Socio-economic inequality of utilization of cancer testing in Europe: A cross-sectional study

H. Bozhar, M. McKee, T. Spadea, P. Veerus, S. Heinävaara, A. Anttila, C. Senore, N. Zielonke, I. M.C.M. de Kok, N. T. van Ravesteyn, I. Lansdorp-Vogelaar, H. J. de Koning, E. A.M. Heijnsdijk*

*Corresponding author for this work

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There are currently screening programmes for breast, cervical and colorectal cancer in many European countries. However, the uptake of cancer screening in general may vary within and between countries. The aim of this study is to assess the inequalities in testing utilization by socio-economic status and whether the amount of inequality varies across European regions. We conducted an analysis based on cross-sectional data from the second wave of the European Health Interview Survey from 2013 to 2015. We analysed the use of breast, cervical, and colorectal cancer testing by socio-economic position (household income, educational level and employment status), socio-demographic factors, self-perceived health and smoking behaviour, by using multinomial logistic models, and inequality measurement based on the Slope index of inequality (SII) and Relative index of inequality (RII). The results show that the utilization of mammography (Odds Ratio (OR) = 0.55, 95% confidence interval (95%CI):0.50–0.61), cervical smear tests (OR = 0.60, 95%CI:0.56–0.65) and colorectal testing (OR = 0.82, 95%CI:0.78–0.86) was overall less likely among individuals within a low household income compared to a high household income. Also, individuals with a non-EU country of birth, low educational level and being unemployed (or retired) were overall less likely to be tested. The income-based inequality in breast (SII = 0.191;RII = 1.260) and colorectal testing utilization (SII = 0.161;RII = 1.487) was the greatest in Southern Europe. For cervical smears, this inequality was greatest in Eastern Europe (SII = 0.122;RII = 1.195). We concluded that there is considerable inequality in the use of cancer tests in Europe, with inequalities associated with household income, educational level, employment status, and country of birth.

Original languageEnglish
Article number101733
JournalPreventive Medicine Reports
Publication statusPublished - Apr 2022

Bibliographical note

This study is part of the EU-TOPIA project, funded by the EU-Framework Programme (Horizon 2020) of the European Commission, project reference 634753. The sponsor had no involvement in the study. The authors alone are responsible for the views expressed in this manuscript.

Publisher Copyright: © 2022 The Author(s)


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