Do social inequalities in cervical cancer screening persist among patients who use primary care? The Paris Prevention in General Practice survey

ObjectiveSocial inequalities in cervical cancer screening may be related to either lack of access to care or inadequate delivery of preventive care by providers. We sought to characterize social inequalities among women consulting general practitioners with a wide range of social position indicators.MethodsIn 2005–06, 59 randomly recruited general practitioners from the Paris metropolitan area enrolled every woman aged 50–69 years seen during a two-week period. Cervical cancer screening status (overdue if the last cervical cancer screening had been more than 3 years earlier) was analyzed for 858 women in a logistic mixed model that considered: occupational class (in 5 levels, based on last occupation), education, income, characteristics related to family, housing, neighborhood, household wealth (social allocations, perceived financial difficulties in 4 levels, income tax), employment status, supplementary health insurance, and social network (4 levels).ResultsThe rate of overdue patients did not vary between general practitioners (21%). social position indicators associated with overdue status (odds ratio between 2 adjacent decreasing social levels) were occupational class (1.20, 95% CI: 1.03–1.41), social network (1.52, 95% CI: 1.18–1.94), financial difficulties (1.42, 95% CI: 1.07–1.88), neighborhood safety (2.15, 95% CI: 1.10–4.20), and allocations (3.34, 95% CI: 1.12–9.96).ConclusionsEven among women visiting general practitioners we observed marked social inequalities that persist above and beyond occupational class.

► Social inequalities in cervical cancer screening exist among users of primary care. ► Beyond occupation, strong inequalities persist according to various indicators. ► Social integration, neighborhood safety and financial difficulties are one of these.