Socioeconomic position and risk of cervical cancer in the Nordic countries: Results from the Nordic Occupational Cancer Study.

Abstract

The Nordic countries benefited from declines in cervical cancer incidence rates due to the implementation of screening programmes. However, it is unclear whether all social groups have equally benefited from these preventive services. We provide an assessment of the temporal trends in cervical cancer incidence by socioeconomic position (SEP) in Denmark, Norway, Finland and Sweden, using data from the Nordic Occupational Cancer Study. Truncated age-standardized incidence rates and 95% confidence intervals (CI) of cervical cancer per 100,000 person-years were computed for women aged 50-69 by SEP and country within the period 1961-2005. We used Poisson regression models to compute relative risks (RRs) and 95% CIs of cervical cancer across SEP, pooling data for the three most recent 5-year periods (except for Denmark 1991-1995 and Norway 1991-2003). Throughout the study period, declines in the rates of cervical cancer were observed among all SEP groups. Lower SEP rates, which started from higher values, declined faster than those for higher SEP. At the conclusion of the study period, we still observed a social gradient, with higher rates seen in lower SEP women. Farmers had the lowest risk in all four countries. The RRs for lowest versus highest SEP ranged from 1.33 (95% CI 1.05-1.69) in Sweden to 1.76 (95% CI 1.13-2.85) in Denmark, with a pooled RR of 1.41 (95% CI 1.22-1.64). Lower SEP women still face the highest risks, indicating a need for continued efforts to provide equitable access to preventive services.