期刊
INTERNATIONAL JOURNAL OF PUBLIC HEALTH
卷 56, 期 2, 页码 139-152出版社
SPRINGER BASEL AG
DOI: 10.1007/s00038-010-0224-6
关键词
Cervical cancer screening; Socioeconomic inequality; Decomposition
资金
- Canadian Institutes for Health Research [191612]
- Fonds de la Recherche en Sante du Quebec (FRSQ)
- CIHR-Institute of Aging
The development of successful policies to reduce income-related inequalities in cervical cancer screening rates requires an understanding of the reasons why low-income women are less likely to be screened. We sought to identify important determinants contributing to inequality in cervical screening rates. We analyzed data from 92,541 women aged 25-64 years, who participated in the World Health Survey in 2002-2003. Income-related inequality in Pap screening was measured using the concentration index (CI). Using a decomposition method for the CI, we quantified the contribution to inequality of age, education level, marital status, urbanicity and recent health-care need. There was substantial heterogeneity in the contributions of different determinants to inequality among countries. Education generally made the largest contribution (median = 15%, interquartile range [IQR] = 23%), although this varied widely even within regions (e.g., 5% in Austria, 28% in Hungary). The contribution of rural residence was greatest in African countries (median = 10%, IQR = 13%); however, there was again substantial within-region variation (e.g., 26% in Zambia, 2% in Kenya). Considerable heterogeneity in the contributions of screening determinants among countries suggests interventions to reduce screening inequalities may require country-specific approaches.
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