Abstract
BackgroundEcological or survey based methods to investigate screening uptake rates are fraught with many limitations which can be circumvented by record linkage between Census and health services datasets using variations in breast screening attendance as an exemplar. The aim of this current study is to identify the demographic, socio-economic factors associated with uptake of breast screening.MethodsRecord linkage study: combining 2001 Census data within the Northern Ireland Longitudinal Study (NILS) with data relating to validated breast screening histories from the National Breast Screening System. A cohort was identified of 37,059 women aged 48-64 at the Census who were invited for routine breast screening in the three years following the Census. All cohort attributes were as recorded on the Census form.ResultsThe record linkage methodology enabled the records of almost 40,000 of those invited for screening to be analysed at an individual level, exceeding the largest published survey by a factor of ten. This produced a more robust analysis and demonstrated (in fully adjusted models) the lower uptake amongst non-married women and those in the lowest social class (OR 0.74; 95%CI 0.66, 0.82), factors that had not been reported earlier in the UK. In addition, with the availability of both individual and area information it was possible to show that the much lower screening uptake in urban areas is not due to differences in population composition suggesting unrecognised organisational problems.ConclusionsLinkage of screening data to Census-based longitudinal studies is an efficient and powerful way to increase the evidence base on sources of variation in screening uptake within the UK.
Highlights
Ecological or survey based methods to investigate screening uptake rates are fraught with many limitations which can be circumvented by record linkage between Census and health services datasets using variations in breast screening attendance as an exemplar
Information about eligibility and uptake of breast screening in Northern Ireland is held by the Quality Assurance Reference Centre (QARC) which is responsible for coordinating breast screening in Northern Ireland for the UK-wide National Breast Screening System
The linked dataset included a total of 37,059 women who, during the three year period (2001-2004), had been invited for breast screening; 11,931 aged 48-52 at the time of the 2001 Census invited for their first screen and 25,128 women aged 53-64 at the time of the 2001 Census who had been invited for routine subsequent screens during the study period. 11.5% of the population were aged less than 50 at the time of the 2001 Census but would have received an invitation to attend their first breast screening appointment during the time period of the study when they reached 50 years of age
Summary
Ecological or survey based methods to investigate screening uptake rates are fraught with many limitations which can be circumvented by record linkage between Census and health services datasets using variations in breast screening attendance as an exemplar The aim of this current study is to identify the demographic, socio-economic factors associated with uptake of breast screening. In the largest UK study published to date, Moser et al [9] examined reported use of breast and cervical screening in 3,185 women interviewed as part of the National Statistics Omnibus Surveys (2005-07) They found that car availability and housing tenure were associated with uptake of breast screening but not with cervical screening (though the effect sizes were suggestive). Similar difficulties are apparent with research relating to screening for colorectal cancer; in some studies just over half of those eligible for screening responded [12], and others have had to use ecological proxies for either deprivation [13] or ethnicity [14]
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