Participation in the nationwide cervical cancer screening programme in Denmark during the COVID-19 pandemic: An observational study
- The Danish Clinical Quality Program - National Clinical Registries, Denmark
- Department of Pathology, Lillebaelt Hospital, Denmark
- Department of Regional Health Research, University of Southern Denmark, Denmark
- University Research Clinic for Cancer Screening, Department of Public Health Programmes,Randers Regional Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
Figures
Figure 1
Flow-chart of the study population.
Figure 2
Participation in cervical cancer screening in Denmark within 90, 180, and 365 d since invitation from 2015 to 2021.
Tables
Table 1
Baseline characteristics of women invited to participate in cervical cancer screening in Denmark from 2015 to 2021.
| Pre-pandemic(01 January 2015–31 January 2020) | Pre-lockdown(01 February 2020–10 March 2020) | First lockdown(11 March 2020–15 April 2020) | First re-opening(16 April 2020–15 December 2020) | Second lockdown(16 December 2020–27 February 2021) | Second re-opening(28 February 2021–30 September 2021) | Total | |
|---|---|---|---|---|---|---|---|
| N (%) | N (%) | N (%) | N (%) | N (%) | N (%) | N (%) | |
| Total | 1,641,199 (73.9) | 41,876 (1.9) | 31,255 (1.4) | 223,386 (10.1) | 69,729 (3.1) | 212,555 (9.6) | 2,220,000 (100.0) |
| Age at invitation | |||||||
| 23–29 y | 384,272 (23.4) | 10,223 (24.4) | 7731 (24.7) | 58,569 (26.2) | 17,624 (25.3) | 56,816 (26.7) | 535,235 (24.1) |
| 30–39 y | 412,249 (25.1) | 10,614 (25.3) | 7712 (24.7) | 56,783 (25.4) | 17,571 (25.2) | 54,367 (25.6) | 559,296 (25.2) |
| 40–49 y | 495,153 (30.2) | 12,690 (30.3) | 9233 (29.5) | 63,872 (28.6) | 19,051 (27.3) | 59,366 (27.9) | 659,365 (29.7) |
| 50–59 y | 246,814 (15.0) | 6665 (15.9) | 5269 (16.9) | 34,841 (15.6) | 11,810 (16.9) | 31,387 (14.8) | 336,786 (15.2) |
| 60–64 y | 102,711 (6.3) | 1684 (4.0) | 1310 (4.2) | 9321 (4.2) | 3673 (5.3) | 10,619 (5.0) | 129,318 (5.8) |
| Median (IQI) | 41 (31; 49) | 40 (30; 48) | 40 (30; 49) | 39 (30; 48) | 40 (30; 49) | 39 (30; 48) | 40 (30; 49) |
| Ethnicity | |||||||
| Danish descent | 1,358,106 (82.8) | 33,975 (81.2) | 25,778 (82.5) | 177,501 (79.5) | 45,340 (81.3) | 132,376 (81.0) | 1,773,076 (82.2) |
| Descendant of immigrant | 31,339 (1.9) | 918 (2.2) | 781 (2.5) | 5723 (2.6) | 1260 (2.3) | 3881 (2.4) | 43,902 (2.0) |
| Western immigrant | 87,100 (5.3) | 2581 (6.2) | 1655 (5.3) | 15,869 (7.1) | 3247 (5.8) | 9710 (5.9) | 120,162 (5.6) |
| Non-western immigrant | 163,638 (10.0) | 4375 (10.5) | 3027 (9.7) | 24,176 (10.8) | 5928 (10.6) | 17,535 (10.7) | 218,679 (10.1) |
| Cohabitation status | |||||||
| Living alone | 529,023 (32.3) | 13,708 (32.8) | 10,300 (33.0) | 76,687 (34.4) | 3867 (35.1) | N/A | 633,585 (32.5) |
| Cohabiting | 351,991 (21.5) | 9225 (22.1) | 6829 (21.9) | 50,379 (22.6) | 2369 (21.5) | N/A | 420,793 (21.6) |
| Married | 759,009 (46.3) | 18,890 (45.2) | 14,088 (45.1) | 96,132 (43.1) | 4794 (43.5) | N/A | 892,913 (45.9) |
| Educational level (ISCED) | |||||||
| ISCED15 level 1–2 | 960,324 (60.6) | 24,481 (59.3) | 18,667 (60.6) | 129,791 (59.3) | 40,565 (60.1) | 122,230 (60.4) | 1,296,058 (60.4) |
| ISCED15 level 3–5 | 393,390 (24.8) | 10,185 (24.7) | 7539 (24.5) | 52,354 (23.9) | 16,772 (24.8) | 48,870 (24.1) | 529,110 (24.7) |
| ISCED15 level 6–8 | 231,157 (14.6) | 6589 (16.0) | 4600 (14.9) | 36,716 (16.8) | 10,173 (15.1) | 31,395 (15.5) | 320,630 (14.9) |
| Disposable income | |||||||
| Lowest quintile | 322,307 (19.9) | 7419 (18.2) | 5869 (19.0) | 43,920 (20.4) | 12,715 (18.6) | 39,486 (19.3) | 431,716 (19.8) |
| Second quintile | 334,113 (20.6) | 7611 (18.7) | 5878 (19.0) | 40,851 (19.0) | 12,137 (17.8) | 36,480 (17.9) | 437,070 (20.0) |
| Third quintile | 338,563 (20.9) | 8066 (19.8) | 5850 (18.9) | 40,863 (19.0) | 11,738 (17.2) | 34,157 (16.7) | 439,237 (20.1) |
| Fourth quintile | 326,174 (20.1) | 8604 (21.1) | 6449 (20.9) | 43,279 (20.1) | 14,025 (20.5) | 40,367 (19.8) | 438,898 (20.1) |
| Highest quintile | 301,566 (18.6) | 9067 (22.2) | 6878 (22.2) | 46,484 (21.6) | 17,742 (26.0) | 53,702 (26.3) | 435,439 (20.0) |
| Healthcare usage | |||||||
| Rare | 319,960 (19.5) | 8519 (20.3) | 5985 (19.1) | 47,619 (21.3) | 13,413 (19.2) | 43,973 (20.7) | 439,469 (19.8) |
| Low | 366,807 (22.3) | 9020 (21.5) | 6774 (21.7) | 48,280 (21.6) | 15,181 (21.8) | 45,102 (21.2) | 491,164 (22.1) |
| Average | 347,589 (21.2) | 8758 (20.9) | 6637 (21.2) | 46,608 (20.9) | 14,364 (20.6) | 44,024 (20.7) | 467,980 (21.1) |
| High | 299,358 (18.2) | 7583 (18.1) | 5727 (18.3) | 40,091 (17.9) | 12,967 (18.6) | 38,760 (18.2) | 404,486 (18.2) |
| Frequent | 307,485 (18.7) | 7996 (19.1) | 6132 (19.6) | 40,788 (18.3) | 13,804 (19.8) | 40,696 (19.1) | 416,901 (18.8) |
| Time from invitation to participation, median (IQI) | 94 (42; 200) | 120 (72; 207) | 122 (53; 201) | 86 (36; 161) | 69 (29; 133) | 51 (28; 101) | 89 (39; 184) |
-
IQI = interquartile interval; ISCED = International Standard Classification of Education; Information on cohabitation status was only available from Statistics Denmark until the end of February 2021, whereas all other socio-economic variables were available until end of the study period.
Table 2
Prevalence ratios and 95% CIs of participation in cervical cancer screening in Denmark within 365 d since invitation from 2015–2021*.
| N | Pre-pandemic(01 January 2015–31 January 2020) | Pre-lockdown(01 February 2020–10 March 2020) | First lockdown(11 March 2020–15 April 2020) | First re-opening(16 April 2020–15 December 2020) | Second lockdown(16 December 2020–31 December 2020) | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| N=164,1199 | N=41,876 | N=31,255 | N=223,386 | N=69,729 | |||||||
| PR | (95% CI) | PR | (95% CI) | PR | (95% CI) | PR | (95% CI) | PR | (95% CI) | ||
| Overall | 2,220,000 | 1.00 | - | 0.97 | (0.96; 0.98) | 0.97 | (0.96; 0.98) | 1.01 | (1.00; 1.01) | 0.99 | (0.97; 1.00) |
| Age at invitation | |||||||||||
| 23–29 y | 535,235 | 1.00 | - | 0.96 | (0.94; 0.98) | 0.98 | (0.95; 1.00) | 0.99 | (0.98; 1.00) | 1.00 | (0.96; 1.04) |
| 30–39 y | 559,296 | 1.00 | - | 0.97 | (0.95; 0.99) | 0.99 | (0.97; 1.01) | 1.01 | (1.00; 1.02) | 1.00 | (0.97; 1.04) |
| 40–49 y | 659,365 | 1.00 | - | 0.95 | (0.93; 0.96) | 0.94 | (0.92; 0.95) | 1.00 | (0.99; 1.01) | 0.93 | (0.90; 0.96) |
| 50–59 y | 336,786 | 1.00 | - | 1.01 | (0.99; 1.03) | 1.00 | (0.98; 1.02) | 1.02 | (1.01; 1.03) | 1.05 | (1.01; 1.08) |
| 60–64 y | 129,318 | 1.00 | - | 0.95 | (0.92; 0.99) | 0.93 | (0.90; 0.97) | 0.98 | (0.96; 1.00) | 0.93 | (0.87; 0.99) |
| Ethnicity | |||||||||||
| Danish descent | 1,773,076 | 1.00 | - | 0.96 | (0.95; 0.97) | 0.96 | (0.95; 0.97) | 1.00 | (1.00; 1.01) | 0.97 | (0.96; 0.99) |
| Descendant of immigrant | 43,902 | 1.00 | - | 0.95 | (0.86; 1.05) | 0.88 | (0.79; 0.98) | 0.97 | (0.92; 1.02) | 0.93 | (0.78; 1.12) |
| Western Immigrant | 120,162 | 1.00 | - | 1.03 | (0.98; 1.09) | 1.04 | (0.98; 1.11) | 1.09 | (1.06; 1.12) | 1.06 | (0.95; 1.17) |
| Non-western immigrant | 218,679 | 1.00 | - | 0.99 | (0.95; 1.02) | 0.98 | (0.94; 1.02) | 1.04 | (1.02; 1.06) | 1.07 | (1.00; 1.14) |
| Cohabitation status | |||||||||||
| Living alone | 633,585 | 1.00 | - | 0.97 | (0.95; 0.98) | 0.96 | (0.94; 0.98) | 1.02 | (1.01; 1.02) | 0.98 | (0.95; 1.02) |
| Cohabiting | 420,793 | 1.00 | - | 0.96 | (0.94; 0.98) | 0.97 | (0.95; 0.99) | 1.00 | (0.99; 1.01) | 1.00 | (0.96; 1.04) |
| Married | 892,913 | 1.00 | - | 0.97 | (0.96; 0.98) | 0.97 | (0.96; 0.99) | 1.00 | (1.00; 1.01) | 0.98 | (0.96; 1.01) |
| Educational level (ISCED) | |||||||||||
| ISCED15 level 1–2 | 1,297,050 | 1.00 | - | 0.96 | (0.95; 0.97) | 0.96 | (0.95; 0.98) | 1.01 | (1.00; 1.01) | 0.99 | (0.97; 1.01) |
| ISCED15 level 3–5 | 529,165 | 1.00 | - | 0.96 | (0.95; 0.98) | 0.97 | (0.95; 0.99) | 1.00 | (0.99; 1.01) | 0.97 | (0.94; 1.00) |
| ISCED15 level 6–8 | 319,925 | 1.00 | - | 1.00 | (0.98; 1.02) | 0.99 | (0.97; 1.02) | 1.04 | (1.03; 1.05) | 1.06 | (1.01; 1.10) |
| Disposable income | |||||||||||
| Lowest quintile | 419,122 | 1.00 | - | 0.95 | (0.93; 0.98) | 0.96 | (0.93; 0.98) | 1.02 | (1.01; 1.04) | 1.02 | (0.97; 1.07) |
| Second quintile | 422,225 | 1.00 | - | 0.95 | (0.92; 0.97) | 0.94 | (0.91; 0.96) | 1.00 | (0.99; 1.01) | 1.00 | (0.95; 1.04) |
| Third quintile | 424,081 | 1.00 | - | 0.96 | (0.94; 0.98) | 0.95 | (0.93; 0.97) | 0.99 | (0.98; 1.00) | 0.94 | (0.91; 0.98) |
| Fourth quintile | 425,069 | 1.00 | - | 0.96 | (0.95; 0.98) | 0.96 | (0.95; 0.98) | 1.00 | (0.99; 1.01) | 0.96 | (0.93; 0.99) |
| Highest quintile | 424,457 | 1.00 | - | 0.98 | (0.96; 0.99) | 0.96 | (0.95; 0.98) | 1.00 | (0.99; 1.00) | 0.97 | (0.95; 1.00) |
| Healthcare usage | |||||||||||
| Rare | 439,469 | 1.00 | - | 0.97 | (0.95; 0.99) | 0.97 | (0.95; 1.00) | 1.02 | (1.01; 1.03) | 0.99 | (0.94; 1.04) |
| Low | 491,164 | 1.00 | - | 0.97 | (0.95; 0.99) | 0.95 | (0.93; 0.97) | 1.00 | (0.99; 1.01) | 0.95 | (0.91; 0.99) |
| Average | 467,980 | 1.00 | - | 0.95 | (0.94; 0.97) | 0.95 | (0.93; 0.97) | 1.00 | (0.99; 1.01) | 1.00 | (0.97; 1.04) |
| High | 404,486 | 1.00 | - | 0.97 | (0.95; 0.98) | 0.96 | (0.94; 0.98) | 1.01 | (1.00; 1.02) | 0.99 | (0.96; 1.03) |
| Frequent | 416,901 | 1.00 | - | 0.97 | (0.95; 0.99) | 0.98 | (0.97; 1.00) | 1.00 | (0.99; 1.01) | 0.96 | (0.93; 1.00) |
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*Adjusted for month, year, and age at invitation; PR = prevalence ratio; ISCED = International Standard Classification of Education.
Additional files
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Supplementary file 1
Proportion of women participating in cervical cancer screening in Denmark within 90 d since invitation from 2015 to 2021.
- https://cdn.elifesciences.org/articles/81522/elife-81522-supp1-v2.xlsx
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Supplementary file 2
Proportion of women participating in cervical cancer screening in Denmark within 180 d since invitation from 2015 to 2021.
- https://cdn.elifesciences.org/articles/81522/elife-81522-supp2-v2.xlsx
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Supplementary file 3
Proportion of women participating in cervical cancer screening in Denmark within 365 d since invitation from 2015 to 2021.
- https://cdn.elifesciences.org/articles/81522/elife-81522-supp3-v2.xlsx
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Supplementary file 4
Prevalence ratios and 95% CIs of participation in cervical cancer screening in Denmark within 90 d since invitation from 2015 to 2021.
- https://cdn.elifesciences.org/articles/81522/elife-81522-supp4-v2.xlsx
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Supplementary file 5
Prevalence ratios and 95% CIs of participation in cervical cancer screening in Denmark within 180 d since invitation from 2015 to 2021.
- https://cdn.elifesciences.org/articles/81522/elife-81522-supp5-v2.xlsx
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MDAR checklist
- https://cdn.elifesciences.org/articles/81522/elife-81522-mdarchecklist1-v2.pdf
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Participation in the nationwide cervical cancer screening programme in Denmark during the COVID-19 pandemic: An observational study
eLife 12:e81522.
https://doi.org/10.7554/eLife.81522
