title: Participation inequality in the National General Health Examination based on enterprise size.
abstract: BACKGROUND
  Health examinations are performed so that diseases can be identified and treated earlier. Several studies have evaluated the determinants of participation in health examinations including cancer screening, but few have evaluated the relationship between the size of the enterprise and their participation in Workers' General Health Examinations (WGHE). The aim of the present study was to estimate the association of WGHE participation with the size of the enterprise and the type of policyholder.
  
  
  METHODS
  The eligible population from 2006 through 2013 was extracted from the National Health Insurance Service (NHIS) database. The population size ranged from 14-17 million. After adjustment for age and gender, multiple logistic regression analysis was performed to estimate the odds ratios of participating in the WGHE (by age group) based on the type of policyholder (reference: public officers) and the size of the enterprise (reference: enterprise size ≥300 employees), respectively.
  
  
  RESULTS
  Workers employed at enterprises with <50 persons were less likely to participate in WGHEs than those employed at enterprises with ≥300 persons. After policyholders were stratified by type (non-office workers vs. public officers), a disparity in the WGHE participation rate was found between the different types of policyholders at enterprises with <50 employees (reference: those employed at enterprises with ≥300 employees); the odds ratios for subjects in their 40s and 50s were 0.2-0.3 for non-office workers vs. 0.8-2.0 for public officers.
  
  
  CONCLUSIONS
  Workplace policyholders at small enterprises comprised a vulnerable group less likely to participate in WGHEs. Efforts should be made to raise the WGHE participation rate among the vulnerable employees belonging to small enterprises, as well as among their dependents.
authors.affiliation: Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, 400, Jongga-ro, Jung-gu Ulsan, Republic of Korea.
authors.forename: Young Joong
authors.initials: YJ
authors.lastname: Kang
authors.affiliation: Big Data Steering Department, National Health Insurance Service, 32, Sambo-ro, Wonju-si, Gangwon-do Republic of Korea.
authors.forename: Jong Heun
authors.initials: JH
authors.lastname: Park
authors.affiliation: Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, 400, Jongga-ro, Jung-gu Ulsan, Republic of Korea.
authors.forename: Huisu
authors.initials: H
authors.lastname: Eom
authors.affiliation: Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, 400, Jongga-ro, Jung-gu Ulsan, Republic of Korea.
authors.forename: Bohwa
authors.initials: B
authors.lastname: Choi
authors.affiliation: Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, 222 Banpo-Daero Seocho-gu, Seoul, 06591 Republic of Korea.
authors.forename: Seyoung
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, 222 Banpo-Daero Seocho-gu, Seoul, 06591 Republic of Korea.
authors.forename: Ji-Won
authors.initials: JW
authors.lastname: Lee
authors.affiliation: Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, 222 Banpo-Daero Seocho-gu, Seoul, 06591 Republic of Korea.
authors.forename: Jun-Pyo
authors.identifier: 0000-0001-8674-1034
authors.initials: JP
authors.lastname: Myong
keywords: Enterprise; Healthcare disparities; Mass screening; Policyholder; Size