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Decomposing income-related inequality in cervical screening in 67 countries

  • Original Article
  • Published:
International Journal of Public Health

Abstract

Objectives

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.

Methods

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.

Results

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).

Conclusions

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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Acknowledgments

We thank the Institute for Health Metrics and Evaluation for providing us with the estimates of permanent income that were used in these analyses. This work was supported by the Canadian Institutes for Health Research (191612). At the time of this research, Sam Harper was supported by a Chercheur-boursier from the Fonds de la Recherche en Santé du Québec (FRSQ), and Spencer Moore was supported through a New Investigator Award from the CIHR-Institute of Aging.

Conflict of interest

The authors declare that they have no competing interests.

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Authors and Affiliations

  1. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada

    Brittany McKinnon & Sam Harper

  2. School of Kinesiology and Health Studies, Queens University, Kingston, Canada

    Spencer Moore

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  1. Brittany McKinnon
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  2. Sam Harper
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Correspondence to Brittany McKinnon.

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McKinnon, B., Harper, S. & Moore, S. Decomposing income-related inequality in cervical screening in 67 countries. Int J Public Health 56, 139–152 (2011). https://doi.org/10.1007/s00038-010-0224-6

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  • DOI: https://doi.org/10.1007/s00038-010-0224-6

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