title: Cervical cancer screening in Germany: group-specific participation rates in the state of Niedersachsen (Lower Saxony). A study with health insurance data.
abstract: OBJECTIVE
  The participation rates in cervical screenings are varying over different countries. This is only partly due to the availability of organized screening programs, as the rates are also varying between countries were such programs were implemented. For Germany the level of knowledge is low, and information are outdated. In order to improve the level of knowledge, we examined whether the participation rates in cervical screenings in a large German insurance population were changing over time, and whether these changes were different with respect to age and qualification of the participating women.
  
  
  METHODS
  The analyses were based on the complete anonymised dataset of a large statutory health insurance in Lower Saxony, Germany, with case numbers between 940,827 (2006) and 1,044,797 (2011) women aged 20 years and older.
  
  
  RESULTS
  Between 2006 and 2011 the overall annual participation rates were increasing from 44.8 to 47.6%. The highest rates occurred in women with the highest qualification level, thus leading to increasing social differences over time. There was a peak in the age group of 25-29 years from annually 60.3 (2006) to 60.2% (2011), and bi-annually from 77 to 77.1% with constantly decreasing rates up to the age of 60. No substantial differences occurred between a 2- and a 3-year observation period.
  
  
  CONCLUSIONS
  Over time only small increases of participation rates in cervical screenings occurred. These findings may be interpreted in favor of population-based screenings within an invitation program.
authors.affiliation: Medical Sociology Unit, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany, geyer.siegfried@mh-hannover.de.
authors.forename: Siegfried
authors.initials: S
authors.lastname: Geyer
authors.forename: Jelena
authors.initials: J
authors.lastname: Jaunzeme
authors.forename: Peter
authors.initials: P
authors.lastname: Hillemanns
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D055088:Early Detection of Cancer / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D016015:Logistic Models; D008403:Mass Screening / Q000706:statistics & numerical data* / Q000639:trends; D008875:Middle Aged; D011159:Population Surveillance; D015397:Program Evaluation; D012042:Registries; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*