Unit of Virus, Lifestyle, and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark.
Unit of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark.
Prev Med. 2018 Jun;111:94-100. doi: 10.1016/j.ypmed.2018.02.035. Epub 2018 Mar 6.
Cervical cancer occurs most often in under-screened women. In this nationwide register study, we described differences in sociodemographic characteristics between passive and active non-participants and examined socio-demographic characteristics, reproductive history, and mental and physical health as potential determinants for passive non-participation compared with participation in the Danish cervical cancer screening program. Screening history in women aged 23-49 years invited for cervical cancer screening in 2008-2009 was retrieved from the Danish Pathology Databank with information about dates of invitation and unsubscription. We identified participants (n = 402,984), active non-participants (n = 10,251) and passive non-participants (n = 63,435) within four years following baseline invitation and retrieved data about the study population from high-quality registries. We examined differences in socio-demographic characteristics of passive and active non-participants, and used multiple logistic regression analyses to identify potential determinants of passive non-participation. We found that active and passive non-participants differed in relation to socio-demography. When compared with screening participants, the odds of passive non-participation was increased in women who originated from less developed countries; were unmarried; had basic education or low income; had four or more children; smoked during pregnancy; had multiple induced abortions; or had a history of obesity, intoxicant abuse or schizophrenia or other psychoses. In conclusion, in this nationwide, prospective, population-based study, differences in socio-demographic characteristics between passive and active non-participants were found. Furthermore, sociodemography, reproductive history, and mental and physical health were determinants for passive non-participation. Addressing inequalities in screening attendance may help to further decrease the incidence of and mortality from cervical cancer.
宫颈癌最常发生在筛查不足的女性中。在这项全国范围内的登记研究中，我们描述了被动和主动不参与者之间在社会人口统计学特征方面的差异，并检查了社会人口统计学特征、生殖史以及心理健康和身体健康是否可能是与参与丹麦宫颈癌筛查计划相比，被动不参与的决定因素。在 2008-2009 年邀请 23-49 岁女性进行宫颈癌筛查时，从丹麦病理学数据库中检索了这些女性的筛查史，包括邀请和退订的日期信息。我们在基线邀请后的四年内确定了参与者（n=402984）、主动不参与者（n=10251）和被动不参与者（n=63435），并从高质量登记处获取了研究人群的数据。我们检查了被动和主动不参与者在社会人口统计学特征方面的差异，并使用多因素逻辑回归分析确定了被动不参与的潜在决定因素。我们发现，主动和被动不参与者在社会人口统计学方面存在差异。与筛查参与者相比，来自欠发达国家的女性、未婚女性、接受过基本教育或收入较低的女性、有四个或更多孩子的女性、怀孕期间吸烟的女性、有多次人工流产的女性、有肥胖、滥用酒精或精神分裂症或其他精神病病史的女性，被动不参与的可能性更高。总之，在这项全国性、前瞻性、基于人群的研究中，我们发现了被动和主动不参与者之间在社会人口统计学特征方面的差异。此外，社会人口统计学特征、生殖史以及心理健康和身体健康是被动不参与的决定因素。解决筛查参与率的不平等问题可能有助于进一步降低宫颈癌的发病率和死亡率。
