Trends in Socioeconomic Inequalities in Cancer Screening Participation Before and After the COVID-19 Pandemic in Japan
Tshewang Gyeltshen, Hirokazu Tanaka, Kota Katanoda
Abstract
BACKGROUND: Socioeconomic inequalities in cancer screening participation remain a public health issue worldwide. We assessed trends in cancer screening participation according to socioeconomic status in Japan between 2013 and 2022, considering the potential impact of the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Data from the nationally representative Comprehensive Survey of Living Conditions (2013-2022: approximately 500,000 persons per survey) were analyzed for age-standardized self-reported cancer screening rates for stomach, lung, colon, breast (aged 40-69 years), and cervical (aged 20-69 years) cancers, stratified by education levels. An age-adjusted Poisson model was used to assess the statistical significance of changes between the survey years. RESULTS: A clear socioeconomic gradient was observed, particularly in stomach cancer screening, where the 2022 rates ranged from 28.3% (low education) to 58.2% (high education) for men and 20.2% to 43.2% for women, depending on education level. Between 2019 and 2022, screening rates for stomach, lung, and colorectal cancers changed by -1.2%, -0.9%, and +0.6% for men and -1.0%, +0.1%, and +1.4% for women, respectively. Breast and cervical cancer screening rates declined by 0.5% and 0.4%, respectively. The COVID-19 pandemic worsened inequalities, with a 3.1% decline in breast cancer screening among individuals with low education level, compared to a 1.0% decline among those with higher education level. CONCLUSION: The COVID-19 pandemic had a minor impact on screening rates (counteracting increasing trends of screening rates), except for colorectal cancer screening rates; however, the impact was relatively severe for individuals with lower socioeconomic status, especially for women.