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Socio-economic and demographic determinants affecting participation in the Swedish cervical screening program: A population-based case-control study
Department of Obstetrics and Gynaecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg (Sweden); The Regional Cancer Centre, Western Health Care Region, Gothenburg, Sweden; Närhälsan Primary Care, Western Health Care Region, Skövde, Sweden . (Sexuell och reproduktiv hälsa)
Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden. (Sexuell och reproduktiv hälsa)
Public Dental Service, Region Västra Götaland, Vänersborg, Sweden; Department of Behavioural and Community Dentistry, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden . (Sexuell och reproduktiv hälsa)
Örebro University, School of Health Sciences. The Centre for Women’s, Family and Child Health, Faculty of Health Sciences, Buskerud & Vestfold University College, Kongsberg, Norway . (Sexuell och reproduktiv hälsa)ORCID iD: 0000-0002-2577-1632
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2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 1, article id e0190171Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Cervical screening programs are highly protective for cervical cancer, but only for women attending screening procedure.

OBJECTIVE: 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. The case group, non-attending women, (N = 314,302) had no smear registered for 6-8 years. The control group (N = 266,706) attended within 90 days of invitation. Main outcome measures: Risk of non-attendance by 9 groups of socioeconomic and demographic variables. Analysis: Unadjusted odds ratios (OR) and OR after adjustment for all variables in logistic regression models were calculated.

RESULTS: Women with low disposable family income (adjOR 2.06; 95% confidence interval (CI) 2.01-2.11), with low education (adjOR 1.77; CI 1.73-1.81) and not cohabiting (adjOR 1.47; CI 1.45-1.50) were more likely to not 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: County of residence and socio-economic factors were strongly associated with lower attendance in cervical screening, while being born in another country was of less importance. This indicates considerable potential for improvement of cervical screening attendance in several areas if best practice of routines is adopted.

Place, publisher, year, edition, pages
San Francisco, CA, USA: Public Library of Science , 2018. Vol. 13, no 1, article id e0190171
Keywords [en]
Cervical cancer, demography, mass screening, non-attendance, socioeconomic factors
National Category
Cancer and Oncology
Research subject
Obstetrics and Gynaecology; Health and Medical Care Research
Identifiers
URN: urn:nbn:se:oru:diva-63531DOI: 10.1371/journal.pone.0190171ISI: 000419689600036PubMedID: 29320536Scopus ID: 2-s2.0-85040318150OAI: oai:DiVA.org:oru-63531DiVA, id: diva2:1168885
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Swedish Cancer Society, 12 0870Available from: 2017-12-21 Created: 2017-12-21 Last updated: 2018-09-11Bibliographically approved

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Adolfsson, Annsofie

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