Abstract

Background
South Korea operates a national health screening program aimed at early detection of major diseases. Although participation rates have been linked to various socioeconomic and demographic factors, occupational determinants remain insufficiently characterized.
Methods
This study analyzed 37,987 employed wage earners from the Korea National Health and Nutrition Examination Survey conducted between 2007 and 2023. The primary outcome was self-reported health screening program participation within the preceding two years. Occupational characteristics—including classification of occupations, employment status, working hours, work arrangement, and supervisory role—as well as workplace conditions and hazard exposures were examined. Prevalence ratios (PRs) with 95% confidence intervals were calculated for each characteristic. Generalized additive models were used to examine the nonlinear association between weekly working hours and participation rates. Multivariable modified Poisson regression models incorporating interaction terms between occupational characteristics and survey year assessed temporal trends in participation disparities.
Results
The overall health examination rate was 71.32%. Compared with managers, all other occupational categories—except armed forces—had significantly lower PRs of participation, with sales workers showing the lowest. Temporary, daily, non-regular, and part-time workers showed significantly lower PRs. Those working less than 35 or more than 52 hours per week showed significantly lower PRs than the reference group (35–52 hours). An inverted U-shaped association was observed, with participation peaking at approximately 40–50 hours per week. Among workplace conditions, decision-making authority, working under time pressure, and physical hazard exposure were associated with higher participation, whereas prolonged uncomfortable postures and heavy material handling were associated with lower participation. Over the 17-year study period, the adjusted PRs for working hours showed no significant temporal change.
Conclusions
Significant occupational disparities in health screening participation exist among Korean wage earners. Targeted interventions addressing vulnerable occupational groups are warranted to reduce disparities and improve overall worker health outcomes.

• Keywords: Preventive Health Services; Healthcare Disparities; Employment; Workplace