Abstract
PurposeTo assess the change in mammography screening attendance in Sweden—overall and in sociodemographic groups at risk of low attendance—after removal of the out-of-pocket fee in 2016.MethodsIndividual-level data on all screening invitations and attendance between 2014 and 2018 were linked to sociodemographic data from Statistics Sweden. Odds ratios and 95% confidence intervals (CIs) for attendance by time period and sociodemographic factor were computed using mixed logistic regression to account for repeated measures within women. The study sample included 1.4 million women, aged 40–75, who had a mammography screening appointment in 2014–2015 and/or 2017–2018 in 14 of Sweden’s 21 health care regions.ResultsOverall screening attendance was 83.8% in 2014–2015 and 84.1% in 2017–2018 (+ 0.3 percentage points, 95% CI 0.2–0.4). The greatest increase in attendance was observed in non-Nordic women with the lowest income, where attendance rose from 62.9 to 65.8% (+ 2.9 points, 95% CI 2.3–3.6), and among women with four or more risk factors for low attendance, where attendance rose from 59.2 to 62.0% (+ 2.8 points, 95% CI 2.2–3.4).ConclusionScreening attendance did not undergo any important increase after implementing free screening, although attendance among some sociodemographic groups increased by almost three percentage points after the policy change.
Highlights
Most European countries have national population-based programs that offer mammography screening to women in varying age ranges between 40 and 74 [1]
The percentage of screening appointments attended was calculated for each time period, by region and sociodemographic factor, and reported with 95% confidence intervals (CIs)
In 2014–2015, the mean age at the time of the screening appointment was 56 years; 61% of women were living with a partner; 16% had a low level of education; 12% got their main income from social assistance and benefits and 85% from employment or retirement income; 74% owned their home; 84% were born in Sweden; 25% lived in a large city or surrounding commuting areas; and 37% lived in smaller cities and rural areas
Summary
Most European countries have national population-based programs that offer mammography screening to women in varying age ranges between 40 and 74 [1]. Since the public health impact of population-based screening depends on Sweden has offered a nationwide outreach mammography screening program since 1997 [3, 4]. As part of the Swedish government’s efforts to improve health care equality and women’s health, mammography screening became free of charge on July 1 2016 [11], before which time most regions charged a small out-of-pocket fee (≤ 200 SEK ≈ $23 USD). According to research conducted in the USA, reducing or removing the out-of-pocket fee can increase screening attendance [12,13,14].
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