Socioeconomic inequalities in uptake of outreach mammography before and after accessibility improvement of Taiwan's national universal breast cancer screening policy

• Published in: BMC public health Vol. 24; no. 1; pp. 2439 - 9
• Main Authors: Shen, Cheng-Ting, Hsieh, Hui-Min, Tsao, Yu-Hsiang
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 08.09.2024; BioMed Central; BMC
• Subjects: Accessibility; Aged; Analysis; Breast cancer; Breast Cancer Screening; Breast Neoplasms - diagnosis; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - prevention & control; Cancer screening; Care and treatment; Community-Institutional Relations; Data science; Demographic aspects; Diagnosis; Early Detection of Cancer - statistics & numerical data; Economic aspects; Education; Family medical history; Female; Females; Health care disparities; Health disparities; Health Policy; Health Services Accessibility; Healthcare Disparities; Hospitals; Humans; Local communities; Mammography; Mammography - statistics & numerical data; Mass Screening - statistics & numerical data; Medical screening; Middle Aged; Mobile Mammography units; National health insurance; Observational studies; Outreach Screening; Participation; Population studies; Quality control; Quality Improvement; Rural areas; Social aspects; Socioeconomic Factors; Socioeconomic inequalities; Socioeconomics; Taiwan; Urbanization; Utilization; Womens health; Taiwan; France; Outreach Screening; Socioeconomic inequalities; Mammography; Breast Cancer Screening; Mobile Mammography units
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/s12889-024-19896-7

Taiwan implemented the Cancer Screening Quality Improvement Program (CAQIP) in 2010. The program sought to enhance mass breast cancer screening accessibility. This study aimed to examine socioeconomic disparities in outreach screening utilization pre-CAQIP (2005-2009) and post-CAQIP (2010-2014). We conducted a nationwide population-based observational study in Taiwan, analyzing four population databases to evaluate socioeconomic disparities among women aged 50 to 69 years undergoing their first mammography screening pre-CAQIP. Multivariate logistic regression was used to examine changes in utilization of outreach screening pre- and post-CAQIP implementation, and to estimate the Slope Index of Inequity (SII) and Relative Index of Inequity (RII) values. Utilization of outreach screening through mobile mammography units (MMUs) increased from 6.12 to 32.87% between the two periods. Following CAQIP, a higher proportion of screened women were older, less educated, and from suburban or rural areas. The SII and RII for age, income, and urbanization levels decreased post-CAQIP. However, regarding education level, SII was - 0.592 and RII was 0.392 in the pre-CAQIP period, increasing to -0.173 and 0.804 post-CAQIP, respectively. Our study observed that utilization of outreach screening through MMUs increased after CAQIP. The MMUs made outreach screening services more accessible in Taiwan. Expanding outreach screening services and educational programs to promote mammography uptake in local communities could help reduce the potential effect of socioeconomic disparities, and thus may enhance early detection of breast cancer. Further study could focus on the accessibility of outreach screening and breast cancer outcomes.