Department of Obstetrics and Gynaecology, Nykøbing Falster Hospital, Nykøbing Falster, Denmark.
Omicron Aps, Roskilde, Denmark.
Eur J Public Health. 2023 Aug 1;33(4):568-573. doi: 10.1093/eurpub/ckad091.
Cervical cancer is preventable. Screening is important for early detection. However, even in high-income countries, coverage is sub-optimal. We identified socioeconomic, lifestyle and biological determinants of cervical screening coverage.
In Denmark, women aged 23-64 are free of charge personally invited to screening. All cervical cell samples are registered centrally in the Patobank. We linked data from the Lolland-Falster Health Study (LOFUS) with Patobank data. LOFUS was a population-based health survey undertaken in 2016-2020. With logistic regression, coverage defined as ≥1 cervical sample registered within a 6-year period from 2015 to 2020 was compared across levels of risk factors expressed as adjusted odds ratios (aOR) with 95% confidence intervals (CI).
Among 13 406 women of screening aged 23-64 and invited to LOFUS, 72% had ≥1 cervical sample registered. Non-participation in LOFUS was a strong predictor of low coverage; aOR 0.32; 95% CI 0.31-0.36. Among LOFUS participants, education was a strong predictor of coverage in univariate analysis, OR 0.58; 95% CI 0.48-0.71, but this association disappeared in multi-variate analysis, aOR 0.86; 95% CI 0.66-1.10. In multi-variate analysis, predictors of low coverage were high age, living without a partner, retired, current smoker, poor self-rated health, elevated blood pressure and elevated glycated haemoglobin.
Women with low cervical screening coverage had limited contact to healthcare, exemplified by non-participation in LOFUS, and pertinent health and social problems, exemplified by elevated blood pressure and glycated haemoglobin, poor self-rated health, and retirement already in screening age. Structural changes in screening are needed to reach non-screened women.
宫颈癌是可预防的。筛查对于早期发现至关重要。然而，即使在高收入国家，覆盖率也不理想。我们确定了社会经济、生活方式和生物学因素对宫颈癌筛查覆盖率的影响。
在丹麦，23-64 岁的女性可免费接受个人邀请进行筛查。所有宫颈细胞样本都在中央的 Patobank 中进行登记。我们将来自洛兰-法尔斯特健康研究（LOFUS）的数据与 Patobank 数据进行了关联。LOFUS 是 2016-2020 年进行的一项基于人群的健康调查。通过逻辑回归，将 2015 年至 2020 年 6 年内至少有 1 份宫颈样本登记的覆盖率定义为因变量，与各危险因素水平进行比较，采用调整后的优势比（aOR）及其 95%置信区间（CI）表示。
在 13406 名符合筛查年龄 23-64 岁且受邀参加 LOFUS 的女性中，有 72%的人至少有 1 份宫颈样本登记。未参加 LOFUS 是低覆盖率的强烈预测因素；aOR 为 0.32；95%CI 为 0.31-0.36。在 LOFUS 参与者中，教育在单因素分析中是覆盖率的一个强有力的预测因素，OR 为 0.58；95%CI 为 0.48-0.71，但在多因素分析中，这种关联消失，aOR 为 0.86；95%CI 为 0.66-1.10。在多因素分析中，低覆盖率的预测因素包括年龄较大、无伴侣生活、退休、当前吸烟者、自我报告健康状况较差、血压升高和糖化血红蛋白升高。
低宫颈癌筛查覆盖率的女性与医疗保健接触有限，例如未参加 LOFUS，并且存在相关的健康和社会问题，例如血压和糖化血红蛋白升高、自我报告健康状况较差、以及在筛查年龄就已经退休。需要对筛查结构进行改革，以覆盖未接受筛查的女性。
