Cervical cancer screening spatial associations of outcome and risk factors in Rotterdam

Objective : Obtaining insight into the geographic distribution of attendance and smear test results at the cervical cancer screening program in Rotterdam neighbourhoods, associated with socio-economic status, marital status and the percentage migrants. Design : Ecological analysis was carried out on data on cervical cancer screening outcome and population figures, provided by the Rotterdam Local Health Information System, in which health information is collected at neighbourhood level. Setting : The cervical cancer screening program in the city of Rotterdam. Participants : Fifty-three neighbourhoods, with overall 569 105 inhabitants, of whom 70 621 women between 1992 and 1994 were invited for the screening program. Main results : Between neighbourhoods a large difference in attendance rate and the percentage positive smears exists. A high socio-economic level of a neighbourhood, and a low percentage migrants, single or divorced women correspond with high attendance. A high socio-economic status of a neighbourhood and a low percentage migrants correspond with a low percentage smear test Pap 3B or higher. Socio-economic status, percentage migrants and marital status are highly interrelated on neighbourhood level. Multivariate analysis showed a negative correlation between the attendance rate and the percentage of single and divorced women, and a positive correlation between the percentage migrants and the percentage of positive smears (Pap 3B or higher). Conclusion : Various risk groups, showing low attendance or a high percentage of positive smears, are clustered in neighbourhoods and can be identified by socio-economic status, marital status and nationality. Activities to improve attendance can be focused towards these neighbourhoods.