title: Identifying specific non-attending groups in breast cancer screening--population-based registry study of participation and socio-demography.
abstract: BACKGROUND
  A population-based breast cancer screening programme was implemented in the Central Denmark Region in 2008-09. The objective of this registry-based study was to examine the association between socio-demographic characteristics and screening participation and to examine whether the group of non-participants can be regarded as a homogeneous group of women.
  
  
  METHODS
  Participation status was obtained from a regional database for all women invited to the first screening round in the Central Denmark Region in 2008-2009 (n=149,234). Participation data was linked to registries containing socio-demographic information. Distance to screening site was calculated using ArcGIS. Participation was divided into 'participants' and 'non-participants', and non-participants were further stratified into 'active non-participants' and 'passive non-participants' based on whether the woman called and cancelled her participation or was a 'no-show'.
  
  
  RESULTS
  The screening participation rate was 78.9%. In multivariate analyses, non-participation was associated with older age, immigrant status, low OECD-adjusted household income, high and low level education compared with middle level education, unemployment, being unmarried, distance to screening site >20 km, being a tenant and no access to a vehicle. Active and passive non-participants comprised two distinct groups with different socio-demographic characteristics, with passive non-participants being more socially deprived compared with active non-participants.
  
  
  CONCLUSIONS
  Non-participation was associated with low social status e.g. low income, unemployment, no access to vehicle and status as tenant. Non-participants were also more likely than participants to be older, single, and of non-Danish origin. Compared to active non-participants, passive non-participants were characterized by e.g. lower income and lower educational level. Different interventions might be warranted to increase participation in the two non-participant groups.
authors.affiliation: The Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C 8000, Denmark. line.jensen@alm.au.dk
authors.forename: Line Flytkjær
authors.initials: LF
authors.lastname: Jensen
authors.forename: Anette Fischer
authors.initials: AF
authors.lastname: Pedersen
authors.forename: Berit
authors.initials: B
authors.lastname: Andersen
authors.forename: Peter
authors.initials: P
authors.lastname: Vedsted
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D016208:Databases, Factual; D003718:Denmark / Q000453:epidemiology; D055088:Early Detection of Cancer / Q000379:methods / Q000706:statistics & numerical data; D004522:Educational Status; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012042:Registries; D012959:Socioeconomic Factors