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BMC public health
02 14, 2024;24 (1): 471.

Socioeconomic disparities in Papanicolaou test utilization in Western Iran.

Bahare Safari-Faramani, Roya Safari-Faramani, Farid Najafi, Davoud Khorasani Zavareh, Ali Kazemi Karyani, Mitra Darbandi
Author Information
  1. Bahare Safari-Faramani: Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran.
  2. Roya Safari-Faramani: Social Development and Health Promotion Research Center, Research Institute for Health, Kermanshah University of Medical Sciences, Kermanshah, Iran. roya.safari@kums.ac.ir.
  3. Farid Najafi: Social Development and Health Promotion Research Center, Research Institute for Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
  4. Davoud Khorasani Zavareh: Department of Health in Emergencies and Disasters, Workplace Health Promotion Research Center (WHPRC), School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  5. Ali Kazemi Karyani: Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
  6. Mitra Darbandi: Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
PMID: 38355473 DOI: 10.1186/s12889-024-17927-x

Abstract

BACKGROUND: Cervical cancer remains the fourth most frequently diagnosed cancer among women, and its impact is particularly significant in women residing in less developed countries. This study aims to assess socioeconomic inequality in using Papanicolaou tests, commonly known as Pap tests, which are crucial for detecting cervical cancer. The research also seeks to decompose this inequality, identifying its contributing factors. This investigation is conducted within a sizable population-based study focused on the Kurdish population, with an additional examination of potential variations between urban and rural areas.
METHOD: The study utilized baseline data from the Ravansar Non-Communicable Disease Cohort Study (RaNCD), involving 3,074 ever-married women aged 35-65. Asset data was employed to determine socioeconomic status (SES), and Principal Component Analysis was applied. The uptake of Papanicolaou tests was assessed for inequality using the Concentration Index (Cn). Additionally, decomposition analysis was conducted to identify and understand the factors contributing to socioeconomic inequality.
RESULTS: The study found that overall, 86% of women reported having undergone cervical cancer screening at least once in their lifetime. The Concentration Index (Cn) for the total population was 0.21 (p < 0.0001), indicating a higher concentration of Papanicolaou test uptake among wealthier groups. In urban areas, the Cn was 0.34 (p < 0.0001), reflecting a significant concentration among the rich. However, in rural areas, the Cn was -0.10 (p = 0.3006), suggesting no significant socioeconomic inequality. Factors such as socioeconomic status (SES), education, and age contributed to reducing inequality, explaining 62.7%, 36.0%, and 1.7% of the observed inequality, respectively. Interestingly, place of residence had a negative influence on inequality.
CONCLUSION: The uptake of Papanicolaou tests varies across different socioeconomic status levels, with a higher concentration among wealthier groups. The results enable health policymakers and researchers to tailor health intervention toward increasing public awareness, especially among women with lower levels of education women in economically deprived groups.

Keywords

Cervical cancer Inequality Iran Papanicolaou test Socioeconomic status

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MeSH Term

Humans
Female
Socioeconomic Factors
Papanicolaou Test
Socioeconomic Disparities in Health
Cohort Studies
Iran
Uterine Cervical Neoplasms
Early Detection of Cancer
Journal Article Research Support, Non-U.S. Gov't

Word Cloud

Created with Highcharts 10.0.0inequalitywomensocioeconomicPapanicolaoucanceramongstudytestsstatusCnsignificantareasuptakeconcentrationtestgroupsCervicalusingcervicalcontributingfactorsconductedpopulationurbanruraldataSESConcentrationIndex0p < 00001higherwealthiereducation7%levelshealthSocioeconomicIranBACKGROUND:remainsfourthfrequentlydiagnosedimpactparticularlyresidinglessdevelopedcountriesaimsassesscommonlyknownPapcrucialdetectingresearchalsoseeksdecomposeidentifyinginvestigationwithinsizablepopulation-basedfocusedKurdishadditionalexaminationpotentialvariationsMETHOD:utilizedbaselineRavansarNon-CommunicableDiseaseCohortStudyRaNCDinvolving3074ever-marriedaged35-65AssetemployeddeterminePrincipalComponentAnalysisappliedassessedAdditionallydecompositionanalysisidentifyunderstandRESULTS:foundoverall86%reportedundergonescreeningleastlifetimetotal21indicating34reflectingrichHowever-010p = 03006suggestingFactorsagecontributedreducingexplaining62360%1observedrespectivelyInterestinglyplaceresidencenegativeinfluenceCONCLUSION:variesacrossdifferentresultsenablepolicymakersresearcherstailorinterventiontowardincreasingpublicawarenessespeciallylowereconomicallydepriveddisparitiesutilizationWesternInequality

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