Factors Associated with Employment Status and Sex Differences in Occupational Continuity among Cancer Survivors: A Cross-Sectional Study Using the Korea National Health and Nutrition Examination Survey
Abstract
Purpose: This study examined sociodemographic, clinical, and symptom-related factors associated with current employment among cancer survivors and described sex-based differences in occupational continuity. Methods: This cross-sectional study used data from the 2019 and 2021 Korea National Health and Nutrition Examination Survey. The sample included cancer survivors aged 19 to 65 years who did not have multiple primary cancers or missing data (n=289). Employment status was categorized as employed or non-employed. Sociodemographic factors (age, sex, education, marital and household characteristics, household income, and private insurance), clinical factors (time since diagnosis, cancer type, current cancer status, and comorbidity), and symptom-related factors (pain, fatigue, depression, memory problems, and sleep difficulties) were evaluated using hierarchical logistic regression. Weighted descriptive analyses were performed to examine sex-based differences in occupational continuity.Results: Overall, 56.6% of participants were employed. In the final model, male sex was associated with higher odds of employment (odds ratio [OR], 4.69; 95% confidence interval [CI], 2.21–9.94; p<.001), whereas monthly household income below 3 million Korean won was associated with lower odds of employment (OR, 0.41; 95% CI, 0.19–0.88; p<.05). Sleep difficulties were non-significantly associated with lower odds of employment (OR, 0.64; 95% CI, 0.41–1.00; p=.051). No clinical factor was significantly associated with employment. Male participants were more likely than female participants to retain their longest-held occupation (58.3% vs. 30.9%). Conclusion: Employment among cancer survivors was associated with sex and household income, and occupational continuity differed by sex. Although sleep difficulties were not statistically significant in the final model, sleep assessment and sex-sensitive vocational support may be useful components of survivorship nursing care.