Employment conditions and use of gastric cancer screening services in Korea: a nationwide survey

BACKGROUND: Although it is well known that employment conditions exert considerable effects on health and health equity, the association between employment conditions and the use of preventative health services has rarely been studied. We explored whether inequities in the use of preventative services were associated with employment conditions. We used gastric cancer screening as a surrogate for the use of preventative health services. METHODS: The study population was derived from the Korea National Health and Nutrition Survey IV (2007–2009), which included data on 5626 individuals over 40 years of age. Employment conditions were grouped by employment status, work hours, employment contract term, and salary source. Participants who had undergone gastroscopy or an upper gastrointestinal series within the past 2 years were considered to have used cancer screening services according to the National Cancer Screening Program guidelines. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multiple logistic regression analysis. As the survey procedure incorporated sample weights, we adjusted our calculations to consider the complex sample design. RESULTS: Self-employed workers were less likely to participate in regular cancer screening than were wage workers (OR = 0.79, 95% CI = 0.68–0.92), and part-time workers were less likely to participate than were full-time workers (OR = 0.81, 95% CI = 0.67–0.99). Among wage workers, temporary workers and daily workers exhibited lower participation rates than did regular workers (OR = 0.81, 95% CI = 0.63–1.05 and OR = 0.58, 95% CI = 0.44–0.76, respectively). Dispatched workers also exhibited lower participation rates (OR = 0.45, 95% CI = 0.25–0.80). CONCLUSIONS: We found obvious inequities in the use of preventative health services associated with various employment conditions. Self-employed, irregular, and dispatched workers were significantly less likely to participate in cancer screening than were other workers. Political efforts should be made to reduce employment insecurity and to improve participation in preventative screening services by vulnerable employees so as to resolve the evident health inequities.