoni, and Sumba ethnicities (33.0, 32.3, and 30.2%, respectively). Malaria awareness was significantly different amongst these groups; it was most common in the Manggarai ethnicity (65.1%; 95% confidence interval [CI], 59.9 to 70.3) and least common in the Sumba ethnicity (35.0%; 95% CI, 27.6 to 42.4). The most prominent factor influencing the malaria awareness in the Sumba and Manggarai ethnicities was education level, whilst it was socioeconomic status (SES) in the Atoni ethnicity. The likelihood of malaria awareness was significantly higher in adults with an education level of diploma or above (adjusted odds ratio [aOR], 21.4; 95% CI, 3.59 to 127.7 for Manggarai; aOR, 6.94; 95% CI, 1.81 to 26.6 for Sumba). Malaria awareness was significantly more common amongst high-SES adults in the Atoni group (aOR, 24.48; 95% CI, 8.79 to 68.21). Conclusions: Low education levels and low SES were prominent contributors to lower levels of malaria awareness in rural ENTP. Interventions should focus on improving malaria awareness to these groups to support the Indonesian government's national commitment to achieve a malaria elimination zone by 2030.

• Journal of agricultural medicine and community health
• /
• v.38 no.3
• /
• pp.182-194
• /
• 2013

Objectives: To identify and compare the health behaviors and health status of the elderly between urban and rural areas using the data of the Korean National Health and Nutrition Examination Survey (KNHANES). Methods: The study population comprised 3,823 elderly people aged 65 years or older who participated in the $4^{th}$ KNHANES (2007-2009). The areas were classified into "large cities," "cities," and "rural areas" using the administrative and residential areas. The health behaviors and health status of the elderly between the rural and urban areas were compared using a complex sample design with the Rao-Scott chi-square test and weighted multiple logistic regression analysis. Results: Compared to large cities, the odds ratios (ORs) (95% confidence interval [CI]) of rural areas were as high as 1.58 (1.25-2.01) for the influenza vaccination and as low as 0.47 (0.37-0.59) for flexibility exercises, 0.56 (0.38-0.81) for muscular exercises, and 0.76 (0.62-0.92) for obesity. The ORs (CI) for osteoarthritis and diabetes mellitus were as low as 0.81 (0.66-0.99) and 0.70 (0.55-0.89), respectively. Conclusions: The health behaviors and health status of the elderly are better in rural areas than in urban areas despite the fact that the socioeconomic conditions in rural areas are poorer that those in urban areas. These findings suggest that programs suitable for residential areas should be developed and that studies to explain the differences in residential areas are needed.