Abstract
BackgroundCervical cancer screening rates are known to be strongly associated with socioeconomic status. Our objective was to assess whether the rate is also associated with an aggregated deprivation marker, defined by the location of family doctors’ offices.MethodsTo access this association, we 1) collected data from the claim database of the French Health Insurance Fund about the registered family doctors and their enlisted female patients eligible for cervical screening; 2) carried out a telephone survey with all registered doctors to establish if they were carrying out Pap-smears in their practices; 3) geotracked all the doctors’ offices in the smallest existing blocks of socioeconomic homogenous populations (IRIS census units) that were assigned a census derived marker of deprivation, the European Deprivation Index (EDI), and a binary variable of urbanization; and 4) we used a multivariable linear mixed model with IRIS as a random effect.ResultsOf 348 eligible doctors, 343 responded to the telephone survey (98.6%) and were included in the analysis, encompassing 88,152 female enlisted patients aged 25–65 years old. In the multivariable analysis (adjusted by the gender of the family doctor, the practice of Pap-smears by the doctor and the urbanization of the office location), the EDI of the doctor’s office was strongly associated with the cervical cancer screening participation rate of eligible patients (p<0.001).ConclusionThe EDI linked to the location of the family doctor’s office seems to be a robust marker to predict female patients’ participation in cervical cancer screening.
Highlights
In 2012, cervical cancer was the second most common cancer in women worldwide after breast cancer [1] with 80% of cancers occurring in developing countries [2]
Among the 402 family doctors registered at the health insurance fund of Flanders, 50 were excluded because they had less than 100 female patients on their patients list and four were excluded due to retirement
This study demonstrated that the European Deprivation Index (EDI) of the location of the family doctor’s office was strongly associated with the cervical cancer screening participation rate of female patients enlisted with this family doctor, in a multivariable model including size of the doctor’s office, gender of the doctor, practice of Papsmears by the doctor and location of the office
Summary
In 2012, cervical cancer was the second most common cancer in women worldwide after breast cancer [1] with 80% of cancers occurring in developing countries [2]. The French official guidance (citation: HAS) recommends cervical screening by Pap-smears every three years for women aged 25 to 65 [4,5] as this is widely associated with a reduction of both cervical cancer incidence and specific mortality [6,7,8]. Socioeconomic deprivation is a major risk factor for both lack of vaccination [9] and lack of regular gynecological follow-up [10] and as a consequence, lack of cervical screening [11,12]. According to a 2003 worldwide meta-analysis, being of disadvantaged socioeconomic status was associated with almost a 100% increased risk of cervical cancer development and with 60% increased risk of dysplasia [13]. Cervical cancer screening rates are known to be strongly associated with socioeconomic status. Our objective was to assess whether the rate is associated with an aggregated deprivation marker, defined by the location of family doctors’ offices.
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