Cancer incidence and mortality among adults with disabilities in Korea: A 15-year study

Background

Despite precision medicine’s growth, 15% of the global population with disabilities remains in a “clinical blind spot.” While previous research focused on fragmented metrics, this study investigates the “Incidence Paradox”—where lower adjusted cancer incidence masks systemic healthcare exclusion—to provide evidence for precision public health policies aimed at clinical equity and addressing systemic neglect.

Methods

This nationwide serial cross-sectional study (2008–2022) linked the National Health Information Database (NHID) and the National Disability Registration Database (NDRD), covering 43,403,837 adults. Age-standardized rates (ASR) were calculated for the 2015 Korean population. Multivariate logistic regression estimated adjusted odds ratios (aOR) for cancer prevalence, incidence, and mortality, controlling for age, sex, income, residence, and Charlson Comorbidity Index (CCI).

Results

In 2022, age-standardized prevalence was higher in the disabled (4,704.3 per 100,000) than the non-disabled (3,981.3). However, an “Incidence Paradox” emerged: adjusted risk of new cancer diagnosis was significantly lower for people with disabilities (Male aOR, 0.70; Female aOR, 0.57). This reflects systemic under-diagnosis, validated by mortality data: post diagnosed, individuals with disabilities faced significantly higher mortality risks (Male aOR: 1.34; Female aOR: 1.96). Notably, men with intellectual/psychological disabilities and women with brain injuries faced 2.08- and 2.07-fold higher mortality, marking the worst survival inequalities.

Conclusions

The gap between low diagnosis and high mortality signifies structural failure in the cancer continuum. Lower incidence is a grave warning of healthcare exclusion, not success. Strategies must shift to disability-specific integrated management and enhanced accessibility to both medical institutions and diagnostic equipment. This study is a critical milestone for bridging the lethal survival gap.

Key messages

• Low cancer incidence in the disabled reflects diagnostic barriers rather than lower risk, leading to higher mortality. This paradox highlights urgent needs for early detection and accessibility.

• Extreme gaps—notably 2.08-fold for intellectual/psychological disabled men and 2.07-fold for brain-injured women—demand disability-specific management and accessibility.