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Title

Revisiting the effects of organized mammography programs on inequalities in breast screening uptake: a multilevel analysis of nationwide data from 1997 to 2017

Authors
Bell, Andrew
Published in Frontiers in public health. 2022, vol. 10, 812776
Abstract This study revisits the effects of mammography screening programs on inequalities in breast screening uptake in Switzerland. The progressive introduction of regional mammography programs by 12 out of the 26 Swiss cantons (regions) since 1999 offers an opportunity to perform an ecological quasi-experimental study. We examine absolute income and marital status inequalities in mammography uptake, and whether the cantons' implementation of mammography programs moderate these inequalities, as previous research has devoted little attention to this. We use five waves of the Swiss Health Interview Survey covering the 1997–2017 period and comprising data on 14,267 women aged 50-70. Both up-to-date and ever-screening outcomes are analyzed with multilevel models which assess the mammography programs' within-canton effect. Findings show that higher income women and married women (compared to unmarried women) had significantly higher mammography uptake probabilities. Mammography programs did not moderate absolute income differences in up-to-date screening; however, they were associated with smaller absolute income differences in ever-screening uptake. Mammography programs related to higher screening uptake for married women, more than for unmarried women. In conclusion, we showed absolute income inequalities in mammography uptake which were not revealed by previous studies using relative inequality measures. Mammography programs may have contributed to reducing income inequalities in ever-screening, yet this was not observed for up-to-date screening. This study has implication for preventive health interventions—e.g., cancer screening promotion should pay attention to women's marital status since screening programs may widen the screening gap between married and unmarried women.
Keywords Socioeconomic inequalitiesSwitzerlandBreast cancer screeningMarital statusMultilevel analysisOrganized population-based screening programs
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Projects
Research Foundation—Flanders: FWOOPR2018005701
Swiss National Science Foundation: 100019E_176115
Citation
(ISO format)
JOLIDON, Vladimir et al. Revisiting the effects of organized mammography programs on inequalities in breast screening uptake: a multilevel analysis of nationwide data from 1997 to 2017. In: Frontiers in public health, 2022, vol. 10, p. 812776. doi: 10.3389/fpubh.2022.812776 https://archive-ouverte.unige.ch/unige:158917

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Deposited on : 2022-02-15

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