Area-based socioeconomic inequalities in cervical cancer screening coverage in France

The objective of this study is to assess spatial and socioeconomic disparities in cervical cancer screening (CCS) coverage in France before the implementation of the national organized screening program.

This ecological study analyzed CCS coverage among 17.2 million women aged 25-65 years residing in ∼35,000 municipalities in mainland France from January 2016 to June 2019. Screening coverage was estimated using universal health insurance data. Socioeconomic deprivation was measured using the French Deprivation Index (FDep), and access to care was assessed using the Access to General Practitioner (AGP) index. Descriptive spatial analyses and a generalized hierarchical binomial model were used to examine the impact of deprivation and healthcare provision on screening participation, while accounting for geographic variability.

Screening coverage varied widely across departments (47.5%-68.0%) and within departments, with a strong social gradient (62.5% in the least deprived quintile vs. 52.4% in the most deprived). FDep explained 34.1% of municipal variations in screening, but a significant portion remained unexplained (random effect: 21 percentage points). The AGP index was weakly associated with participation (+2.2 percentage points between the 90th and 10th percentiles. The screening gap related to deprivation (11.3 percentage points) was smaller than the unexplained variability (15.6).

Our study highlights significant spatial and social disparities in CCS participation before the national program rollout. While organized screening programs were associated with higher participation, inequalities persisted. Addressing these disparities requires targeted interventions and structural changes in the CCS programme. Future evaluations will be essential to determine whether the national CCS program reduces these disparities and improves screening equity.