Equity in Cervical Cancer Screening in Iran: A Cross-Sectional Analysis of the 2016 Nationwide Steps Survey

Abstract

Background One of the most important concerns in every healthcare system is the achievement of equity in health. Studies have shown great socioeconomic and spatial disparity in cervical cancer incidence and mortality. This study aims to investigate equity in cervical cancer screening in Iran. Methods A cross-sectional study was conducted using data from the National Non-Communicable Risk Factors Survey in 2016 (STEPs 2016). Data on cervical cancer screening in addition to demographic and socioeconomic factors from 15975 women aged 18 and above were analyzed. Chi-Square test and logistic regression were used to assess the association of demographic and socioeconomic factors with cervical cancer screening. Equity in screening was assessed by concentration index, and GIS analysis was used to show the provincial indices on the map of Iran. Results Overall, 41·6% of surveyed women in Iran had undergone cervical cancer screening in their lifetime. Participation rate in cervical cancer screening programs varied between provinces; ranging from 7.6% in Sistan and Baluchestan to 61.2% in Isfahan. Being single, living in rural areas, young age, having no education, and being uninsured were associated with lower participation. Concentration index showed pro-poor inequity for the country and across all provinces, indicating that cervical cancer screening services are less utilised by high income groups. GIS analysis demonstrated spatial disparity across provinces of Iran. Conclusions Equity and participation in cervical cancer screening in Iran requires improvement. For this to be achieved, new policies shall have a stronger emphasis on the lowest and the highest socioeconomic population groups, while current strategies have mostly affected the people with middle socioeconomic status.