Never and under cervical cancer screening in Switzerland and Belgium: trends and inequalities

Abstract

Background Research on inequalities in cervical cancer screening (CCS) participation has overlooked the distinction between ‘never-’ and ‘under-screeners’ while different socioeconomic and demographic determinants may underlie ‘non-’ and ‘under-’ screening participation. This study examines socioeconomic and demographic inequalities in never and under CCS participation. We compare cross-national prevalence and trends among these two groups in Switzerland and Belgium, two countries with similar opportunistic CCS strategy but different healthcare systems. Methods Data on 38,806 women aged 20–70 from the Swiss Health Interview Survey (1992–2012) and 19,019 women aged 25–64 from the Belgian Health Interview Survey (1997–2013), both population-based cross-sectional nationally representative surveys, was analysed. Weighted adjusted prevalence ratios were estimated with multivariate Poisson regressions. Results Over the studied period, never screening prevalence was about 15% in both Switzerland and Belgium and under screening prevalence about 14.0%. Socioeconomic gradients were found among both never- and under-screeners. Higher income women had lower never and under screening prevalence in Switzerland and a similar gradient in education was observed in Belgium. Importantly, distinct socioeconomic and demographic determinants were found to underlie never and under screening participation. Never screening was significantly higher among foreign nationals in both countries and this association was not observed in under screening. Never screening prevalence was lower among older age groups, while under screening increased with older age. Over time, age inequalities diminished among never- and under- screeners in Switzerland while educational inequalities increased among never-screeners in Belgium. Conclusion Findings revealed that determinants of screening inequalities differed among never- and under-screeners and hence these should be addressed with different public health strategies. Crucially, socioeconomic and demographic inequalities were more pronounced among never-screeners who appeared to face more structural and persistent inequalities. Differences between the two countries should also be noted. The more liberal-type Swiss healthcare systems appeared to shape income-related screening inequalities, while education appeared to be a stronger determinant of never- and under-screening in Belgium.

Does the Socioeconomic Status Predict Health Service Utilization in Persons with Enhanced Health Care Needs? Results from A Population-Based Survey in Persons with Spinal Cord Lesions from Switzerland

“…Also, previous studies support the notion that preventive screenings are more prevalent in higher SES groups [31,32]. Our nding that higher SES groups higher odds for dentists and dental hygienist visits con rms a wellknown phenomenon [11,12,33,34]. Besides the fact that visits to dentists and dental hygienists are usually not covered by health insurance and thus reinforcing income inequalities in utilization, similar arguments can be used to explain the differences in utilization as other preventive medical treatments.…”

“…Despite the fact that Switzerland is a high-income country with universal health coverage and a highly developed social welfare system, social inequalities in health service utilization were also observed for the Swiss context [6][7][8][9][10][11][12]. Studies report different patterns of utilization across SES groups [6-8, [10][11][12], but also provide evidence for income inequalities in unmet health care needs [9].…”

“…Despite the fact that Switzerland is a high-income country with universal health coverage and a highly developed social welfare system, social inequalities in health service utilization were also observed for the Swiss context [6][7][8][9][10][11][12]. Studies report different patterns of utilization across SES groups [6-8, [10][11][12], but also provide evidence for income inequalities in unmet health care needs [9]. Available studies are however restricted to speci c SES indicators, such as the granting of social bene ts, education and/or income, or and did not adjust ndings for social inequalities in health care needs [6].…”

Macro-contextual determinants of cancer screening participation and inequalities: A multilevel analysis of 29 European countries

“…Socioeconomic inequalities in cervical and breast cancer screening tests were evidenced to persist over time and across European countries ( Damiani et al, 2015 ; Jolidon et al, 2020 ; Sabates & Feinstein, 2006 ; Willems & Bracke, 2018 ; Wubker, 2014 ). Nevertheless, the only country-level factors research has addressed are the cancer screening programmes ( Palencia et al, 2010 ; Walsh et al, 2011 ; Willems & Bracke, 2018 ) and macrolevel gender inequality ( Willems et al, 2020 ).…”

Socioeconomic inequalities in cervical pre-cancer screening among women in Ethiopia, Malawi, Rwanda, Tanzania, Zambia, and Zimbabwe – Analysis of Population-Based HIV Impact Assessment surveys

“…Other factors include, a history of multiple sexual partners, HIV-positive status and women's social interactions [9,10,11,12,13,14,15,16,17,18]. These studies showed that women who were older, resided in urban areas, and were more educated and wealthier were screened more often than younger, rural residents, uneducated, and poor women, with a few exceptions [9,19,20,21,22]. However, these studies did not estimate the magnitude of inequalities and their combined impact on cervical pre-cancer screening.…”