The role of sociodemographic factors in preventive practices. The case of cervical and breast cancer

Abstract

Background: The objective of this study was to investigate the role of sociodemographic factors in the performance of periodic gynaecological visits, cervical smears and mammographies in a population of women over 29 years of age and to describe social inequalities in the use of opportunistic screening for breast and cervical cancer. Methods: A cross-sectional study using a representative stratified sample of the non-institutionalized population resident in Barcelona, Spain, in 1992 was performed. Included were 1,667 women over 29 years of age. The variables studied were periodic gynaecological check-up, periodic smear and periodic mammography, as well as age, marital status, educational level, job situation and social class. Multivariate analysis was performed in order to determine predictive factors of gynaecological preventive practices, through logistic regression models. Results: Unmarried women had a higher risk of not having a periodic cervical smear [odds ratio (OR) adjusted for age, marital status, education level and job situation = 2.53 with 95% confidence Interval (Cl): 1.66–3.86] or periodic mammography (OR=2.84 and 95% Cl: 1.77–4.54). Women with a lower educational level followed preventive practices less often. Women who were unemployed, retired or students had a higher risk of not having periodic smears (OR=2.14 and 95% Cl: 1.452–3.18) and of not having periodic mammography (OR=1.69 and 95% Cl: 1.12–2.55). Conclusions: Opportunistic screening is more susceptible to social inequalities than systematic screening programmes. The risk of not performing these practices increased with women's low social indicators (class and education) and age. This study has a significative relevance in the international context because it shows a population-based analysis that is very scarce in southern Europe and could be used for comparisons in future studies of inequalities in health.