Evidence map›Paper›PMID 34560888›Full record

ArticleInternational journal for equity in health2021

Cervical cancer screening programs and their context-dependent effect on inequalities in screening uptake: a dynamic interplay between public health policy and welfare state redistribution.

Vincent De Prez, Vladimir Jolidon, Barbara Willems, Stéphane Cullati, Claudine Burton-Jeangros, Piet Bracke

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In one paragraph

Article in International journal for equity in health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
22citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

22 citing papers in PubMed, 1 synthesis or guideline pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Vincent De PrezDepartment of Sociology, Ghent University, Korte Meer 5, 9000, Ghent, Belgium. Vincent.DePrez@UGent.be.ORCID 0000-0002-1531-8818
Vladimir JolidonInstitute of Sociological Research, Geneva School of Social Sciences, University of Geneva, 40 bd du Pont-d'Arve, CH- 1211, Geneve 4, Switzerland.
Barbara WillemsDepartment of Sociology, Ghent University, Korte Meer 5, 9000, Ghent, Belgium.
Stéphane CullatiInstitute of Sociological Research, Geneva School of Social Sciences, University of Geneva, 40 bd du Pont-d'Arve, CH- 1211, Geneve 4, Switzerland.
Claudine Burton-JeangrosInstitute of Sociological Research, Geneva School of Social Sciences, University of Geneva, 40 bd du Pont-d'Arve, CH- 1211, Geneve 4, Switzerland.
Piet BrackeDepartment of Sociology, Ghent University, Korte Meer 5, 9000, Ghent, Belgium.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundWhile organized and opportunistic cervical cancer screening (CCS) programs implemented across the European Union have increased participation rates, barriers to socioeconomically deprived women remain substantial, implying high levels of inequality in CCS uptake.

aimThis study assesses how the screening strategy (as a score based on the availability of organized population-based CCS programs), accessibility of the healthcare system (as an index of out-of-pocket expenditure as a proportion of total healthcare costs, public health expenditure as a percentage of total GDP, and general practitioner (GP) density per 10'000 inhabitants) and social protection (as a decommodification index), impact education- and income-based inequalities in CCS uptake.

methodsA two-level design with 25-64-year-old women (N = 96'883), eligible for Pap smear screening, nested in 28 European countries, was used to analyze data from the European Health Interview Survey's second wave, using multilevel logistic regression modelling.

resultsClear educational and income gradients in CCS uptake were found, which were smaller in countries with organized CCS programs, higher accessibility of the healthcare system and a higher level of decommodification. Furthermore, three-way interaction terms revealed that these gradients were smaller when organized CCS programs were implemented in countries with better accessibility of the healthcare system or a high level of decommodification.

conclusionThis study indicates that the combination of organized screening and high accessibility of the healthcare system or social protection is essential for having lower levels of inequality in CCS uptake. In such countries, the structural threshold for poorer and lower educated women to engage in CCS is lower. This may be explained by them having a better interaction with their GP, who may convince them of the screening test, lower out-of-pocket payments, and financial support to buffer against a disadvantageous position on the labor market.

Indexed as

Early Detection of CancerHealthcare DisparitiesUterine Cervical NeoplasmsAdultEuropeFemaleHealth PolicyHumansMiddle AgedProgram EvaluationSocial WelfareSocioeconomic FactorsAccess to healthcareCancer screening participationDecommodificationEducation gradientIncome gradientScreening strategy

Identifiers

PMID34560888
PMCPMC8464130

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.