FC 01-01SOCIO-ECONOMIC AND DEMOGRAPHIC DETERMINANTS OF PARTICIPATION IN THE SWEDISH CERVICAL SCREENING PROGRAM: A POPULATION-BASED CASE-CONTROL STUDY

02. Epidemiology and natural history
G. Broberg 1, J. Wang 2, A.L. Östberg 3, A. Adolfsson 4, S. Nemes 5, P. Sparén 2, B. Strander 6.
11) Department of Obstetrics and Gynaecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg (Sweden), 2Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm (Sweden), 3Department of Behavioural and Community Dentistry, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg (Sweden), 4The School of Health and Medical Sciences, Örebro University (Sweden), 5Swedish Hip Arthroplasty Register, Gothenburg (Sweden), 61) Department of Obstetrics and Gynaecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg. 2)The Regional Cancer Centre, Western Health Care Region, Gothenburg (Sweden)

Background / Objectives

Identify socio-economic and demographic determinants for non-attendance in cervical screening


Methods

Design: Population-based case-control study

Setting: Sweden

Population: Source population was all women eligible for screening. Based on complete screening records, two groups of women aged 30 - 60 were compared. One group (N=266,706) attended within 90 days of invitation. The other group (N=314,302) had no smear registered for 6-8 years.

Main outcome measures: Risk of non-attendance by 9 groups of socioeconomic and demographic variables

Methods: Unadjusted odds ratios (OR) and OR after adjustment for all variables in logistic regression models were calculated.


Results

Women with low disposable family income (OR 2.06;  95% confidence interval (CI) 2.01-2.11), with low education (OR 1.77; CI 1.73-1.81) and not cohabiting (OR 1.47; CI 1.45-1.50) were less likely to attend cervical screening. Other important factors for non-attendance were being outside the labour force and receiving welfare benefits. Swedish counties are responsible for running screening programs;  adjusted OR for non-participation in counties ranged from OR 4.21 (CI 4.06-4.35) to OR 0.54 (CI 0.52-0.57), compared to the reference county. Being born outside Sweden was a risk factor for non-attendance in the unadjusted analysis but this disappeared in certain large groups after adjustment for socioeconomic factors


Conclusion

Low income and low education were associated with increased probability of non-attendance. Low attendance among large groups of immigrant women might be explained by socio-economic factors. Residing in particular Swedish counties was also a strong independent factor. As counties are resonsible for effectuating the screening program this indicates considerable potential for improvement of cervical screening attendance in several areas if best practice of routines is adopted.


References