Abstract
BackgroundNational screening programs have reduced cervical cancer mortality; however participation in these programs varies according to women's personal and social characteristics. Research into these inequalities has been limited by reliance on self-reported service use data that is potentially biased, or administrative data that lacks personal detail. We address these limitations and extend existing research by examining rates and correlates of cervical screening in a large epidemiological survey with linked administrative data.MethodsThe cross-sectional sample included 1685 women aged 44-48 and 64-68 years from the Australian Capital Territory and Queanbeyan, Australia. Relative risk was assessed by logistic regression models and summary Population Attributable Risk (PAR) was used to quantify the effect of inequalities on rates of cervical cancer screening.ResultsOverall, 60.5% of women participated in screening over the two-year period recommended by Australian guidelines. Screening participation was associated with having children, moderate or high use of health services, employment, reported lifetime history of drug use, and better physical functioning. Conversely, rates of cervical screening were lower amongst women who were older, reliant on welfare, obese, current smokers, reported childhood sexual abuse, and those with anxiety symptoms. A summary PAR showed that effective targeting of women with readily observable risk-factors (no children, no partner, receiving income support payments, not working, obese, current smoker, anxiety, poor physical health, and low overall health service use) could potentially reduce overall non-participation in screening by 74%.ConclusionsThis study illustrates a valuable method for investigating the personal determinants of health service use by combining representative survey data with linked administrative records. Reliable knowledge about the characteristics that predict uptake of cervical cancer screening services will inform targeted health promotion efforts.
Highlights
National screening programs have reduced cervical cancer mortality; participation in these programs varies according to women’s personal and social characteristics
This guideline remains despite the introduction of the human papillomavirus (HPV) vaccine, which cannot prevent all types of HPV that can cause cervical cancer [5]
Cervical screening participation rates were consistent with relevant administrative statistics, with around 60% of women having been screened over a two year period
Summary
National screening programs have reduced cervical cancer mortality; participation in these programs varies according to women’s personal and social characteristics Research into these inequalities has been limited by reliance on self-reported service use data that is potentially biased, or administrative data that lacks personal detail. Researchers have attempted to identify women who are less likely to participate in screening to better target these services These studies have reported that non participation is associated with being: single, sexually inactive, obese, a current smoker, uninsured, a non-metropolitan resident, having a low household income, lower level of education, current psychological distress, non-Caucasian background and attitudinal factors [8,9,10,11,12,13,14,15,16,17]. Collection of sociodemographic information to aid in identifying inequitable access has been advocated [8]
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