The Role of Socio-Demographic Factors in the Coverage of Breast Cancer Screening: Insights From a Quantile Regression Analysis

2021
Background: In Flanders, breast cancer (BC) screening is performed in a population-based breast cancer screening program (BCSP), as well as in an opportunistic setting. Women with different socio-demographic characteristics are not equally covered by BC screening. Objective: To evaluate the role of socio-demographic characteristics on the lowest 10th and highest 90th quantile levels of BC screening coverage. Methods: The 2017 neighborhood-level coverage rates of 8,690 neighborhoods with women aged 50-69 and eligible for BCSP and opportunistic screening were linked to socio-demographic data. The association between socio-demographic characteristics and the coverage rates of BCSP and opportunistic screening was evaluated per quantile of coverage using multivariable quantile regression models, with specific attention to the lowest 10th and highest 90th quantiles. Results: The median coverage in the BCSP was 50%, 33.5% in the 10th quantile, and 64.5% in the 90th quantile. The median coverage of the opportunistic screening was 12, 4.2, and 24.8% in the 10th and 90th quantile, respectively. A lower coverage of BCSP was found in neighborhoods with more foreign residents and larger average household size, which were considered indicators for a lower socioeconomic status (SES). However, a higher average personal annual income, which was considered an indicator for a higher SES, was also found in neighborhoods with lower coverage of BCSP. For these neighborhoods, that have a relatively low and high SES, the negative association between the percentage of foreign residents, average household size, and average personal annual income and the coverage in the BCSP had the smallest regression coefficient and 95% confidence interval (CI) values were -0.75 (95% CI: -0.85, -0.65), -13.59 (95% CI: -15.81, -11.37), and -1.05 (95% CI: -1.18, -0.92), respectively, for the 10th quantile. The neighborhoods with higher coverage of opportunistic screening had a relatively higher average personal annual income, with the largest regression coefficient of 1.72 (95% CI: 1.59, 1.85) for the 90th quantile. Conclusions: Women from relatively low and high SES neighborhoods tend to participate less in the BCSP, whereas women with a relatively high SES tend to participate more in opportunistic screening. For women from low SES neighborhoods, tailored interventions are needed to improve the coverage of BCSP.
FRONTIERS IN PUBLIC HEALTH
卷号:9
收录类型
SSCI
发表日期
2021
学科领域
循证公共卫生
国家
荷兰
语种
英语
DOI
10.3389/fpubh.2021.648278
其他关键词
SOCIOECONOMIC DISPARITIES; PROGRAMS; HEALTH; INDEX
EISSN
2296-2565
资助机构
China Scholarship Council (CSC)China Scholarship Council [201808320439]
资助信息
LD was supported by the China Scholarship Council (CSC) Ph.D. scholarship (File No. 201808320439) for his research and study at the University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. The scholarship had no role in study design, data analysis, and interpretation, the writing of the manuscript, and the decision to submit the article for publication. We would like to extend our sincere gratitude to Prof. Dr. Pieter U. Dijkstra, who providedmany kind suggestions to improve this manuscript during the coach sessions of the ScienceWriting course.
被引频次(WOS)
0
被引更新日期
2022-01
来源机构
University of Groningen University of Antwerp Ghent University Ghent University Hospital University of Groningen University of Twente
关键词
breast cancer mammography screening coverage social inequality determinant quantile regression