Data_Sheet_1_Revisiting the Effects of Organized Mammography Programs on Inequalities in Breast Screening Uptake: A Multilevel Analysis of Nationwide Data From 1997 to 2017.pdf

This study revisits the effects of mammography screening programs on inequalities in breast screening uptake in Switzerland. The progressive introduction of regional mammography programs by 12 out of the 26 Swiss cantons (regions) since 1999 offers an opportunity to perform an ecological quasi-experimental study. We examine absolute income and marital status inequalities in mammography uptake, and whether the cantons' implementation of mammography programs moderate these inequalities, as previous research has devoted little attention to this. We use five waves of the Swiss Health Interview Survey covering the 1997–2017 period and comprising data on 14,267 women aged 50–70. Both up-to-date and ever-screening outcomes are analyzed with multilevel models which assess the mammography programs' within-canton effect. Findings show that higher income women and married women (compared to unmarried women) had significantly higher mammography uptake probabilities. Mammography programs did not moderate absolute income differences in up-to-date screening; however, they were associated with smaller absolute income differences in ever-screening uptake. Mammography programs related to higher screening uptake for married women, more than for unmarried women. In conclusion, we showed absolute income inequalities in mammography uptake which were not revealed by previous studies using relative inequality measures. Mammography programs may have contributed to reducing income inequalities in ever-screening, yet this was not observed for up-to-date screening. This study has implication for preventive health interventions—e.g., cancer screening promotion should pay attention to women's marital status since screening programs may widen the screening gap between married and unmarried women.

本研究重新审视了瑞士乳腺钼靶筛查（mammography screening）项目对乳腺筛查参与率不平等的影响。自1999年以来，瑞士26个州（行政区）中有12个逐步推行了区域性乳腺钼靶筛查项目，这为开展生态学准实验研究提供了契机。鉴于既往研究对此关注甚少，本研究旨在考察乳腺钼靶筛查参与率方面的绝对收入不平等与婚姻状况不平等，并探究各州推行乳腺钼靶筛查项目是否会对上述不平等起到调节作用。本研究采用覆盖1997至2017年的五轮瑞士健康访谈调查（Swiss Health Interview Survey）数据，样本包含14267名年龄在50至70岁之间的女性。本研究采用多层模型对按时筛查与曾筛查两类结局进行分析，以此评估筛查项目在各州内部的效应。研究结果显示，收入较高的女性与已婚女性（相较于未婚女性）的乳腺钼靶筛查参与率显著更高。乳腺钼靶筛查项目并未对按时筛查中的绝对收入差距起到调节作用，但却与曾筛查参与率的绝对收入差距缩小存在关联。乳腺钼靶筛查项目对已婚女性的筛查参与率提升作用，要大于未婚女性。综上，本研究揭示了既往采用相对不平等测度的研究未能发现的乳腺钼靶筛查参与率绝对收入不平等现象。乳腺钼靶筛查项目或有助于缩小曾筛查维度的收入不平等，但在按时筛查维度中并未观察到此效应。本研究对预防性健康干预具有启示意义——例如，癌症筛查推广工作应关注女性的婚姻状况，因为筛查项目可能会扩大已婚与未婚女性之间的筛查差距。