Activity Limitation, Health-Care Use, and Unmet Need Among Korean Adults: Cumulative and Conditional Cardiometabolic Care Cascades

Background: Adults with activity limitation carry a heavier cardiometabolic burden, but whether differences arise in disease detection or subsequent management remains unclear. Cascade studies rarely measure health-care use directly and compute each stage against all prevalent cases—a cumulative formulation that cannot separate detection from later transitions. I assessed utilization, screening, unmet need, and conditional cascade attainment together. Methods: I analyzed the ninth Korea National Health and Nutrition Examination Survey cycle (2022–2024), a nationally representative cross-sectional survey (16,672 adults aged ≥19 years; cardiometabolic and cascade analyses were restricted to adults aged ≥30, and cancer screening to adults aged ≥40). I estimated prevalence ratios (PRs) using survey-weighted Poisson regression, adjusted for age, sex, education, income, smoking, and drinking, with Benjamini–Hochberg false-discovery control across 17 comparisons. I defined cascade stages conditionally and, secondarily, cumulatively. Results: Activity limitation (11.0%) was associated with higher prevalence of hypertension (PR 1.10, 95% confidence interval [CI]1.04–1.17) and diabetes (PR 1.23, 95% CI 1.11–1.37). Outpatient (1.75, 1.63–1.88) and inpatient (2.20, 1.95–2.48) utilization were higher, whereas general health (0.99, 0.95–1.02) and cancer (0.99, 0.95–1.03) screening were not. Unmet need was 19.0% versus 7.7% (2.39, 2.10–2.71). Awareness was higher (1.06–1.14), but no statistically detectable differences were observed in conditional treatment (0.98–1.01) or control (0.98–1.17). Cumulative point estimates for treatment were higher (1.06–1.11), retaining the awareness difference. Conclusions: Higher utilization did not correspond to greater screening or lower unmet need, and higher awareness was not accompanied by statistically detectable advantages in treatment or control. Cumulative and conditional cascades answer different questions; reporting both locates where a management difference arises.