Risk of late cervical cancer screening in the Paris region according to social deprivation and medical densities in daily visited neighborhoods

Abstract

Background: Social and physical characteristics of the daily visited neighborhoods have gained an extensive interest in analyzing socio-territorial inequalities in health and healthcare. The objective of the present paper is to estimate and discuss the role of individual and contextual factors on participation in preventive health-care activities (smear screening) in the Greater Paris area focusing on the characteristics of daily visited neighborhoods in terms of medical densities and social deprivation. Methods: The study included 1817 women involved in the SIRS survey carried out in 2010. Participants could report three neighborhoods they regularly visit (residence, work/study, and the next most regularly visited). Two "cumulative exposure scores" have been computed from household income and medical densities (general practitioners and gynecologists) in these neighborhoods. Multilevel logistic regression models were used to measure association between late cervical screening (> 3 years) and characteristics of daily visited neighborhoods (residential, work or study, visit). Results: One-quarter of the women reported that they had not had a smear test in the previous 3 years. Late smear test was found to be more frequent among younger and older women, among women being single, foreigners and among women having a low-level of education and a limited activity space. After adjustment on individual characteristics, a significant association between the cumulative exposure scores and the risk of a delayed smear test was found: women who were exposed to low social deprivation and to low medical densities in the neighborhoods they daily visit had a significantly higher risk of late cervical cancer screening than their counterparts. Conclusions: For a better understanding of social and territorial inequalities in healthcare, there is a need for considering multiple daily visited neighborhoods. Cumulative exposure scores may be an innovative approach for analyzing contextual effects of daily visited neighborhoods rather than focusing on the sole residential neighborhood.

Cervical cancer screening pathways in France in 2015–2021, a nationwide study based on medico-administrative data

“…However, this information was unavailable. We may nevertheless presume that, based on their socio-economic status ( Lorant et al, 2002 ) and mobility ( Traore et al, 2020 , Vallee and Chauvin, 2012 ), women visit different type of health professionals in various places.…”

Women’s country of birth and failure to catch up an overdue cervical cancer cytological screening participation during pregnancy in France, an observational study based on survey sources

“…Low participation rates in screening programs increases the risk of dying from invasive cervical cancer, and every year in France, 60% to 70% of the new cases of this cancer are diagnosed among women aged from 35 to 69 years who are unscreened or underscreened [ 8 ]. Recent studies show that risk factors for such non-screening or underscreening include a low education level and/or low income, living alone, unemployment, and lack of medical insurance, compared with women living in more privileged environments [ 10 – 21 ]. Some studies have also found that migrant women are screened less often than native women [ 11 , 22 – 27 ].…”

Enjeux méthodologiques de l’analyse croisée entre mobilité quotidienne, environnements et santé

“…Lipperman- Kreda 2020 ;Lipperman-Kreda et al 2020), d'alcool et autres substances(Byrnes et al 2015 ;Mason et al 2015 ;Freisthler et al 2019) ; les comportements alimentaires(Zenk et al 2011 ;Gustafson et al 2013 ;Widener et al 2018 ;Drewnowski et al 2019 ;Li et Kim 2020 ;Liu et al 2020 ;Raskind et al 2020) ; et le recours aux soins(Sherman et al 2005 ;Vallée et al 2010 ;Traoré et al 2020).. « Enjeux méthodologiques de l'analyse croisée entre mobilité quotidienne, environnements et santé ».InMobilité quotidienne et santé (sous la direction de Julie Vallée), pp 49-86. DOI : 10.51926/ISTE.9109.ch2 ISTE éditions -Encyclopédie des Sciences.…”