Decomposing income-related inequality in cervical screening in 67 countries

Brittany McKinnon*, Sam Harper, Spencer Moore

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

43 Citations (Scopus)


Objectives: The development of successful policies to reduce income-related inequalities in cervical cancer screening rates requires an understanding of the reasons why low-income women are less likely to be screened. We sought to identify important determinants contributing to inequality in cervical screening rates. Methods: We analyzed data from 92,541 women aged 25-64 years, who participated in the World Health Survey in 2002-2003. Income-related inequality in Pap screening was measured using the concentration index (CI). Using a decomposition method for the CI, we quantified the contribution to inequality of age, education level, marital status, urbanicity and recent health-care need. Results: There was substantial heterogeneity in the contributions of different determinants to inequality among countries. Education generally made the largest contribution (median = 15%, interquartile range [IQR] = 23%), although this varied widely even within regions (e.g., 5% in Austria, 28% in Hungary). The contribution of rural residence was greatest in African countries (median = 10%, IQR = 13%); however, there was again substantial withinregion variation (e.g., 26% in Zambia, 2% in Kenya). Conclusions: Considerable heterogeneity in the contributions of screening determinants among countries suggests interventions to reduce screening inequalities may require country-specific approaches.

Original languageEnglish
Pages (from-to)139-152
Number of pages14
JournalInternational Journal of Public Health
Issue number2
Publication statusPublished - Apr 2011
Externally publishedYes


  • Cervical cancer screening
  • Decomposition
  • Socioeconomic inequality


Dive into the research topics of 'Decomposing income-related inequality in cervical screening in 67 countries'. Together they form a unique fingerprint.

Cite this