Educational inequalities in cervical cancer mortality in the Baltic countries and Finland in the context of organized screening: A register-based study 2000-2015.

Cervical cancer (CC) mortality in the Baltic countries remains high. We explored CC mortality trends and educational inequalities in CC mortality in the Baltics in the context of organized CC screening (introduced in 2004 in Lithuania, 2006 in Estonia and 2009 in Latvia) and compared the results with Finland (where screening started in 1963). Data for the Baltic countries came from longitudinal mortality follow-up studies of population censuses in 2000/2001 and 2011, and data for Finland from the longitudinal register-based population data file of Statistics Finland. CC deaths (ICD-10 code C53) were linked from national mortality registries. Information on education was census- or register-based. Overall and education-specific age-standardized mortality rates (ASMRs) and mortality rate ratios were calculated for 2000-2007 and 2008-2015 for women aged 30-49 and 50-64 years. The Baltic countries had 5-9 times higher overall ASMRs than Finland and much larger inequalities in CC mortality between low- and highly educated women. From 2000-2007 to 2008-2015 absolute inequalities in younger women reduced in all countries, except Latvia and relative inequalities increased in Estonia and Latvia. In older women, absolute inequalities increased in the Baltics but not in Finland; relative inequalities increased in all countries. The reduction in CC mortality and in absolute inequalities in younger women in Estonia and Lithuania may be associated with the introduction of organized screening. However, increasing CC mortality among older low-educated women in the Baltic countries is alarming, indicating that they have not benefitted equally from CC prevention.