CIBER Epidemiología y Salud Pública, Spain.
Int J Epidemiol. 2010 Jun;39(3):757-65. doi: 10.1093/ije/dyq003. Epub 2010 Feb 22.
The aim of this study was to describe inequalities in the use of breast and cervical cancer screening services according to educational level in European countries in 2002, and to determine the influence of the type of screening program on the extent of inequality.
A cross-sectional study was performed using individual-level data from the WHO World Health Survey (2002) and data regarding the implementation of cancer screening programmes. The study population consisted of women from 22 European countries, aged 25-69 years for cervical cancer screening (n =11 770) and 50-69 years for breast cancer screening (n = 4784). Dependent variables were having had a PAP smear and having had a mammography during the previous 3 years. The main independent variables were socio-economic position (SEP) and the type of screening program in the country. For each country the prevalence of screening was calculated, overall and for each level of education, and indices of relative (RII) and absolute (SII) inequality were computed by educational level. Multilevel logistic regression models were fitted.
SEP inequalities in screening were found in countries with opportunistic screening [comparing highest with lowest educational level: RII = 1.28, 95% confidence interval (CI) 1.12-1.48 for cervical cancer; and RII = 3.11, 95% CI 1.78-5.42 for breast cancer] but not in countries with nationwide population-based programmes. Inequalities were also observed in countries with regional screening programs (RII = 1.35, 95% CI 1.10-1.65 for cervical cancer; and RII = 1.58, 95% CI 1.26-1.98 for breast cancer).
Inequalities in the use of cancer screening according to SEP are higher in countries without population-based cancer screening programmes. These results highlight the potential benefits of population-based screening programmes.
本研究旨在描述 2002 年欧洲国家中，根据教育水平，乳腺癌和宫颈癌筛查服务的利用不平等情况，并确定筛查项目的类型对不平等程度的影响。
采用 2002 年世卫组织世界卫生调查（WHOS）的个体水平数据和癌症筛查计划实施情况的数据进行了一项横断面研究。研究人群包括来自 22 个欧洲国家的年龄在 25-69 岁的宫颈癌筛查女性（n=11770）和年龄在 50-69 岁的乳腺癌筛查女性（n=4784）。因变量是在过去 3 年内进行过巴氏涂片检查和乳房 X 光检查。主要的独立变量是社会经济地位（SEP）和国家的筛查项目类型。为每个国家计算了筛查的总体流行率和每个教育水平的流行率，并按教育水平计算了相对（RII）和绝对（SII）不平等指数。拟合了多水平逻辑回归模型。
在机会性筛查的国家中发现了筛查的社会经济地位不平等（与最低教育水平相比，最高教育水平：宫颈癌的 RII=1.28，95%置信区间[CI]为 1.12-1.48；乳腺癌的 RII=3.11，95%CI 为 1.78-5.42），但在全国性人群为基础的筛查计划的国家中则没有发现。在区域性筛查计划的国家中也观察到了不平等现象（宫颈癌的 RII=1.35，95%CI 为 1.10-1.65；乳腺癌的 RII=1.58，95%CI 为 1.26-1.98）。
在没有基于人群的癌症筛查计划的国家中，根据 SEP 使用癌症筛查的不平等程度更高。这些结果突出了基于人群的筛查计划的潜在益处。
