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Purpose: To investigate the effect of sending out reminders for colorectal cancer screening on socioeconomic and demographic inequalities in screening uptake. Methods: All citizens aged 50–74 in Denmark are invited every 2 years for colorectal cancer screening. Non-participants receive an electronically distributed reminder. Data for these analyses were derived from national registers. Socioeconomic status was measured by income and educational level. Demographic variables included age, gender and marital status, and the analyses were stratified by immigration status. Logistic regression analyses were conducted to estimate the odds of non-participation for invited citizens and for reminded citizens divided by socioeconomic and demographic predictors. Results: Of 763,511 native Danes invited for screening from 2014 to 2015, 387,116 (50.70%) participated after the initial invitation and 133,470 after receiving a reminder. Differences in participation were present in relation to all subgroups among both the invited citizens and reminded citizens. Differences persisted after full model adjustments with reductions for demographic variables. Odds ratio (OR) for non-participation in the eldest age group was 0.32 (95% CI, 0.32; 0.33) before and 1.11 (95% CI 1, 0.08; 1.14) after the reminder, compared to those under 55 years. OR for the 4th income quartile was 0.54 (95% CI, 0.53; 0.55) before and 0.44 (95% CI, 0.43; 0.45) after the reminder, compared to 1st quartile. Conclusions: Reminders increased the overall participation, and the inequalities in participation in relation to demographic factors were reduced after the distribution of reminders. The age differences were especially reduced. The inequalities in participation related to socioeconomic status were, however, slightly increased after reminder distribution.

PurposeColorectal cancer screening by inviting citizens tocomplete a test for blood in faeces was initiated in Denmarkin 2014. We have examined sociodemographic predictors thatinfluence participation to identify factors that could betargeted to increase compliance.MethodsNational registers were used to link data on invita-tions for colorectal cancer screening in Denmark from 2014 to2015. Region of residence, age, gender, immigration status,income, educational level and marital status were identified.Logistic regression analysis was used to estimate the risk ofnon-participation for invited citizens while adjusting for allother sociodemographic variables.ResultsA total of 854,237 individuals were included in theanalysis. The national participation proportion was 65.33%,with significant differences between sociodemographicgroups. Participation proportions were the lowest in non-Western immigrants (53.00%), individuals without a partner(54.05%) and those in the lowest income quartile (54.65%),with subgroup participation as low as 40.56%. The highestparticipation proportion was seen in individuals in the highestincome quartile (71.56%). Region of residence, age, gender,educational level, income quartile, marital status and immigra-tion status all had statistically significant independent differ-ences in risk of non-participation after full model adjustment.ConclusionParticipation in colorectal cancer screening washigh in Denmark in 2014 and 2015. Large differences in par-ticipation were seen between sociodemographic subgroups,potentially resulting in social inequality in the benefits fromscreening. Future efforts to increase participation should focuson the low compliance subgroups, such as singles, non-Western immigrants and people from the lowest socioeco-nomic groups.

Background Social inequalities has been shown for participation in colorectal cancer screening and recently in the initial stool sample blood test. If these differences persist at follow-up colon examination after a positive stool test, it would suggest that social inequality in screening may be greater than the inequality observed in initial stool sample blood test. Methods All data were derived from national registers. Using logistic regression analyses, odds of non-participation for follow-up colon examination were estimated based on age group, educational level, income quartile, immigration status and marital status in men and in women, who had participated in initial stool sample test for blood with a positive result. Results Among 20 849 men and 16 565 women invited for follow-up colonoscopy in the period 2014–15, 10.63 and 11.37%, respectively, did not attend. In men, odds of non-participation were higher in the eldest, those with lower income and lower educational level, in immigrants and in singles. Odds ratio (OR) in males of highest income quartile was 0.54 [95% confidence interval (CI) 0.46; 0.63] compared with lowest income quartile. In women, the differences were not as large. OR in females of highest income quartile was 0.73 (95% CI 0.61; 0.87) compared with lowest income quartile. Conclusion Sociodemographic differences in odds of non-participation exist in follow-up colon examination in the Danish colorectal cancer screening. Differences were evident in all subgroups of the male population. The same patterns were seen in women. Social inequalities in participation for follow-up colon examination can increase overall social inequality and consequently, lead to health disparities.