Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619, Tallinn, Estonia.
Department of Research, Cancer Registry of Norway, Oslo, Norway.
BMC Womens Health. 2022 Dec 24;22(1):545. doi: 10.1186/s12905-022-02123-z.
Despite the national cervical cancer (CC) screening program established in 2006, the CC incidence in Estonia in 2020 was still one of the highest in Europe. To better understand the possible barriers among women, the aim of this study was to describe the inequalities in the Pap smear uptake trend in 2004-2020 and to analyse the associations between different factors in Estonia.
Weighted data of 25-64-year-old women (N = 6685) from population-based cross-sectional studies of Health Behaviour among Estonian Adult Population in 2004-2020 was used. Linear trends in uptake of Pap smear over time were tested using the Cochrane-Armitage test. Binary logistic regression with interactions was performed to analyse associations between the uptake of Pap smear and sociodemographic, socioeconomic, health-related and lifestyle factors. Crude and adjusted odds ratios with 95% confidence intervals were calculated.
Prevalence of lifetime uptake of Pap smear increased in 2004-2020 from 50.6 to 86.7% (P < 0.001). From 2004 to 2020, uptake of Pap smear increased significantly among women aged 25-34, 35-44, 45-54 and 55-64, in both ethnicity groups and among women with basic, secondary and higher education (P < 0.001). The gap in Pap smear uptake increased between Estonians and non-Estonians but decreased between education levels over time. Lower lifetime uptake of Pap smear was associated from sociodemographic factors with younger age, being non-Estonian and single, from socioeconomic factors with lower educational level and unemployment, from health indicators with higher body mass index indicating overweight and obesity, presence of chronic disease and depressiveness, and from lifestyle factors with non-smoking.
Although Pap smear uptake among 25-64 year old women increased significantly in Estonia in 2004-2020, inequalities were found indicating an opportunity for development of targeted CC prevention strategies.
尽管 2006 年建立了全国性的宫颈癌（CC）筛查计划，但爱沙尼亚 2020 年的 CC 发病率仍位居欧洲之首。为了更好地了解女性中可能存在的障碍，本研究旨在描述 2004-2020 年巴氏涂片检查接受率的不平等趋势，并分析爱沙尼亚不同因素之间的关联。
本研究使用了 2004-2020 年爱沙尼亚成人健康行为的基于人群的横断面研究中 25-64 岁女性的加权数据（N=6685）。使用 Cochrane-Armitage 检验测试巴氏涂片检查接受率随时间的线性趋势。采用二元逻辑回归分析巴氏涂片检查接受率与社会人口统计学、社会经济、与健康相关和生活方式因素之间的关系，并进行交互作用分析。计算了粗比值比和 95%置信区间。
2004-2020 年，一生中接受巴氏涂片检查的比例从 50.6%增加到 86.7%（P<0.001）。2004-2020 年，25-34 岁、35-44 岁、45-54 岁和 55-64 岁的女性、不同族裔群体以及接受基础教育、中等教育和高等教育的女性中，巴氏涂片检查接受率显著增加（P<0.001）。巴氏涂片检查接受率的差距在爱沙尼亚人和非爱沙尼亚人之间扩大，但随着时间的推移，在教育水平之间缩小。较低的巴氏涂片检查终生接受率与社会人口统计学因素（年龄较小、非爱沙尼亚人、单身）、社会经济学因素（教育程度较低、失业）、健康指标（超重和肥胖的体质指数较高）、慢性疾病和抑郁以及生活方式因素（不吸烟）有关。
尽管 2004-2020 年爱沙尼亚 25-64 岁女性巴氏涂片检查接受率显著增加，但仍存在不平等现象，这表明有机会制定有针对性的宫颈癌预防策略。
