The influence of marital status and partner concordance on participation in colorectal cancer screening

Abstract

Background Colorectal cancer screening program using a fecal immunochemical test aims to reduce morbidity and mortality through early detection. Although screening participation is free-of-charge, almost 40% of the invited individuals choose not to participate. To bring new insight into how non-participation can be identified and targeted, we examined the association between marital status and screening participation; with a focus on partner concordance in participation and sex differences. Methods This nationwide cross-sectional study included all Danish citizens aged 50–74 years, who were invited to colorectal cancer screening between 2014 and 2017. Logistic regression analysis was used to estimate odds ratio (OR) of participation while adjusting for sociodemographic variables. Results A total of 1 909 662 individuals were included in the analysis of which 62.7% participated in the screening program. Participation was highest among women. Stratified by marital status, screening participation was markedly lower in widowed (61.5%), divorced (54.8%) and single (47.3%), while participation reached 68.4% in married individuals. This corresponded to ORs of 0.59 (95% CI 0.58–0.59) for widowed, 0.56 (95% CI 0.55–0.56) for divorced and 0.47 (95% CI 0.47–0.48) for single, compared to married individuals. Individuals married to a participating partner were five times more likely to participate than married individuals with a non-participating partner, regardless of gender. Conclusions Marital status was strongly associated with participation in colorectal cancer screening, and participation was even higher in married individuals with a participating partner. Future efforts to increase participation in colorectal cancer screening could potentially benefit from considering the role of partner concordance.

Characteristics of nonparticipants in a randomised colorectal cancer screening trial comparing sigmoidoscopy and faecal immunochemical testing

“…In the publicly funded screening programmes in Denmark, Finland and Spain, uptake in faecal‐based screening was shown to increase by increasing age, 5,7,8 but, similarly to our findings, it decreased from the top participation rate after reaching 70 years of age in Denmark 5 . A common feature with our and the other European studies is that participation in faecal‐based screening was higher in women than men 8,19,20 . We observed that the difference in uptake between males and females was stronger in the FIT than in the sigmoidoscopy arm.…”

“…5 A common feature with our and the other European studies is that participation in faecalbased screening was higher in women than men. 8,19,20 We observed that the difference in uptake between males and females was stronger in the FIT than in the sigmoidoscopy arm. Similarly, the Spanish COL-…”

“…In two studies in Denmark and Finland, living without a partner was also a predictor for nonparticipation in faecal-based screening, but no difference between men and women was evident. 8,19 Although we observed heterogeneity between FIT and sigmoidoscopy for several socio-demographic factors, the difference in odds for nonparticipation between the screening methods are truly large only for some of them, such as immigrants vs nonimmigrants, high vs low income and long vs short travel time to screening centre.…”

Examination of the Association Between Access to Care and Lung Cancer Screening Among High-Risk Smokers

“…Finally, other factors influencing cancer screening behavior such as having a usual source of care ( 72 ), access to transportation ( 73 , 74 ), health literacy ( 75 , 76 ), doctor's recommendation ( 77 , 78 ), and other socioeconomic factors (e.g., marital status, education, income, poverty level, home rental, etc.) ( 79 – 81 ) were not measured due to data limitation and can be controlled in future studies.…”

Lack of an association between marital status and survival in patients receiving stereotactic body radiotherapy for early-stage non-small-cell lung cancer

“…An unmarried status, including being widowed, divorced, or single, is associated with increased mental health problems, cardiovascular diseases, coronary heart disease, and stroke-related death [ 5 , 6 ]. Regarding malignancies, a strong association between marital status and participation in cancer screening has been reported, and participation is even higher in married individuals with a participating partner [ 7 ]. In married individuals, cancer is detected earlier, while unmarried individuals are more likely to be diagnosed at an advanced stage and/or be untreated despite diagnosis [ 8 , 9 ].…”