Determinants of gastric cancer screening attendance in Korea: a multi-level analysis.
BACKGROUND
We aimed to assess individual and area-level determinants of gastric cancer screening participation.


METHODS
Data on gastric cancer screening and individual-level characteristics were obtained from the 2007-2009 Fourth Korea National Health and Nutrition Examination Survey. The area-level variables were collected from the 2005 National Population Census, 2008 Korea Medical Association, and 2010 National Health Insurance Corporation. The data were analyzed using multilevel logistic regression models.


RESULTS
The estimated participation rate in gastric cancer screening adhered to the Korea National Cancer Screening Program guidelines was 44.0% among 10,658 individuals aged over 40 years who were included in the analysis. Among the individual-level variables, the highest income quartile, a college or higher education level, living with spouse, having a private health insurance, limited general activity, previous history of gastric or duodenal ulcer, and not currently smoking were associated with a higher participation rate in gastric cancer screening. Urbanization showed a significant negative association with gastric cancer screening attendance among the area-level factors (odds ratio (OR) = 0.73; 95% confidence interval (CI) = 0.57-0.93 for the most urbanized quartile vs. least urbanized quartile).


CONCLUSIONS
There are differences in gastric cancer screening attendance according to both individual and regional area characteristics.
Department of Preventive Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 110-779, Korea. viviene602@gmail.com.|Department of Family Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 110-779, Korea. viviene602@gmail.com.
Yunryong
Y
Chang
Department of Family Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 110-779, Korea. belong@snu.ac.kr.
Belong
B
Cho
Department of Family Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 110-779, Korea. mdsky75@gmail.com.
Ki Young
KY
Son
Department of Family Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 110-779, Korea. dwshin.snuh@gmail.com.
Dong Wook
DW
Shin
Department of Social and Humanity in Dentistry, Wonkwang University School of Dentistry, 460 Iksan-dearo, Iksan, 570-749, Korea. shinhosung@gmail.com.
Hosung
H
Shin
Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, 323 Ilsanro Ilsandong-gu, Goyang-si, 410-769, Korea. seesky1@gmail.com.
Hyung-Kook
HK
Yang
Department of Preventive Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 110-779, Korea. shinaesun@snu.ac.kr.
Aesun
A
Shin
Department of Preventive Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 110-779, Korea. kyyoo@snu.ac.kr.
Keun-Young
KY
Yoo
D000328:Adult; D000368:Aged; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D007723:Korea; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009313:National Health Programs; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D012959:Socioeconomic Factors; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology