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Published on: August 30, 2013
Morbidity as a Predictor for Participation in the Danish National Mammography Screening Program: A Cross-Sectional
Jakob H Viuff1, Ilse Vejborg2, Walter Schwartz3
1Department of Clinical Epidemiology, Aarhus University Hospital,Aarhus N 8200, Denmark.
Insights
Women with higher comorbidity scores, like those with AIDS or metastatic cancer, are less likely to participate in breast cancer screening. Focusing on common, less severe conditions may increase overall screening participation.
Area of Science:
- Public Health
- Epidemiology
- Oncology
Background:
- Mammography screening programs aim to detect breast cancer early.
- Understanding factors influencing participation is crucial for program effectiveness.
- Morbidity may impact a woman's likelihood to attend screening appointments.
Purpose of the Study:
- To evaluate the association between morbidity and participation in the Danish national mammography screening program.
- To identify specific health conditions linked to lower screening uptake.
Main Methods:
- Cross-sectional study analyzing data from The Danish Quality Database of Mammography Screening and The Danish National Patient Registry.
- Morbidity assessed using the Charlson Comorbidity Index (CCI) and 19 individual diagnoses.
- Prevalence proportion ratios (PR) with 95% confidence intervals (CI) were estimated.
Main Results:
- Nearly 80% of eligible women participated in the initial screening round.
- Women with higher CCI scores (≥3) had significantly lower participation (PR=0.80) compared to those with no comorbidities (CCI=0).
- Specific severe conditions like AIDS (PR=0.69) and metastatic solid tumors (PR=0.73) were associated with lower participation, while common conditions like chronic pulmonary disease showed less impact (PR=0.93).
Conclusions:
- Higher comorbidity burden and severe chronic diseases are associated with reduced mammography screening participation.
- Despite lower participation rates among severely ill, they represent a small fraction of non-participants.
- Targeting women with common, less severe morbidities may be a more effective strategy to increase overall screening participation.
Purpose:
In this cross-sectional study, we evaluated the association between morbidity and participation in the prevalence round of the Danish national mammography screening program.
Patients And Methods:
Morbidity was assessed by the Charlson Comorbidity Index (CCI) score (0, 1-2, and ≥3) and by 19 individual diagnoses. We retrieved data on participation from The Danish Quality Database of Mammography Screening and on diagnoses from The Danish National Patient Registry. We estimated prevalence proportion ratios (PR) with 95% confidence intervals (CI).
Results:
In total, 519,009 (79.8%) women participated in the first national breast cancer screening round. Relative to women with a CCI score of 0, the adjusted PRs were 0.96 (95% CI: 0.95-0.96) for a CCI score of 1-2 and 0.80 (95% CI: 0.79-0.81) for a CCI score of ≥3. Compared with no disease, the PRs for a diagnosis of the most prevalent, but less severe diseases, chronic pulmonary disease, cerebrovascular disease, diabetes I and II were 0.93 (95% CI: 0.93-0.94), 0.96 (95% CI: 0.94-0.96), and 0.96 (95% CI: 0.95-0.97), respectively. Among women with low prevalent, but most severe diseases, the PRs were 0.69 (95% CI: 0.60-0.81) for AIDS and 0.73 (95% CI: 0.70-0.76) for metastatic solid tumor.
Conclusion:
Women with a high CCI score or one severe chronic condition are less likely to participate in breast cancer screening compared to women without disease. However, these women account for a small proportion of all non-participating women. Thus, it might be most beneficial to maximize breast cancer screening participation in women with less severe although more common morbidities.
