Population-based mammography screening attendance in Sweden 2017–2018: A cross-sectional register study to assess the impact of sociodemographic factors

Anna Åkesson,Magdalena Lagerlund,Sophia Zackrisson

doi:10.1016/j.breast.2021.05.011

Anna Åkesson, Magdalena Lagerlund + Show 1 more

Open Access

https://doi.org/10.1016/j.breast.2021.05.011

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Journal: The Breast	Publication Date: Jun 2, 2021
Citations: 16	License type: cc-by

Affiliation: Skåne University Hospital

Abstract

Sweden has a population-based mammography screening programme for women aged 40–74. The objective of this study was to examine the association between mammography screening attendance and sociodemographic factors in 15 of Sweden's 21 health care regions. Register-based information was collected on all mammography screening invitations and attendance during 2017 and 2018, and linked to individual-level sociodemographic data from Statistics Sweden. Odds ratios (ORs) and 95% confidence intervals (CIs) for attendance were computed by sociodemographic factor. The study sample included 1.5 million women, aged 40–75, with an overall screening attendance of 81.3%. The lowest odds of attending were found for women living without a partner (OR = 0.52, 95% CI: 0.52–0.53), low-income women (OR = 0.57, 95% CI: 0.56–0.57), and non-Nordic women born in Europe (OR = 0.60, 95% CI: 0.59–0.61). Other groups with lower odds of attending were women whose main source of income was social assistance or benefits (OR = 0.62, 95% CI: 0.62–0.63), those not owning their home (OR = 0.66, 95% CI: 0.66–0.67), and those with low level of education (OR = 0.72, 95% CI: 0.71–0.73). Having multiple of these sociodemographic characteristics further lowered the odds of attending. Although overall mammography screening attendance in Sweden is high, sociodemographic inequalities exist, and efforts should be made to address these. Particular attention should be given to low-income women who live without a partner.

Highlights

European guidelines recommended that women aged 45e74 are screened regularly in organized mammography screening programmes [1], and most European countries have established national populationbased programmes [2]
Screening attendance was lower among women living in large cities (77.0%) than among those living in mid-sized cities (83.7%) or smaller cities, towns or rural areas (85.3%)
The lowest attendance was found among women whose main source of income was social assistance or benefits (66.7%), nonNordic women born in Europe (68.0%) or elsewhere (68.6%), and among women in the lowest income decile (68.5%)

Summary

Introduction

European guidelines recommended that women aged 45e74 are screened regularly (i.e. every two to three years depending on age group) in organized mammography screening programmes [1], and most European countries have established national populationbased programmes [2]. Previous studies have found attendance to be lower in groups who may be socioeconomically vulnerable, such as women who were born abroad [8e11], have low income [9e11], are unmarried or live without a partner [8,10e13], are not gainfully employed [8e10,13], have lower education, and do not own their home [8]. These studies were limited to two separate health care regions in Sweden (Uppsala and Skåne), and were based on mammography screening data up to 2009

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