title: Do social inequalities in cervical cancer screening persist among patients who use primary care? The Paris Prevention in General Practice survey.
abstract: OBJECTIVE
  Social inequalities in cervical cancer screening may be related to either lack of access to care or inadequate delivery of preventive care by providers. We sought to characterize social inequalities among women consulting general practitioners with a wide range of social position indicators.
  
  
  METHODS
  In 2005-06, 59 randomly recruited general practitioners from the Paris metropolitan area enrolled every woman aged 50-69 years seen during a two-week period. Cervical cancer screening status (overdue if the last cervical cancer screening had been more than 3 years earlier) was analyzed for 858 women in a logistic mixed model that considered: occupational class (in 5 levels, based on last occupation), education, income, characteristics related to family, housing, neighborhood, household wealth (social allocations, perceived financial difficulties in 4 levels, income tax), employment status, supplementary health insurance, and social network (4 levels).
  
  
  RESULTS
  The rate of overdue patients did not vary between general practitioners (21%). social position indicators associated with overdue status (odds ratio between 2 adjacent decreasing social levels) were occupational class (1.20, 95% CI: 1.03-1.41), social network (1.52, 95% CI: 1.18-1.94), financial difficulties (1.42, 95% CI: 1.07-1.88), neighborhood safety (2.15, 95% CI: 1.10-4.20), and allocations (3.34, 95% CI: 1.12-9.96).
  
  
  CONCLUSIONS
  Even among women visiting general practitioners we observed marked social inequalities that persist above and beyond occupational class.
authors: Université Paris-Descartes, Faculté de Médecine, Department of Family Medicine, F-75014, Paris, France. laurent.rigal@inserm.fr
authors: L
authors: L
authors: Rigal
authors: M-J
authors: MJ
authors: Saurel-Cubizolles
authors: H
authors: H
authors: Falcoff
authors: J
authors: J
authors: Bouyer
authors: V
authors: V
authors: Ringa
mesh_terms: D000368:Aged; D016001:Confidence Intervals; D055088:Early Detection of Cancer / Q000295:instrumentation / Q000379:methods*; D004651:Employment; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D006801:Humans; D008875:Middle Aged; D016017:Odds Ratio; D010297:Paris; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*