title: Relationship between socioeconomic status and accessibility for endoscopic resection among gastric cancer patients: using National Health Insurance Cohort in Korea: poverty and endoscopic resection.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Premedical Courses, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Na Yeon
authors.initials: NY
authors.lastname: Kim
authors.affiliation: Premedical Courses, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Jun Seok
authors.initials: JS
authors.lastname: Oh
authors.affiliation: Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, Korea.|Department of Public Health, Graduate School, Yonsei University, Seoul, Korea.
authors.forename: Young
authors.initials: Y
authors.lastname: Choi
authors.affiliation: Department of Preventive Medicine, College of Medicine, Yonsei University, 50, Yonsei-ro, Seodaemun-gu, Seoul, Korea. drshin@yuhs.ac.|Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, Korea. drshin@yuhs.ac.|Department of Public Health, Graduate School, Yonsei University, Seoul, Korea. drshin@yuhs.ac.
authors.forename: Jaeyong
authors.initials: J
authors.lastname: Shin
authors.affiliation: Department of Preventive Medicine, College of Medicine, Yonsei University, 50, Yonsei-ro, Seodaemun-gu, Seoul, Korea.|Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, Korea.|Department of Public Health, Graduate School, Yonsei University, Seoul, Korea.
authors.forename: Eun-Cheol
authors.initials: EC
authors.lastname: Park
mesh_terms: D000368:Aged; D015331:Cohort Studies; D000069916:Endoscopic Mucosal Resection / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D009367:Neoplasm Staging; D011203:Poverty / Q000191:economics*; D011379:Prognosis; D056910:Republic of Korea; D012923:Social Class; D013274:Stomach Neoplasms / Q000191:economics* / Q000473:pathology / Q000601:surgery
keywords: Endoscopic resection; Endoscopy; Gastric cancer; Inequality; Korea; Screening; Socioeconomic status