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Determinants of mammography screening participation–a cross-sectional analysis of the German population-based Gutenberg Health Study (GHS)

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Listed:
  • Roman M Pokora
  • Matthias Büttner
  • Andreas Schulz
  • Alexander K Schuster
  • Hiltrud Merzenich
  • Andrea Teifke
  • Matthias Michal
  • Karl Lackner
  • Thomas Münzel
  • Sylke Ruth Zeissig
  • Philipp S Wild
  • Susanne Singer
  • Daniel Wollschläger

Abstract

Purpose: We investigated the association between social inequality and participation in a mammography screening program (MSP). Since the German government offers mammography screening free of charge, any effect of social inequality on participation should be due to educational status and not due to the financial burden. Methods: The ‘Gutenberg Health Study’ is a cohort study in the Rhine-Main-region, Germany. A health check-up was performed, and questions about medical history, health behavior, including secondary prevention such as use of mammography, and social status are included. Two indicators of social inequality (equivalence income and educational status), an interaction term of these two, and different covariables were used to explore an association in different logistic regression models. Results: A total of 4,681 women meeting the inclusion criteria were included. Only 6.2% never participated in the MSP. A higher income was associated with higher chances of ever participating in a mammography screening (odds ratios (OR): 1.67 per €1000; 95%CI:1.26–2.25, model 3, adjusted for age, education and an interaction term of income and education). Compared to women with a low educational status, the odds ratios for ever participating in the MSP was lower for the intermediate educational status group (OR = 0.64, 95%CI:0.45–0.91) and for the high educational status group (0.53, 95%CI:0.37–0.76). Results persisted also after controlling for relevant confounders. Conclusions: Despite the absence of financial barriers for participation in the MSP, socioeconomic inequalities still influence participation. It would be interesting to examine whether the educational effect is due to an informed decision.

Suggested Citation

  • Roman M Pokora & Matthias Büttner & Andreas Schulz & Alexander K Schuster & Hiltrud Merzenich & Andrea Teifke & Matthias Michal & Karl Lackner & Thomas Münzel & Sylke Ruth Zeissig & Philipp S Wild & S, 2022. "Determinants of mammography screening participation–a cross-sectional analysis of the German population-based Gutenberg Health Study (GHS)," PLOS ONE, Public Library of Science, vol. 17(10), pages 1-10, October.
  • Handle: RePEc:plo:pone00:0275525
    DOI: 10.1371/journal.pone.0275525
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    Cited by:

    1. Pedrós Barnils, Núria & Gustafsson, Per E., 2025. "Intersectional inequities in colorectal cancer screening attendance in Sweden: Using decision trees for intersectional matrix reduction," Social Science & Medicine, Elsevier, vol. 365(C).

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