Exploring inequalities in service use: the case of cervical cancer screening in Ireland, the United Kingdom and United States

Abstract

This study examined inequalities in uptake of cervical cancer screening in the Republic of Ireland, Britain and Northern Ireland, and the United States using data from nationally representative surveys in 2007/2008. Regression analyses and a comparison of concentration indices measuring income related inequalities were used to explore between group differences across all countries. Uptake of cervical cancer screening in the past 12 months is significantly higher in the US (59.90%) than in the UK (28.43%) and Ireland (17.98%). Concentration indices for screening in the past 3 years demonstrated a pro-rich inequality in uptake in England (0.076***) no inequality in Wales (-0.027) and Scotland (-0.013) and increasing pro-poor inequalities amongst Northern Ireland Catholics (-0.155**). Whites had the largest inequalities in the US (0.261***) compared to Blacks (0.092**) and Hispanics (0.115***). Results from the marginal effects showed no inequalities in the UK as a whole, but significant disparities for Ireland and the US across both income and education levels in the US. There are a variety of potential explanations for the observed differences between countries in the pattern of uptake among demographic groups, including divergence in health systems across country and differences in perception of risk. Racial and cultural differences also appear to play a role. That such differences may exist but be masked by estimates of inequality at a national level indicates the importance of a more nuanced approach to the examination of inequality and policy makers should be cognisant of such potential heterogeneity when developing policy instruments to address inequalities. A policy which decreases inequality at a national level may exacerbate existing inequities between groups if such heterogeneity is ignored when formulating policy.