Decomposing socio-economic inequality in colorectal cancer screening uptake in England

Abstract

Colorectal cancer (CRC) is the second largest cause of cancer death in the UK. Since 2010, CRC screening based on Faecal Occult Blood testing has been offered by the NHS in England biennially to all persons age 60 to 69 years. Several studies have demonstrated a gradient in uptake using area-level markers of socio-economic status (SES), but few have examined the individual-level contributors to the gradient. We aimed to quantify the extent of SES inequality in CRC screening uptake in England using individual-level data, and to identify individual factors associated with this inequality.We used data from 1,833 participants (aged 61-69) in Wave 5 (collected in years 2010/11) of the English Longitudinal Study of Ageing (ELSA) eligible for having been sent at least one CRC screening invitation. Uptake was defined by self-report of ever having been screened as part of the National Screening Programme. We assessed socio-economic inequality using the corrected concentration index of uptake against SES rank, which was derived by regressing a range of SES markers against net non-pension household wealth. Other demographic and health-related variables were included in the analysis. Factors associated with inequality were measured using concentration index decomposition.There was a significant pro-rich gradient in screening uptake (concentration index: 0.16, 95% CI:0.11-0.22), mostly explained within our model by differences in non-pension wealth (38.7%), partner screening status (15.9%), sickness/disability (13.5%), and health literacy (8.5%).Interventions aimed at reducing inequalities in CRC screening uptake should focus on improving acceptability of screening in populations with low levels of education and literacy barriers.

Socioeconomic and ethnic inequities within organised colorectal cancer screening programmes worldwide

“…In the seven findings using income level and/or economic difficulties, lower income and greater economic burden were associated with lower participation. The largest difference for low versus high income was 42% versus 66% 41. Participation was stratified by occupation in two studies.…”

Association between socioeconomic deprivation and colorectal cancer screening outcomes: Low uptake rates among the most and least deprived people

“…The reasons described for non-participation among the most deprived groups are a lack of information, prioritisation of other problems, not understanding the written information provided, underestimation of the benefits of screening and stronger fears and fatalistic attitudes [24,25]. While insurance status has been described in other contexts to influence CRC screening uptake [15], in Spain health care access is guaranteed for all residents regardless of their socioeconomic level and the BCRCSP is completely free of charge throughout the whole process including all screening and diagnostic tests as well as cancer treatment.…”

Socio‐economic status and theories of health behaviour: Time to upgrade a control variable

“…The causes underlying health inequalities are multifaceted and include considerable SES‐related differences in health behaviours (Stringhini et al ., ). For example, people of lower SES engage in less recreational physical activity (Gidlow, Johnston, Crone, Ellis, & James, ), consume alcohol in a more risky manner (Bloomfield, Grittner, Kramer, & Gmel, ), smoke more (Marmot, ), and participate in less screening or prevention programmes (Solmi et al ., ). However, despite this wealth of epidemiologic evidence on the role of SES for health and health behaviours, psychological research in general and research in health psychology in particular has not been engaging with SES in great or sufficient detail (Sweeney, ).…”