Inequalities in cervical cancer screening for women with or without a regular consulting in primary care for gynaecological health, in Paris, France.

Abstract

OBJECTIVES: To describe the individual characteristics associated with the absence of cervical smear (CCST); to investigate the role of residential neighbourhood, particularly practitioner density; and to explore changes in individual and contextual determinants after taking regular consulting in primary care for gynaecological health (RCGH) into account. DATA: 1843 adult women from the SIRS survey conducted in 2005 in the Paris metropolitan area. Multilevel logistic regressions analysed factors associated with never-screening. RESULTS: 10% of the women had never undergone CCST. Being single, less educated, of foreign origin, with no children, and without health insurance, having never worked, having never undergone a serious health problem and/or having nobody in their circle with cancer were associated with no CCST. Once adjusted on individual characteristics, living in a middle- (OR=1.95; IC=1.05-3.62) or in a lower-class neighbourhood (OR=2.31; IC=1.26-4.25) was associated with increased risks of never-screening, but neighbourhood physician density was not. Interactions were found between socioeconomic status and RCGH. Individual- and neighbourhood-level associations with CCST were different for women with or without an RCGH. CONCLUSION: This study analysed individual and contextual inequalities in CCST practice in the Paris metropolitan area. To benefit from an RCGH did not seem to reduce all the social inequalities in CCST practice.