Keywords: Healthcare Administrative Claims; Primary prevention; Early Detection of Cancer; Healthcare Disparities; Uterine Cervical Neoplasms; Cervix Uteri
The socioeconomic deprivation of women is a factor associated with the inequality in uterine cervical cancer (UCC) screening uptake. An UCC organised screening program has proven to be effective in increasing the uptake but may also increase socioeconomic inequality. General practitioners (GPs) are involved in both UCC primary and secondary preventions: papillomavirus (HPV) vaccination and cytological screening.
In order to assess the effect of an organisation of UCC screening on inequalities, we aimed to compare a French department with organised screening with a French control department, using HPV vaccination uptake as a control group.
We used reimbursement data from the main French health insurance scheme to compare vaccination rates and screening rates in the municipalities of the two departments over a three-year period. Social inequality was measured at the municipal level using a validated aggregated indicator: the French European Deprivation Index.
Unlike screening reimbursement data, vaccination data revealed a large and unexpected proportion of young girls whose identified place of living did not match the expected department and did not allow compared analyses. However, the organised screening department had higher screening rates but the increase in deprivation was associated with a greater effect on the decrease in UCC screening participation in this department. While GPs were overwhelmingly involved in the prescriptions of reimbursed vaccines, cervical smear reimbursements were mainly consequent to a gynaecologist’s prescription.
The vaccination data revealed an unexpected geographic distribution that did not allow the analyses planned in the protocol. Several hypotheses have been made to explain this distribution and will be presented with the results. Screening reimbursement data seemed to confirm previous studies, both on the attention to be paid to the socioeconomic inequality and on the limited involvement of French GPs in UCC screening.
Points for discussion:
Have other members carried out or planned similar analyzes in order to improve the quality of the available databases?
How does other members manage the identification of teenagers' reimbursements, whose data are often linked to their parents’ identification?
Are some members aware of prospective primary care cohorts to monitor populations vaccinated or not against HPV?