Does a national screening programme reduce socioeconomic inequalities in mammography use?
OBJECTIVE
To investigate possible changes in socioeconomic inequalities in mammography use among women aged 50-69 years between the start of the Belgian national screening programme in 2001 and three years later (2004), and to assess if the implementation of an organised screening programme has been successful in reducing socioeconomic inequalities in the uptake of mammography.


METHODS
Data was obtained from the 2001 and 2004 Health Interview Survey. Data were analysed by logistic regression with educational level as proxy for the socioeconomic status. The gradient of socioeconomic inequalities was estimated with the relative index of inequality.


RESULTS
Despite a substantial increase in the use of mammography from 59% in 2001 to 71% in 2004, a variation in the coverage according to educational level was detected: women with lower education were less likely to undergo mammography than those with higher education [(OR 1.93 (95% CI 1.21-3.09 in 2001 and 2.21 (95% CI 1.37-3.56) in 2004].


CONCLUSIONS
Socioeconomic inequalities in breast screening uptake seem to persist 3 years after the implementation of the national screening programme. Although the national programme improved the coverage, it could not counteract the socioeconomic gradients in the use of mammography. Additional work is needed to identify effective methods of decreasing socioeconomic inequalities in mammography use.
Puddu
Marina
M
Scientific Institute of Public Health, Epidemiology Unit, J. Wytsmanstreet 14, 1050, Brussels, Belgium. Marina.puddu@iph.fgov.be
Demarest
Stefaan
S
Tafforeau
Jean
J
D000368:Aged; D001530:Belgium; D005260:Female; D005544:Forecasting; D006266:Health Education / Q000639:trends; D006306:Health Surveys; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio; D012959:Socioeconomic Factors; D014600:Utilization Review / Q000706:statistics & numerical data