Department of Family Medicine/Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea.
Cancer Res Treat. 2020 Jan;52(1):60-73. doi: 10.4143/crt.2018.660. Epub 2019 May 7.
Implementation of screening program may lead to increased health disparity within the population if participation differs by socioeconomic status. In Korea, colorectal cancer screening is provided at no or minimal cost to all people over 50 by National Cancer Screening Program. We investigated colorectal cancer screening participation rate and its trend over the last 10 years in relation to disabilities.
We linked national disability registration data with National Cancer Screening Program data. Age, sex-standardized participation rates were analyzed by type and severity of disability for each year, and factors associated with colorectal cancer screening participation were examined by multivariate logistic regression.
Age, sex-standardized participation rate in people without disability increased from 16.2 to 33.9% (change, +17.7), but it increased from 12.7% to 27.2% (change, +14.5) among people with severe disability. People with severe disabilities showed a markedly lower colorectal cancer screening participation rate than people without disability (adjusted odds ratio [aOR], 0.714; 95% confidence interval, 0.713 to 0.720). People with autism (aOR, 0.468), renal failure (aOR, 0.498), brain injury (aOR, 0.581), ostomy (aOR, 0.602), and intellectual disability (aOR, 0.610) showed the lowest participation rates.
Despite the availability of a National Cancer Screening Program and overall increase of its usage in the Korean population, a significant disparity was found in colorectal cancer screening participation, especially in people with severe disabilities and or several specific types of disabilities. Greater effort is needed to identify the barriers faced by these particularly vulnerable groups and develop targeted interventions to reduce inequality.
如果参与率因社会经济地位而异，筛查计划的实施可能会导致人群中的健康差距扩大。在韩国，国家癌症筛查计划为所有 50 岁以上的人提供免费或低费用的大肠癌筛查。我们调查了过去 10 年来与残疾相关的大肠癌筛查参与率及其趋势。
我们将国家残疾登记数据与国家癌症筛查计划数据相联系。每年按残疾类型和严重程度分析年龄、性别标准化的参与率，并通过多变量逻辑回归分析与大肠癌筛查参与相关的因素。
无残疾者的年龄、性别标准化参与率从 16.2%增加到 33.9%（变化幅度为+17.7%），而严重残疾者的参与率从 12.7%增加到 27.2%（变化幅度为+14.5%）。严重残疾者的大肠癌筛查参与率明显低于无残疾者（调整后的优势比[aOR]，0.714；95%置信区间，0.713 至 0.720）。自闭症（aOR，0.468）、肾衰竭（aOR，0.498）、脑损伤（aOR，0.581）、造口术（aOR，0.602）和智力残疾（aOR，0.610）的参与者的参与率最低。
尽管有国家癌症筛查计划，并且韩国人口对其总体使用率有所增加，但在大肠癌筛查参与方面仍存在显著差异，尤其是在严重残疾者和/或某些特定类型的残疾者中。需要做出更大的努力来确定这些特别脆弱群体所面临的障碍，并制定有针对性的干预措施来减少不平等。
