[Geomapping of 10-year coverage rate of cervical cancer screening in Sweden - a basis for targeting population-level...

A high coverage rate of cervical cancer screening is necessary to prevent cervical cancer. Women who have not been tested in the last 10 years are considered as long-term non-attenders from the screening program. A recent report from the Regional Cancer Centers in Sweden addressed geographic disparities in the 10-year coverage rate among 33-62-year-old women residing in Sweden in 2023, and compared the results with those in a previous report from 2020. The analytic method employed is referred to as geomapping, based on geo-coded data to 5984 neighborhoods (Statistics Sweden's Demographic Statistics Areas [DeSO]). Individual data on HPV/Pap testing in the previous 10-year period, age, and residential address (used for the geo-coding) were retrieved from the National Cervical Screening Registry. Neighborhood-level data on economic standard, proportion of non-Western immigrants, and geographic location (urban/semi-urban/rural) were assessed, based on data from Statistics Sweden, for estimation of neighborhood-level associations. The overall 10-year coverage rate decreased from 91.9% in 2020 to 91.1% in 2023. We identified 147 out of the 5984 neighborhoods as showing statistical evidence for a pronouncedly lower 10-year coverage rate than the overall average of 91.1 %. Furthermore, we found a decreasing 10-year coverage rate with lower economic standard, as well as with increasing proportion of non-Western immigrants. After adjustments for these two neighborhood-level covariates, we found that rural geographical location was associated with lower 10-year coverage rate. The results demonstrate that geomapping can provide a rational basis for targeting population-level interventions to improve screening. Specifically, it is rational to allocate extra resources, if available, towards the 147 identified neighborhoods with a pronouncedly lower 10-year coverage rate.