Reduced likelihood of cancer screening among women in urban areas and with low socio-economic status: A multilevel analysis in Japan

Objectives: To elucidate socio-economic predictors of participation in cancer screening in Japanese women, paying attention to regional variations. Methods: In a nationally representative sample of women aged 40-64 years (n = 15,224) in Japan, the relationships of self-reported attendance at screening for stomach, colon, uterine and breast cancers with individual characteristics (marital status, occupation and household income) and regional variables (living in a metropolitan area or not, and per capita income) were examined using multilevel analysis. Results: The participation rate ranged from 21.6% for colon cancer to 32.5% for uterine cancer. Being married, employed and having a higher household income were significantly associated with a higher likelihood of cancer screening for all types of cancer: the adjusted odds ratio in the lowest income quintile ranged from 0.45 for uterine cancer to 0.53 for colon cancer compared with the highest income quintile. There was significant regional variance, and living in a metropolitan area and per capita income were associated with a reduced likelihood of cancer screening. Conclusions: Women with lower socio-economic status and living in urban areas are less likely to participate in cancer screening in Japan. Cancer screening should be encouraged in urban areas, taking account of the socio-economic inequalities. (c) 2005 The Royal Institute of Public Health. published by Elsevier Ltd. All rights reserved.