Abstract
BackgroundInequality in health and health care is increasing in Sweden. Contributing to widening gaps are various factors that can be assessed by determinants, such as age, educational level, occupation, living area and country of birth. A health care service that can be used as an indicator of health inequality in Sweden is mammographic screening. The non-attendance rate is between 13 and 31 %, while the average is about 20 %. This study aims to shed light on three associations: between municipality and non-attendance, between age and non-attendance, and the interaction of municipality of residence and age in relation to non-attendance.MethodsThe study is based on data from the register that identifies attenders and non-attenders of mammographic screening in a Swedish county, namely the Radiological Information System (RIS). Further, in order to provide a socio-demographic profile of the county’s municipalities, aggregated data for women in the age range 40–74 in 2012 were retrieved from Statistics Sweden (SCB), the Public Health Agency of Sweden, the National Board of Health and Welfare, and the Swedish Social Insurance Agency. The sample consisted of 52,541 women. Analysis conducted of the individual data were multivariate logistic regressions, and pairwise chi-square tests.ResultsThe results show that age and municipality of residence associated with non-attendance of mammographic screening. Municipality of residence has a greater impact on non-attendance among women in the age group 70 to 74. For most of the age categories there were differences between the municipalities in regard to non-attendance to mammographic screening.ConclusionsAge and municipality of residence affect attendance of mammographic screening. Since there is one sole and pre-selected mammographic screening facility in the county, distance to the screening facility may serve as one explanation to non-attendance which is a determinant of inequity. From an equity perspective, lack of equal access to health and health care influences facility utilization.
Highlights
Inequality in health and health care is increasing in Sweden
This study describes and analyses reasons for nonattendance of mammographic screening using age, municipality of residence where distance from the sole and pre-selected facility in the county serves to give an understanding of the context, and aggregated sociodemographic variables as factors of interest in a crosssectional design
The results show that age and municipality of residence has an impact on attendance of mammographic screening, but municipality have a greater effect on women in the age group 70–74
Summary
Inequality in health and health care is increasing in Sweden. Contributing to widening gaps are various factors that can be assessed by determinants, such as age, educational level, occupation, living area and country of birth. A health care service that can be used as an indicator of health inequality in Sweden is mammographic screening. Since the patient fee for mammographic screening in Sweden is low, ranging from free-of-charge to 200 SEK [3] depending on county council, other individual and structural reasons for declining may be at work and could be a marker of inequity. This is of importance to investigate since breast cancer is the most common type of cancer in women, and was ranked as the fifth cause of death from cancer globally in 2012 [4].
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