COVID-19 has resulted in significant changes in various aspects of life worldwide, including direct disease burden, behavioral changes, and socioeconomic changes, such as income reductions due to social measures, such as social distancing. In Korea, there is an increasing interest in overall health, with a focus on prevention and early detection of diseases. Although there were no national restrictions on medical care usage before or after the pandemic, individual behaviors may have changed due to fear and anxiety about contagion. Continuous engagement in preventive activities is crucial because it improves the survival rate and quality of life of the population and reduces medical costs by preventing disease burden and associated treatment costs (9–11).
Several studies have evaluated differences in medical usage based on income, emphasizing the vulnerability of low-income individuals. However, there is a lack of studies on the effects of income loss due to COVID-19 on preventive activities in Korea.
In the present study, household income loss and a low household income level were associated with lower involvement in preventive activities, in line with previous studies, suggesting that a low household income or unstable working conditions can lead to lower involvement in preventive activities such as cancer screening (20). Concerns about healthcare costs among individuals with lower incomes could potentially impact such involvement. Additionally, concerns about contracting the disease could play a role (21). Beliefs about health, including perceptions of sensitivity, severity, and benefits, influence the willingness of adults to undergo health checkups (22). Furthermore, there was a larger decline in the rate of medical checkups versus other preventive behaviors because their perceived sensitivity was lower than that of vaccination (e.g., influenza vaccination) and their perceived severity was lower than that of cancer screening (23).
We observed lower involvement in preventive activities among males and single individuals. Involvement in such activities significantly differs by sex (22, 24, 25), as well as age (24, 25). Previous studies have demonstrated that women make more frequent visits to primary care clinics and utilize preventive healthcare services more than men (26, 27). These patterns can be attributable to traditional gender roles, where women typically assume responsibility for their family’s health (28), whereas men are often reluctant to seek medical care, perceiving it as a sign of weakness and vulnerability. As a result, men may consider their symptoms minor or unimportant (29, 30). Single individuals might be less attentive to self-healthcare, leading to reduced engagement in preventive activities. Additionally, older adults demonstrated a higher prevalence of preventive activities due to an increased perception of susceptibility and severity related to diseases such as flu and cancer. Previous studies have demonstrated higher knowledge about health checkups among individuals with chronic diseases than those without chronic diseases (31). Increased knowledge about medical checkups correlates with higher rates of participation, which explains why the rate of medical checkups was higher among individuals with chronic diseases.
In subgroup analyses, males had lower participation rates in medical checkups compared to females, consistent with previous studies (25). This may be attributed to the lower interest in health among males than females. Therefore, recommendations from spouses, family members, relatives, and neighbors might be necessary to increase participation in medical checkups for men (32). Conversely, increasing age was associated with a higher prevalence of medical checkups, likely due to growing health concerns with age. Furthermore, individuals diagnosed with chronic diseases tend to undergo more vaccinations or health checkups than those without such diagnoses (33). However, for cancer screening, the reduced participation rate did not vary with the presence or absence of chronic diseases due to the typically high perceived severity of cancer.
Preventive screening is an economically efficient public health intervention, which may have been adversely affected by the COVID-19 pandemic. Individuals with lower incomes tend to engage in preventive activities less frequently than those with higher incomes. In particular, income decline due to the COVID-19 pandemic was associated with a further reduction in involvement in preventive activities. Thus, our findings provide insights into the impacts of income inequality caused by COVID-19 on population health and preventive activity rates.
This study had certain limitations. First, it had a cross-sectional design, making it difficult to establish a definite cause-and-effect relationship between preventive activities and changes in income following COVID-19. Second, changes in household income due to COVID-19, the main variable of interest, was defined as the relative change in income level at the time of the survey compared to January 2020. Ongoing changes in income levels during the pandemic were not considered. Moreover, we did not analyze the occupation or income level of participants. Third, due to the limitations of available data, the effects of local-level variables, such as the appropriate number of medical institutions and medical personnel in the region, and individual-level variables, such as personal health status and family history, on preventive activities were not evaluated. Future studies should consider these factors to gain a better understanding of relationships between prevention activities and changes in income during and after the pandemic. Finally, because we used community health survey data obtained during the pandemic, further studies are needed to determine whether the model can be applied to other infectious diseases.
Despite these limitations, our study had notable strengths. First, we used data from the 2021 Community Health Survey, which provided reliable, large-scale, representative data from the entire country. Second, to the best of our knowledge, this was the first study to evaluate preventive activities among low-income individuals who experienced greater health disparities due to COVID-19.