Personal factors influence use of cervical cancer screening services: epidemiological survey and linked administrative data address the limitations of previous research

BACKGROUND National screening programs have reduced cervical cancer mortality; however participation in these programs varies according to women's personal and social characteristics. Research into these inequalities has been limited by reliance on self-reported service use data that is potentially biased, or administrative data that lacks personal detail. We address these limitations and extend existing research by examining rates and correlates of cervical screening in a large epidemiological survey with linked administrative data. METHODS The cross-sectional sample included 1685 women aged 44-48 and 64-68 years from the Australian Capital Territory and Queanbeyan, Australia. Relative risk was assessed by logistic regression models and summary Population Attributable Risk (PAR) was used to quantify the effect of inequalities on rates of cervical cancer screening. RESULTS Overall, 60.5% of women participated in screening over the two-year period recommended by Australian guidelines. Screening participation was associated with having children, moderate or high use of health services, employment, reported lifetime history of drug use, and better physical functioning. Conversely, rates of cervical screening were lower amongst women who were older, reliant on welfare, obese, current smokers, reported childhood sexual abuse, and those with anxiety symptoms. A summary PAR showed that effective targeting of women with readily observable risk-factors (no children, no partner, receiving income support payments, not working, obese, current smoker, anxiety, poor physical health, and low overall health service use) could potentially reduce overall non-participation in screening by 74%. CONCLUSIONS This study illustrates a valuable method for investigating the personal determinants of health service use by combining representative survey data with linked administrative records. Reliable knowledge about the characteristics that predict uptake of cervical cancer screening services will inform targeted health promotion efforts.This work was supported by Australian National Health and Medical Research Council grants (Program Grant 179805 and Project Grant 157125). In addition, PB was funded by a fellowship from the Australian National Health and Medical Research Council and SCO, PJ and RJT by the Australian National University