According to a study published in the Journal of Public Health, women who are young, non-Caucasian or live in areas of socioeconomic deprivation are less likely to attend cervical screening.
Cervical cancer is the second most common cancer in women, with around 400,000 new cases and 250,000 deaths each year. In 2008, 25,000 of the 54,800 European women who were diagnosed with cervical cancer died from the disease. 2,500 of these new cases and 830 deaths were in the UK.
The researchers state that strategies to improve cervical screening attendance among young, non-Caucasian women, and those living on low incomes need to be developed and implemented, in order to address this disparity.
The researchers, Ji Young Bang, Ghasem Yadegarfar, Michael Soljak and Azeem Majeed, set out to identify general practice and socioeconomic factors linked to cervical screening in England, using data on 26,497,476 women, registered with 7,970 practices in 152 English Primary Care Trusts (PCT).
The Quality and Outcomes Framework (QOF) is a UK system that allows for general participating practices to be monitored in terms of their achievements. For their study, the researchers obtained data on staffing levels, socioeconomic status and QOF Indicators from the QOF system, between 2008 and 2009.
Furthermore, using data from the 2007 Information Center for Health & Social Care Database, the researchers calculated the number of female patients per full-time general practitioner, in a population of 100,000.
The Index of Multiple Deprivation (IMD) score was obtained from the 2004 Department of Communities and Local Government (DCLG) IMD database. The IMD calculates the degrees of socioeconomic deprivation based on education, health, housing, employment, income, and crime.
The team also included the proportion of female patients aged 25 to 49 years and 50 to 64 years that were registered with practices since 2008, as well as the estimated number of patients of different ethnicities.
In both PCTs and practices, the researchers found that women aged 25 to 49, ethnic women and those living in areas of socioeconomic deprivation were significantly less likely to attend cervical screening.
In addition, women aged 50 to 64 years, overall QOF score and the records/information score were significantly positively associated with cervical screening coverage, but only at practice level.
The median range for cervical screening at a practice level was 83.5% (0 to 100%), and ranged from 65.8% to 85.8% at a PCT level.
The study outcome has established which groups of women could gain major benefits by improving their attendence for cervical screening. It furthermore confirms findings of other research that have also identified insufficient screening attendance in young, non-Caucasian women that are socioeconomically deprived.
According to earlier studies, the reason why non-Caucasian women have lower cervical screening attendance may be due to lack of knowledge about the cervical screening program.
Bang explained:
“To improve cervical screening, a system for educating these individuals and improving knowledge of the service provided needs to be instituted.
More organized practices may be better at monitoring and delivering health care to the local population, resulting in the implementation of policies that can deliver positive results in increasing cervical screening. To improve cervical screening a multifaceted approach is needed that includes patients, physicians, individual practices and policy makers.
Performance indicators, such as cervical screening coverage, can be substantially influenced by population factors such as age, ethnicity, and socioeconomic status.
Using crude performance data to determine the quality of care provided by general practices and PCTs can be misleading. This is an important issue as the UK government has announced this year that the general practice performance data will be made available publicly in the near future.”
Bang concludes:
“Our study illustrates that population and health system characteristics remain important influences on participation in preventative interventions such as cervical screening, even in a health system that offers free of charge access to universal healthcare.
Also, in the 21st century, more than twenty years after the start of cervical screening in England, socioeconomic, ethnic, and age-related disparities still exist. To improve cervical screening in England, efforts should focus on implementing and developing strategies for improving cervical screening attendance in the young, socioeconomically disadvantaged and ethnic minority women.”
Written By Grace Rattue