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J Epidemiol Community Health. 2012 Jan;66(1):37-40. doi: 10.1136/jech.2009.104554. Epub 2010 Oct 19.

Contribution of income-related inequality and healthcare utilisation to survival in cancers of the lung, liver, stomach and colon.

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Department of Preventive Medicine, Gachon University of Medicine and Science, 534-2 Yeonsu3-dong, Yeonsu-gu, Incheon, 406-799, Korea.



To examine differences in the survival rates of cancer patients according to socioeconomic status, focusing on the role of the degree of healthcare utilisation by the patient.


An observational follow-up study was done for 261 lung cancer, 259 liver cancer, 268 stomach cancer and 270 colon cancer patients, diagnosed during 1999-2002. Income status and healthcare utilisation were assessed with National Health Insurance (NHI) data; survival during 1999-2002 was identified by death certificate. HRs and 95% CI were derived from Cox proportional hazards regression.


The HRs for low income status are larger for colon cancer (2.37, 95% CI 1.17 to 4.80), followed by stomach (1.67, 95% CI 1.01 to 2.78), liver (1.57, 95% CI 1.03 to 2.39) and lung cancers (1.46, 95% CI 0.99 to 2.14). In the model including the variable of healthcare utilisation, colon and stomach cancers exhibited a lower HR in the moderate healthcare utilisation groups (0.40, 95% CI 0.21 to 0.76 in colon; 0.59, 95% CI 0.37 to 0.96 in stomach), whereas for liver cancer, the high utilisation group exhibited a higher hazard (1.72, 95% CI 1.07 to 2.75). A lower income status is independently related to a shorter survival time in cancer patients, especially in less fatal cancers. Healthcare utilisation independently affects the likelihood of survival from colon and stomach cancers, implying that a moderate degree of healthcare utilisation contributes to a longer survival time.

[Indexed for MEDLINE]

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