Disparities in Cervical Cancer Screening Participation in Iran: A Cross-Sectional Analysis of the 2016 Nationwide Steps Survey

Abstract

Background: One of the most important concerns in every healthcare system is the elimination of disparities in health service utilization and achievement of health equity. This study aims to investigate the disparities in cervical cancer screening participation in Iran.Methods: A cross-sectional study was conducted using data from the National Non-Communicable Risk Factors Survey in 2016 (STEPs 2016). Data on cervical cancer screening in addition to demographic and socio-economic factors from 15975 women aged 18 and above were analyzed. The distribution of surveyed women with regard to cervical cancer screening practice was described. Chi Square and logistic regression were used to assess the association of demographic and socio-economic factors with cervical cancer screening. Socio-economic equity in screening was assessed by concentration index, and GIS analysis was used to show the provincial indices on the map of Iran.Results: Overall, 52.1% of women aged 30-59 years, had undergone cervical cancer screening at least once in their lifetime. Participation rate in cervical cancer screening programs varied between provinces; ranging from 7.6% in Sistan and Baluchestan to 61.2% in Isfahan. Young age, having no education, and being uninsured were associated with lower participation. Concentration index showed pro-poor inequity for the country and across all provinces, indicating that cervical cancer screening services are less utilised by high income groups. GIS analysis demonstrated spatial disparity across provinces of Iran.Conclusions: Equity and participation in cervical cancer screening in Iran requires improvement. For this to be achieved, new policies shall have a stronger emphasis on the lowest and the highest socio-economic population groups, while current strategies have mostly affected the people with middle socio-economic status.

Acceptance of cervical cancer screening among women: global and Indian scenario

“…The participation rate for women aged 30-59 years was 52.1%. 15 Bano 18 Up to 2017, the project has offered cervical cancer screening for 73.99 million women. In July 2019, the State council issued the "healthy China action (2019-2030)" plan, emphasizing the need to move forward the diagnosis and treatment and optimize the allocation of medical resources, from the treatment-centered to the health-centered, and to improve health level of the whole people.…”

Increasing cervical cancer screening in Iran: effectiveness of a theory-based educational intervention

“…The performance rate of CCS programs in Iran is below the optimal level, and significantly needs improvement. As for the distribution of CCS behavior, social and geographical differences show the need for further research and more comprehensive strategies to reduce the rate of the disease and increase the performance rate [14].…”