A cross-national comparative study on the influence of individual life course factors on mammography screening

- Socioeconomic inequalities in mammography screening can originate in childhood.
- Childhood preventive health behavior is linked to mammography screening in nine European countries.
- National mammography screening programs can reduce socioeconomic inequalities.
- Screening is strongly embedded in historical time and countries' health policies.
- Incorporating a longitudinal approach is essential to further disentangle the mechanism.

ObjectivesDrawing on insights from the life course perspective, the aim of this paper is to gain a better understanding of persistent socioeconomic inequalities related to the uptake of mammography screening in 13 European countries. We examine whether these inequalities originate in childhood and relate them to the history and progression of each country's screening programs.MethodsRetrospective data from the third wave of the Survey of Health, Ageing and Retirement (SHARELIFE) is analyzed by means of event-history analyses to examine the role of childhood preventive health behavior on mammography screening initiation. The results are framed within the context of policy developments concerning mammography screening in each of the separate European countries.ResultsChildhood preventive health care behavior predicts mammography screening in 9 of the 13 countries after conventional measurements of socioeconomic position in childhood and adulthood are accounted for. Net effects of education and income are still found for respectively 6 and 7 countries, but in about half of these countries national screening programs are able to reduce the social gradient. Very strong cohort and period effects are found for every country.ConclusionsIn a substantial number of the European countries, socioeconomic inequalities in preventive health behavior originate in childhood, which point to the deeply rooted nature of these inequalities. A long-term perspective is essential to further unravel how health policies can reduce or eliminate these persistent inequalities.