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Evolution of social inequalities after the introduction of a breast cancer screening program. Conference Proceeding of the 5th International Congres of Epidemiology of Adelf-Epiter, Brusselss 2012

Renard, Françoise
Tafforeau, Jean
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Abstract

Introduction: Opportunistic breast cancer screening associated with a better coverage for highest socio-economic status (SES) existed in Belgium before the introduction of a national screening program in 2001-2002. This work examined the changes in the mammographic coverage by SES and the changes in SE-inequalities since 1997.Methods: Data were obtained from the Health Interview Surveys (1997-2001-2004-2008). The mammographic coverage rate was computed for women aged 50-69. Educational levels (EL) were used as proxies for SES. SE-inequality for mammographic coverage was estimated with absolute and relative disparity measures (absolute differences and ratio of the lowest versus highest EL-prevalence), regression indices (the SII and RII), and the Population-Attributable Fraction (PAF). The evolution over time of the indices was measured by testing for the differences between the first and the last survey year, and by fitting a weighted linear regression.Results: In each EL a substantial increase in the coverage was observed over time. The relative increase of prevalence (absolute increase in prevalence between 2 years divided by the prevalence in the first year) between 1997 and 2008 was larger in the 2 less educated groups (respectively + 62.8% and +92.75% increase from initial value) than in the more educated groups (+ 33% and +19%). All inequality indices reflected a change towards less inequality: the absolute prevalence difference (lowest vs highest) decreased with 55% (p=0.13), the RR of being screened (lowest vs highest) increased with 40% (p=0.07) , the PAF decreased with 72% (p<0.01) , the RII increased with 76% (p=0.07) and the SII decreased with 52% (p=0.13). However, for most of the indices, no linear trend in SE-inequalities could be observed: only between 1997 and 2001 these inequalities seem to have been reducedDiscussion and Conclusions: Since 1997, the prevalence rates of mammographic coverage increased for every EL. At the beginning of the study period - before the introduction of the screening program - a reduction of SE-inequality could be observed. The figures reflect little improvement since its introduction.

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2012-07-01
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ADELF (Association des Epidémiologistes de Langue Française) congress
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Scientific poster, presentation or proceeding
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2001, 2008, 2012, Absolute, Aged, ALL, AS, association, at, Belgium, breast, breast cancer, breast cancer screening, Breast-cancer, cancer, cancer screening, Categories, Change, Changes, conference, Coverage, data, differences, Discussion, Educational level, Educational-level, epidemiology, Evolution, Fraction, FR_CV, Gini coefficient, Group, health, Health inequalities, health interview survey, health interview surveys, Improvement, Income, Increase, inequalities, inequality, International, Interview, Interview survey, IQ, IT, Less, LEVEL, levels, linear regression, mammographic, mammographic screening, measure, measures, method, methods, national, national screening, objectives, observed, ODDS RATIO, PAF, period, prevalence, PROGRAM, proxies, Proxy, RATES, Ratio, Reduction, regression, relative, result, results, RII, RR, SCREENING, SCREENING PROGRAM, self reported, Self-reported, SES, SOCIAL, Social inequalities, Social inequality, Socio economic, socio economic inequalities, Socio economic status, Socio-economic, socio-economic inequality, Socio-economic status, Socioeconomic, Socioeconomic inequalities, Socioeconomic status, status, study, survey, surveys, TESTING, time, trend, trends, WOMEN, work
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