Socioeconomic latent classes and cancer screening uptake among Korean adults, 2025

Background

Socioeconomic status (SES) is associated with unequal cancer screening uptake of national screening for six major cancers (stomach, liver, colorectal, breast, cervical, lung). However, current variable-centred approaches evaluating single indicators fail to capture the multidimensional nature of SES. This study identified multidimensional SES profiles, based on income, education, occupation and residential area, among Korean adults and examined their associations with screening uptake.

Methods

This cross-sectional study utilised the 2025 Korean Community Health Survey, including 181,561 adults aged ≥40 years. We employed Latent Class Analysis (LCA) using four categorical SES indicators (income, education, occupation, residential area). To determine the optimal number of classes, we evaluated AIC, BIC, aBIC, and entropy. Survey-weighted hierarchical logistic regression estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs), with sequential adjustment for sociodemographic, health-related, and community environmental factors.

Results

LCA identified four distinct socioeconomic classes (entropy=0.72): Class 1 (Socially advantaged, 35.7%), Class 2 (Socially intermediate, 38.7%), Class 3 (Economically vulnerable; profound poverty/job insecurity despite urban residence, 21.8%), and Class 4 (Regionally & economically vulnerable; poverty combined with rural residence, 3.8%). Compared to Class 1, Class 3 had the lowest odds of cancer screening (aOR 0.47, 95% CI 0.45–0.50), even lower than Class 4 (aOR 0.78, 95% CI 0.73–0.82), in the fully adjusted model.

Conclusions

Multidimensional economic deprivation was more strongly associated with missed cancer screening than rural residence combined with poverty. Screening policies should move beyond infrastructure expansion and address opportunity costs and the economic burdens related to job insecurity for deprived adults. Such profiling may strengthen equity monitoring in organised screening programmes.

Key messages

• A multidimensional SES approach identified urban adults with severe economic vulnerability as the group least likely to receive cancer screening.

• Screening policy should address opportunity costs, not only geographic access, to reach economically deprived adults.