Migration and Health Indicators of Mammography Use in South Korea Among Korea American Immigrant Women

Background: Korean American immigrant women (KAIW) have lower mammogram screening rates than other racial/ethnic women, which put them at greater risk for advanced stage of breast cancer and increases potential mortality. Potential barriers to mammography use in KAIW reported cost, lack of health insurance, time-consuming and complicated procedure, and limited low English proficiency (Oh et al., 2017; Lee & Schwartz, 2019). Recent evidence suggests that Korean Americans return to their home country to access medical services (e.g., cancer screening and treatments). However, there is limited research on determinants of preventive care utilization such as mammography use among KAIW after their immigration to the US. In this study we examined associated factors of KAIW’s mammography use in South Korea post US immigration, focusing on health care access (e.g., type of health insurance) and immigration factors (e.g., year of immigration to the US and years living in the US).

Methods: A cross-sectional survey of KAIW (N=187), ages 40-79 years, residing in Los Angeles, California, was conducted in 2016. The mean age of study participants was 58.6 years old and their average length of time in the United States was 23.1 years. About two-thirds (67.3%) completed undergraduate or graduate school, 34.5% reported their income was less than $25,000 per year. We conducted unadjusted and multivariable logistic regression models to examine factors associated with KAIW’s mammography use in South Korea after US immigration. We used SAS® statistical software version 9.4.to analyze the data.

Results: Over two-thirds (69%) of KAIW indicated that they had their first mammogram in the US. Less than a third (28.3%) of KAIW had a mammogram in South Korea after immigrating to the US. Majority of the participants reported to have a mammogram in South Korea as part of comprehensive exam package (e.g., various cancer screening, chest X-ray, eye exam, and blood pressure). Two factors were significantly related to seeking a mammography in South Korea post US immigration: KAIW that had their first mammography in South Korea, vs. in the US, were more likely to return for subsequent screenings (AOR= 0.02, 95% CI: <.001, 0.05); and KAIW that had employer-based health insurance were less likely return to South Korea for a mammogram (AOR= 0.01, 95% CI: <0.001, 0.18).

Conclusion and Implications: The results of this study suggest that women who are more familiar with medical system in South Korea (e.g., comprehensive exam is offered at lower price at a hospital) and who have unstable insurance may seek to care outside of US. To promote breast cancer screening among KAIW, health education may need to include information such as free or low-cost screening services, and potential risks of visiting home country to get medical services (e.g., possible impacts of postposing preventive care, treatments, and follow-up cares). Second, health care providers need to assess patients’ medical service history in their home country during clinic visits or when patients delay cancer screenings or treatments to ensure their adherence to screening guidelines (Ko et al., 2016).