Lower attendance rates in BreastScreen Norway among immigrants across all levels of socio-demographic factors: a population-based study
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Several studies have shown that immigrants attend mammographic screening less frequently than non-immigrants. Studies have also shown that attendance is influenced by socio-demographic factors. We aimed to describe the relationship between socio-demographic factors and first attendance among immigrant and non-immigrant women invited to BreastScreen Norway.
Our cohort consisted of 885,979 women invited to BreastScreen Norway for their first time between 1996 and 2015. We merged individual-level socio-demographic data to attendance data corresponding to women’s first invitation to the program. Using Poisson regression, we calculated rate ratios with 95% confidence intervals (95% CI) for attendance, stratified by region of origin. Covariates of interest included age, income, education level, employment status, marital status, citizenship and years since immigration, among others.
Fifty-three percent of immigrants and 76% of non-immigrants attended mammographic screening after their first invitation; immigrants as a whole had lower attendance rates across all socio-demographic factors. However, the association between socio-demographic factors and attendance varied between immigrant groups. For all immigrants, no recorded education demonstrated the strongest association with non-attendance compared with ≤ 10 years recorded education (RRadj: 0.69, 95% CI: 0.67–0.71). Other factors associated with non-attendance were low income, living in Oslo, not being employed and being a recent immigrant.
The association between socio-demographic factors and mammographic screening attendance differed between immigrant groups. Further studies and preventive health measures should take into account that considering immigrants as a homogeneous group may lead to less effective interventions.
KeywordsBreast Cancer Ethnicity Health inequalities Screening Migration
This study was supported by a grant from the Norwegian Breast Cancer Society, funded by the Norwegian ExtraFoundation for Health and Rehabilitation (2016/FO76429) (https://www.extrastiftelsen.no/logo/). The funding source had no involvement in the conduction of the study, interpretation of the results or preparation of the manuscript.
Compliance with ethical standards
The Regional Committees for Medical and Health Research Ethics (REC 2013/795) approved this study.
Conflict of interest
The authors declare that they have no conflicts of interest.
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