Published in:
01-04-2011 | Original Article
Decomposing income-related inequality in cervical screening in 67 countries
Published in: International Journal of Public Health | Issue 2/2011
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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.