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Changes in the social gradients for pap smears and mammograms in Argentina: evidence from the 2005 and 2009 National Risk Factor Surveys
Public Health (2012)
  • Fernando De Maio, DePaul University
  • Bruno Linetzky
  • Daniel Ferrante
Abstract
Objectives: To identify changes in the social gradients for Pap smears and mammograms in Argentina. Study Design: Secondary analysis of the 2005 and 2009 Argentine National Risk Factor Surveys. Methods: Logistic regression analysis was used to examine social gradients by income and education, adjusting for age and health insurance. Results: The proportion of women who received a Pap smear in the previous two years increased from 51.6% in 2005 to 60.5% in 2009 (χ2 = 344.8, p < 0.001). A significant increase was also seen in the receipt of a mammogram in the previous two years by women 50 years old or over, with an increase from 39.6% in 2005 to 52.6% in 2009 (χ2 = 279.6, p < 0.001). In 2005, women with low income were most likely to not have received a Pap test (OR = 3.27, 95% CI = 2.70 – 3.98), followed by women with medium income (OR = 1.73, 95% = 1.41 – 2.12), compared to women with high income. The gradient by education was of a similar magnitude, and both income and education gradients remained stable from 2005 to 2009. Restricting the analysis to eight provinces that have been deemed high-priority due to their high levels of mortality from cervical cancer reveals an increasing income-based gradient in Pap smears. In contrast, inequalities in mammography diminished across the country, with a significant reduction in the social gradient measured either by income or education. In contrast to women with high income, women with low income experienced higher odds of not having a mammogram, but the gap diminished over time (OR = 4.14, 95% CI = 2.96 – 5.78 in 2005 to OR 2.37, 95% CI = 1.81 – 3.11 in 2009). Conclusion: Social gradients in cancer screening are changing in Argentina. There are signs of a reduction in inequalities in mammograms, although this is attenuated by indications that inequalities in Pap smear utilization in provinces deemed priority areas are growing. Surveillance of population indicators is needed to verify if these short-term changes persist over time.
Disciplines
Publication Date
2012
Citation Information
Fernando De Maio, Bruno Linetzky and Daniel Ferrante. "Changes in the social gradients for pap smears and mammograms in Argentina: evidence from the 2005 and 2009 National Risk Factor Surveys" Public Health Vol. 126 Iss. 10 (2012)
Available at: http://works.bepress.com/fdemaio/23/