Cancer Res Treat.  2024 Apr;56(2):380-403. 10.4143/crt.2023.650.

Health Inequities in Cancer Incidence According to Economic Status and Regions Are Still Existed Even under Universal Health Coverage System in Korea: A Nationwide Population Based Study Using the National Health Insurance Database

• Chang Y
• Hwang SH
• Cho SA
• Lee H
• Cho E
• Lee JY

• KMID: 2554330
• DOI: http://doi.org/10.4143/crt.2023.650

Abstract

Purpose
The purpose of this study is to determine the level of health equity in relation to cancer incidence.
Materials and Methods
We used the National Health Insurance claims data of the National Health Insurance Service between 2005 and 2022 and annual health insurance and medical aid beneficiaries between 2011 and 2021 to investigate the disparities of cancer incidence. We calculated age-sex standardized cancer incidence rates by cancer and year according to the type of insurance and the trend over time using the annual percentage change. We also compared the hospital type of the first diagnosis by cancer type and year and cancer incidence rates by cancer type and region in 2021 according to the type of insurance.
Results
The total cancer incidence increased from 255,971 in 2011 to 325,772 cases in 2021. The absolute difference of total cancer incidence rate between the NHI beneficiaries and the medical aid (MA) recipients increased from 510.1 cases per 100,000 population to 536.9 cases per 100,000 population. The odds ratio of total cancer incidence for the MA recipients increased from 1.79 (95% confidence interval [CI], 1.77 to 1.82) to 1.90 (95% CI, 1.88 to 1.93). Disparities in access to hospitals and regional cancer incidence were profound.
Conclusion
This study examined health inequities in relation to cancer incidence over the last decade. Cancer incidence was higher in the MA recipients, and the gap was widening. We also found that regional differences in cancer incidence still exist and are getting worse. Investigating these disparities between the NHI beneficiaries and the MA recipients is crucial for implementing of public health policies to reduce health inequities.

Keyword

Health inequities; Cancer incidence; National Health Programs; Korea

Figure

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  Fig. 1. Yearly age-sex standardized cancer incidence rates by cancer type (Units: cases per 100,000 population). APC, annual percentage change; MA, medical aid; NHI, National Health Insurance. *p < 0.05.

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  Fig. 2. Yearly odds ratio of cancer incidence by cancer type with 95% confidence interval (ref: the National Health Insurance).

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  Fig. 3. Hospital types at the first diagnosis of cancer by year (Units: %). MA, medical aid; NHI, National Health Insurance.

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  Fig. 4. Age-sex standardized cancer incidence rates by region and insurance type in 2021 (Units: cases per 100,000 population). MA, medical aid; NHI, National Health Insurance.

Reference

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