National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea.
Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.
JMIR Public Health Surveill. 2024 Jul 22;10:e55011. doi: 10.2196/55011.
In South Korea, the cancer incidence rate has increased by 56.5% from 2001 to 2021. Nevertheless, the 5-year cancer survival rate from 2017 to 2021 increased by 17.9% compared with that from 2001 to 2005. Cancer survival rates tend to decline with lower socioeconomic status, and variations exist in the survival rates among different cancer types. Analyzing socioeconomic patterns in the survival of patients with cancer can help identify high-risk groups and ensure that they benefit from interventions.
The aim of this study was to analyze differences in survival rates among patients diagnosed with six types of cancer-stomach, colorectal, liver, breast, cervical, and lung cancers-based on socioeconomic status using Korean nationwide data.
This study used the Korea Central Cancer Registry database linked to the National Health Information Database to follow up with patients diagnosed with cancer between 2014 and 2018 until December 31, 2021. Kaplan-Meier curves stratified by income status were generated, and log-rank tests were conducted for each cancer type to assess statistical significance. Hazard ratios with 95% CIs for any cause of overall survival were calculated using Cox proportional hazards regression models with the time since diagnosis.
The survival rates for the six different types of cancer were as follows: stomach cancer, 69.6% (96,404/138,462); colorectal cancer, 66.6% (83,406/125,156); liver cancer, 33.7% (23,860/70,712); lung cancer, 30.4% (33,203/109,116); breast cancer, 91.5% (90,730/99,159); and cervical cancer, 78% (12,930/16,580). When comparing the medical aid group to the highest income group, the hazard ratios were 1.72 (95% CI 1.66-1.79) for stomach cancer, 1.60 (95% CI 1.54-1.56) for colorectal cancer, 1.51 (95% CI 1.45-1.56) for liver cancer, 1.56 (95% CI 1.51-1.59) for lung cancer, 2.19 (95% CI 2.01-2.38) for breast cancer, and 1.65 (95% CI 1.46-1.87) for cervical cancer. A higher deprivation index and advanced diagnostic stage were associated with an increased risk of mortality.
Socioeconomic status significantly mediates disparities in cancer survival in several cancer types. This effect is particularly pronounced in less fatal cancers such as breast cancer. Therefore, considering the type of cancer and socioeconomic factors, social and medical interventions such as early cancer detection and appropriate treatment are necessary for vulnerable populations.
在韩国，2001 年至 2021 年期间，癌症发病率增长了 56.5%。然而，2017 年至 2021 年的 5 年癌症生存率与 2001 年至 2005 年相比增长了 17.9%。癌症生存率往往随社会经济地位降低而下降，不同癌症类型之间的生存率也存在差异。分析癌症患者的社会经济模式生存情况有助于确定高危人群，并确保他们受益于干预措施。
本研究旨在使用韩国全国数据，根据社会经济状况，分析六种癌症（胃癌、结直肠癌、肝癌、乳腺癌、宫颈癌和肺癌）患者生存率的差异。
本研究使用韩国中央癌症登记数据库与国家健康信息数据库进行关联，对 2014 年至 2018 年期间诊断为癌症的患者进行随访，随访时间截至 2021 年 12 月 31 日。根据收入状况生成 Kaplan-Meier 曲线，并对每种癌症类型进行对数秩检验，以评估统计学意义。使用 Cox 比例风险回归模型计算任何原因导致的总生存的风险比及其 95%置信区间，时间起点为诊断时间。
六种不同类型癌症的生存率如下：胃癌，69.6%（96,404/138,462）；结直肠癌，66.6%（83,406/125,156）；肝癌，33.7%（23,860/70,712）；肺癌，30.4%（33,203/109,116）；乳腺癌，91.5%（90,730/99,159）；宫颈癌，78%（12,930/16,580）。与最高收入组相比，医疗救助组的风险比分别为胃癌 1.72（95%CI 1.66-1.79）、结直肠癌 1.60（95%CI 1.54-1.56）、肝癌 1.51（95%CI 1.45-1.56）、肺癌 1.56（95%CI 1.51-1.59）、乳腺癌 2.19（95%CI 2.01-2.38）和宫颈癌 1.65（95%CI 1.46-1.87）。剥夺指数较高和诊断较晚与死亡率增加相关。
社会经济地位显著影响多种癌症的生存差异。这种影响在乳腺癌等致死率较低的癌症中更为明显。因此，考虑到癌症类型和社会经济因素，需要对弱势群体进行早期癌症检测和适当治疗等社会和医疗干预措施。
