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Disparity in Health Screening and Health Utilization according to Economic Status
Min Jung Kim1, Hyejin Lee1, Eun Ha Kim1
1Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Korea.
Insights
Higher and lower economic status groups show increased health screening attendance. Lower economic groups utilize fewer outpatient services post-screening despite higher cardiovascular disease diagnoses.
Area of Science:
- Public Health
- Epidemiology
- Health Services Research
Background:
- Cardiovascular disease (CVD) is a leading global cause of mortality and morbidity.
- Health screening facilitates early detection and management of CVD-related conditions like diabetes, hypertension, and dyslipidemia.
- Understanding the interplay between socioeconomic status, screening, and healthcare utilization is crucial for public health interventions.
Purpose of the Study:
- To investigate the association between socioeconomic status and health screening attendance.
- To examine the relationship between economic status, CVD diagnosis rates, and subsequent healthcare utilization post-screening.
Main Methods:
- Analysis of a large cohort database from the National Health Insurance Corporation (306,206 participants).
- Inclusion criteria: individuals over 40 without prior CVD, related diseases, cancer, or chronic renal disease.
- Follow-up period: January 1, 2003, to December 31, 2005.
Main Results:
- Health screening attendance rates were higher in both the highest and lowest economic status groups compared to the middle group.
- Diagnostic rates for diabetes mellitus, hypertension, and dyslipidemia varied across economic strata.
- Outpatient visit rates post-diagnosis showed complex patterns, with the lowest economic group exhibiting lower utilization despite higher CVD diagnosis rates.
Conclusions:
- Socioeconomic disparities influence health screening participation.
- Lower economic status is linked to reduced post-screening outpatient visits, even with elevated CVD risk.
- Targeted strategies may be needed to improve healthcare access and utilization for lower socioeconomic groups post-screening.
Background:
Cardiovascular disease (CVD) has become the most common cause of mortality and morbidity worldwide. Health screening is associated with higher outpatient visits for detection and treatment of CVD-related diseases (diabetes mellitus, hypertension, and dyslipidemia). We examined the association between health screening, health utilization, and economic status.
Methods:
A sampled cohort database from the National Health Insurance Corporation was used. We included 306,206 participants, aged over 40 years, without CVD (myocardial infarction, stroke, and cerebral hemorrhage), CVD-related disease, cancer, and chronic renal disease. The follow-up period was from January 1, 2003 through December 31, 2005.
Results:
Totally, 104,584 participants received at least one health screening in 2003-2004. The odds ratio of the health screening attendance rate for the five economic status categories was 1.27 (95% confidence interval [CI], 1.24 to 1.31), 1.05 (95% CI, 1.02 to 1.08), 1, 1.16 (95% CI, 1.13 to 1.19) and 1.50 (95% CI, 1.46 to 1.53), respectively. For economic status 1, 3, and 5, respectively, the diagnostic rate after health screening was as follows: diabetes mellitus: 5.94%, 5.36%, and 3.77%; hypertension: 32.75%, 30.16%, and 25.23%; and dyslipidemia: 13.43%, 12.69%, and 12.20%. The outpatient visit rate for attendees diagnosed with CVD-related disease was as follows for economic status 1, 3, and 5, respectively: diabetes mellitus: 37.69%, 37.30%, and 43.70%; hypertension: 34.44%, 30.09%, and 32.31%; and dyslipidemia: 18.83%, 20.35%, and 23.48%.
Conclusion:
Thus, higher or lower economic status groups had a higher health screening attendance rate than the middle economic status group. The lower economic status group showed lower outpatient visits after screening, although it had a higher rate of CVD diagnosis.
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