University of Coimbra, CeBER, Faculty of Economics, Portugal; CEISUC, Portugal.
University of Coimbra, CeBER, Faculty of Economics, Portugal.
Soc Sci Med. 2022 Nov;312:115371. doi: 10.1016/j.socscimed.2022.115371. Epub 2022 Sep 15.
Screening for breast and cervical cancer is strongly related with a reduction in cancer mortality but previous evidence has found socioeconomic inequalities in screening. Using up-to-date data from the second wave of the European Health Interview Survey (2013-2015), this study aims to analyse income-related inequalities in mammography screening and Pap smear test in 30 European countries. We propose a framework that combines age group and screening interval, identifying situations of due-, under-, and over-screening. Coverage rates, standard and generalised concentration indices are calculated. Overall, pro-rich inequalities in screening persist though there are varied combinations of prevalence of screening attendance and relative inequality across countries. Bulgaria and particularly Romania stand out with low coverage and high inequality. Some Baltic and Mediterranean countries also present less favourable figures on both accounts. In general, there are not marked differences between mammography and Pap smear test, for the recommended situation ('Due-screening'). 'Extreme under-screening' is concentrated among lower income quintiles in basically all countries analysed, for both screenings. These women, who never screened, are at risk of entering the group of 'Lost opportunity', once they reach the upper-limit age of the target group. At the same time, there are signals of 'Over-screening', within target group, due to screening more frequently than recommended. In several countries, 'Over-screening' seems to be concentrated among richer women. This is not only a waste of resources, but it can also cause harms. The inequalities found in 'Extreme under-screening' and 'Over-screening' raise concerns on whether women are making informed choices.
乳腺癌和宫颈癌筛查与癌症死亡率的降低密切相关，但先前的证据表明筛查存在社会经济不平等。本研究利用欧洲健康访谈调查（EHIS）第二波（2013-2015 年）的最新数据，旨在分析 30 个欧洲国家中与收入相关的乳房 X 光检查和巴氏涂片检查的不平等情况。我们提出了一个结合年龄组和筛查间隔的框架，确定了应筛查、未筛查和过度筛查的情况。计算了覆盖率、标准和广义集中指数。总体而言，尽管各国的筛查参与率和相对不平等程度存在差异，但仍存在有利于富人的筛查不平等现象。保加利亚，尤其是罗马尼亚，其覆盖率低，不平等程度高。一些波罗的海和地中海国家在这两个方面也呈现出不太有利的情况。一般来说，在推荐的情况（“应筛查”）下，乳房 X 光检查和巴氏涂片检查之间没有明显差异。在基本所有分析的国家中，处于较低收入五分位的女性都存在“极端未筛查”的情况，这些女性从未接受过筛查，一旦达到目标人群的上限年龄，就有可能进入“错失机会”群体。与此同时，由于筛查频率高于推荐频率，在目标人群中也出现了“过度筛查”的信号。在一些国家，“过度筛查”似乎集中在较富裕的女性中。这不仅是资源的浪费，还可能造成伤害。在“极端未筛查”和“过度筛查”中发现的不平等现象引发了人们对女性是否做出知情选择的关注。
