Determinants of gastric cancer screening attendance in Korea: A multi-level analysis

Background: We aimed to assess individual and area-level determinants of gastric cancer screening participation. Method: Data on gastric cancer screening and individual-level characteristics were obtained from the 2007-2009 Fourth Korea National Health and Nutrition Examination Survey. The area-level variables were collected from the 2005 National Population Census, 2008 Korea Medical Association, and 2010 National Health Insurance Corporation. The data were analyzed using multilevel logistic regression models. Results: The estimated participation rate in gastric cancer screening adhered to the Korea National Cancer Screening Program guidelines was 44.0% among 10,658 individuals aged over 40years who were included in the analysis. Among the individual-level variables, the highest income quartile, a college or higher education level, living with spouse, having a private health insurance, limited general activity, previous history of gastric or duodenal ulcer, and not currently smoking were associated with a higher participation rate in gastric cancer screening. Urbanization showed a significant negative association with gastric cancer screening attendance among the area-level factors (odds ratio (OR)=0.73; 95% confidence interval (CI)=0.57-0.93 for the most urbanized quartile vs. least urbanized quartile). Conclusion: There are differences in gastric cancer screening attendance according to both individual and regional area characteristics.