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Relationship between Socioeconomic status and Accessibility for Endoscopic resection for Gastric Cancer Patients: using National Health Insurance Cohort in Korea

 Na Yeon Kim  ;  Jun Seok Oh  ;  Young Choi  ;  Jaeyong Shin  ;  Eun-Cheol Park 
 Gastric Cancer, Vol.20(1) : 61-69, 2017 
Journal Title
 Gastric Cancer 
Issue Date
Aged ; Cohort Studies ; Endoscopic Mucosal Resection/economics* ; Female ; Follow-Up Studies ; Gastric Mucosa/pathology ; Gastric Mucosa/surgery* ; Health Services Accessibility/economics* ; Humans ; Male ; Middle Aged ; National Health Programs* ; Neoplasm Staging ; Poverty/economics* ; Prognosis ; Republic of Korea ; Social Class ; Stomach Neoplasms/economics* ; Stomach Neoplasms/pathology ; Stomach Neoplasms/surgery
Endoscopic resection ; Endoscopy ; Gastric cancer ; Inequality ; Korea ; Screening ; Socioeconomic status
BACKGROUND: Gastric cancer is one of the most common types of cancer among patients in Korea. We measured the inequity in accessibility to endoscopic mucosal/submucosal resection (EMR) for early and curable gastric cancer treatment among different income classes in patients diagnosed from late 2011 to 2013. METHODS: Data were obtained from the National Health Insurance Cooperation Claim Data from patients diagnosed from late 2011 until the end of 2013, to provide a total of 1,671 patients with newly diagnosed carcinoma in situ of gastric and gastric cancer among 1,025,340 enrollees. Multiple logistic regression analysis was conducted to investigate the associations between independent variables and the rate of treatment with EMR. RESULTS: Among 1671 gastric cancer patients, 317 (19.0 %) subjects were treated with EMR. The 'lowest' income group was associated with a statistically significant lower rate of EMR treatment [odds ratio (OR) = 0.55, 95 % confidence index (CI) 0.34-0.89] compared to the 'highest' income group. The ORs for the 'low-middle' and 'middle-high' income groups were both higher than for the reference group, although these were not significantly different. According to the subgroup analysis by gender, rate of EMR treatment of 'lowest' income group (OR = 0.37, 95 % CI 0.18-0.74) was significantly lower only among men. CONCLUSION: In conclusion, we suggest that although universal health insurance in Korea has covered EMR treatment since August 2011, patients from the lowest income group are less likely to receive this treatment. Thus, we need to detect more eligible early-stage gastric cancer and treatment for individuals of low socioeconomic status.
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1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
Yonsei Authors
박은철(Park, Eun-Cheol) ORCID logo https://orcid.org/0000-0002-2306-5398
신재용(Shin, Jae Yong)
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