Nationwide mammography screening participation in Denmark during the COVID-19 pandemic: An observational study
- The Danish Clinical Quality Program – National Clinical Registries (RKKP), Denmark
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
- Department of Breast Examinations, Copenhagen University Hospital, Denmark
Figures
Figure 1
Flowchart of the study population.
Figure 2
Proportion of women participating in mammography screening in Denmark within 90, 180, and 365 d since invitation from 2016 to 2021.
Tables
Table 1
Baseline characteristics of women invited to participate in mammography screening in Denmark from 2016 to 2021.
| Pre-pandemic (1 January 2016 to 31 January 2020) | Pre-lockdown (1 February 2020 to 10 March 2020) | First lockdown (11 March 2020 to 15 April 2020) | First reopening (16 April 2020 to 15 December 2020) | Second lockdown (16 December 2020 to 27 February 2021) | Second reopening (28 February 2021 to 30 September 2021) | Total | |
|---|---|---|---|---|---|---|---|
| N (%) | N (%) | N (%) | N (%) | N (%) | N (%) | N (%) | |
| Total | 1,346,959 (73.7) | 35,175 (1.9) | 14,134 (0.8) | 201,613 (11.0) | 61,991 (3.4) | 168,919 (9.2) | 1,828,791 (100.0) |
| Age at invitation (y) | |||||||
| 50–54 | 421,813 (31.3) | 10,660 (30.3) | 3998 (28.3) | 66,325 (32.9) | 19,792 (31.9) | 48,669 (28.8) | 57,1257 (31.2) |
| 55–59 | 326,444 (24.2) | 9439 (26.8) | 3516 (24.9) | 49,481 (24.5) | 14,914 (24.1) | 44,000 (26.0) | 447,794 (24.5) |
| 60–64 | 305,389 (22.7) | 7824 (22.2) | 3362 (23.8) | 44,793 (22.2) | 13,897 (22.4) | 38,487 (22.8) | 413,752 (22.6) |
| 65–69 | 293,313 (21.8) | 7252 (20.6) | 3258 (23.1) | 41,014 (20.3) | 13,388 (21.6) | 37,763 (22.4) | 395,988 (21.7) |
| Median age (IQI) | 58 (54; 64) | 58 (54; 64) | 59 (54; 64) | 58 (54; 64) | 58 (54; 64) | 58 (54; 64) | 58 (54; 64) |
| Ethnicity | |||||||
| Danish descent | 1,237,422 (91.9) | 32,030 (91.1) | 12,811 (90.6) | 182,860 (90.7) | 49,328 (91.4) | 136,255 (92.2) | 1,650,706 (91.7) |
| Descendant of immigrant | 2213 (0.2) | 52 (0.1) | 26 (0.2) | 358 (0.2) | 70 (0.1) | 237 (0.2) | 2956 (0.2) |
| Western immigrant | 35,894 (2.7) | 1042 (3.0) | 456 (3.2) | 5823 (2.9) | 1436 (2.7) | 3659 (2.5) | 48,310 (2.7) |
| Non-Western immigrant | 71,293 (5.3) | 2047 (5.8) | 841 (6.0) | 12,557 (6.2) | 3124 (5.8) | 7572 (5.1) | 97,434 (5.4) |
| Cohabitation status | |||||||
| Living alone | 411,431 (30.6) | 11,161 (31.7) | 4504 (31.9) | 61,551 (30.5) | 2362 (30.4) | N/A | 491,009 (30.6) |
| Cohabiting | 122,870 (9.1) | 3373 (9.6) | 1301 (9.2) | 19,823 (9.8) | 720 (9.3) | N/A | 148,087 (9.2) |
| Married | 812,442 (60.3) | 20,632 (58.7) | 8327 (58.9) | 120,209 (59.6) | 4678 (60.3) | N/A | 966,288 (60.2) |
| Educational level (ISCED) | |||||||
| ISCED15 levels 1–2 | 766,480 (57.8) | 21,103 (60.8) | 8453 (60.6) | 121,233 (60.9) | 37,204 (60.9) | 103,826 (62.4) | 1,058,299 (58.7) |
| ISCED15 levels 3–4 | 397,781 (30.0) | 9642 (27.8) | 3904 (28.0) | 54,964 (27.6) | 16,609 (27.2) | 44,245 (26.6) | 527,145 (29.2) |
| ISCED15 levels 5–8 | 162,943 (12.3) | 3991 (11.5) | 1588 (11.4) | 22,755 (11.4) | 7316 (12.0) | 18,406 (11.1) | 216,999 (12.0) |
| Disposable income | |||||||
| Lowest quintile | 271,215 (20.1) | 6306 (17.9) | 2642 (18.7) | 34,833 (17.3) | 10,176 (16.4) | 27,802 (16.5) | 352,974 (19.3) |
| Second quintile | 270,148 (20.1) | 6849 (19.5) | 2790 (19.7) | 37,553 (18.7) | 11,000 (17.8) | 30,887 (18.3) | 359,227 (19.7) |
| Third quintile | 273,315 (20.3) | 7088 (20.2) | 2757 (19.5) | 40,063 (19.9) | 11,220 (18.1) | 30,898 (18.3) | 365,341 (20.0) |
| Fourth quintile | 269,796 (20.0) | 7126 (20.3) | 2840 (20.1) | 43,042 (21.4) | 13,115 (21.2) | 35,539 (21.1) | 371,458 (20.3) |
| Highest quintile | 262,055 (19.5) | 7768 (22.1) | 3102 (22.0) | 45,789 (22.7) | 16,440 (26.5) | 43,540 (25.8) | 378,694 (20.7) |
| Healthcare usage | |||||||
| Rare | 301,815 (22.4) | 7894 (22.4) | 3070 (21.7) | 45,216 (22.4) | 13,344 (21.5) | 37,009 (21.9) | 408,348 (22.3) |
| Low | 240,671 (17.9) | 6145 (17.5) | 2473 (17.5) | 35,618 (17.7) | 10,607 (17.1) | 29,030 (17.2) | 324,544 (17.7) |
| Average | 292,576 (21.7) | 7667 (21.8) | 3122 (22.1) | 43,970 (21.8) | 13,526 (21.8) | 36,837 (21.8) | 397,698 (21.7) |
| High | 248,125 (18.4) | 6607 (18.8) | 2693 (19.1) | 37,863 (18.8) | 11,962 (19.3) | 32,309 (19.1) | 339,559 (18.6) |
| Frequent | 263,772 (19.6) | 6862 (19.5) | 2776 (19.6) | 38,946 (19.3) | 12,552 (20.2) | 33,734 (20.0) | 358,642 (19.6) |
-
IQR = interquartile range; IQI = interdecentile interval (10, 50, 90); ISCED = International Standard Classification of Education
Table 2
Prevalence ratios (PR) and 95% confidence intervals (95% CI) of participation in mammography screening in Denmark within 365 d since invitation from 2016 to 2021*.
| Pre-pandemic (1 January 2016 to 31 January 2020) | Pre-lockdown (1 February 2020 to 10 March 2020) | First lockdown (11 March 2020 to 15 April 2020) | First reopening (16 April 2020 to 15 December 2020) | Second lockdown (16 December 2020 to 31 December 2020) | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| N = 1,346,959 | N = 35,175 | N = 14,134 | N = 201,613 | N = 61,991 | |||||||
| N | PR | [95% CI] | PR | [95% CI] | PR | [95% CI] | PR | [95% CI] | PR | [95% CI] | |
| Overall | 1,828,791 | 1.00 | - | 0.94 | [0.93; 0.95] | 0.97 | [0.96; 0.97] | 0.99 | [0.99; 0.99] | 1.00 | [0.99; 1.01] |
| Age at invitation (y) | |||||||||||
| 50–54 | 571,257 | 1.00 | - | 0.94 | [0.93; 0.95] | 0.96 | [0.95; 0.98] | 0.99 | [0.99; 1.00] | 0.97 | [0.95; 0.99] |
| 55–59 | 447,794 | 1.00 | - | 0.94 | [0.93; 0.95] | 0.97 | [0.96; 0.99] | 0.99 | [0.99; 1.00] | 1.02 | [1.00; 1.04] |
| 60–64 | 413,752 | 1.00 | - | 0.94 | [0.93; 0.95] | 0.97 | [0.95; 0.98] | 0.99 | [0.99; 1.00] | 1.02 | [1.00; 1.04] |
| 65–69 | 395,988 | 1.00 | - | 0.94 | [0.93; 0.95] | 0.96 | [0.95; 0.98] | 0.98 | [0.98; 0.99] | 0.99 | [0.97; 1.01] |
| Ethnicity | |||||||||||
| Danish descent | 165,070 | 1.00 | - | 0.94 | [0.94; 0.95] | 0.97 | [0.96; 0.98] | 0.99 | [0.99; 1.00] | 1.00 | [0.99; 1.01] |
| Descendant of immigrant | 2956 | 1.00 | - | 1.00 | [0.86; 1.16] | 1.09 | [0.89; 1.34] | 0.91 | [0.84; 0.98] | 1.22 | [1.10; 1.36] |
| Western immigrant | 48,310 | 1.00 | - | 0.91 | [0.87; 0.96] | 0.96 | [0.90; 1.03] | 0.97 | [0.95; 0.99] | 0.97 | [0.88; 1.06] |
| Non-Western immigrant | 97,434 | 1.00 | - | 0.88 | [0.85; 0.91] | 0.95 | [0.90; 1.00] | 0.96 | [0.95; 0.98] | 0.95 | [0.89; 1.02] |
| Cohabitation status | |||||||||||
| Living alone | 491,009 | 1.00 | - | 0.92 | [0.91; 0.93] | 0.95 | [0.94; 0.97] | 0.98 | [0.97; 0.98] | 0.98 | [0.95; 1.00] |
| Cohabiting | 148,087 | 1.00 | - | 0.92 | [0.91; 0.94] | 0.96 | [0.93; 0.99] | 0.99 | [0.98; 1.00] | 1.02 | [0.98; 1.05] |
| Married | 966,288 | 1.00 | - | 0.95 | [0.95; 0.96] | 0.97 | [0.96; 0.98] | 0.99 | [0.99; 1.00] | 1.00 | [0.99; 1.01] |
| Educational level (ISCED) | |||||||||||
| ISCED15 levels 1–2 | 105,829 | 1.00 | - | 0.94 | [0.93; 0.95] | 0.96 | [0.95; 0.97] | 0.99 | [0.99; 0.99] | 1.00 | [0.99; 1.01] |
| ISCED15 levels 3–5 | 527,145 | 1.00 | - | 0.94 | [0.93; 0.95] | 0.97 | [0.96; 0.98] | 0.99 | [0.99; 1.00] | 1.00 | [0.98; 1.02] |
| ISCED15 levels 6–8 | 216,999 | 1.00 | - | 0.94 | [0.92; 0.96] | 0.98 | [0.96; 1.01] | 0.99 | [0.98; 1.00] | 1.01 | [0.98; 1.04] |
| Disposable income | |||||||||||
| Lowest quintile | 352,974 | 1.00 | - | 0.91 | [0.89; 0.92] | 0.94 | [0.91; 0.96] | 0.98 | [0.97; 0.99] | 0.95 | [0.91; 0.98] |
| Second quintile | 359,227 | 1.00 | - | 0.92 | [0.90; 0.93] | 0.95 | [0.93; 0.97] | 0.97 | [0.96; 0.98] | 0.99 | [0.96; 1.02] |
| Third quintile | 365,341 | 1.00 | - | 0.95 | [0.93; 0.96] | 0.96 | [0.95; 0.98] | 1.00 | [0.99; 1.00] | 1.00 | [0.98; 1.02] |
| Fourth quintile | 371,458 | 1.00 | - | 0.95 | [0.94; 0.96] | 0.99 | [0.97; 1.00] | 1.00 | [0.99; 1.00] | 1.01 | [0.99; 1.03] |
| Highest quintile | 378,694 | 1.00 | - | 0.97 | [0.96; 0.98] | 0.99 | [0.97; 1.00] | 0.99 | [0.99; 1.00] | 1.02 | [1.00; 1.03] |
| Healthcare usage | |||||||||||
| Rare | 408,348 | 1.00 | - | 0.93 | [0.92; 0.95] | 0.96 | [0.94; 0.98] | 0.98 | [0.98; 0.99] | 0.99 | [0.97; 1.02] |
| Low | 324,544 | 1.00 | - | 0.95 | [0.94; 0.96] | 0.97 | [0.95; 0.99] | 0.99 | [0.98; 1.00] | 1.01 | [0.99; 1.03] |
| Average | 397,698 | 1.00 | - | 0.94 | [0.93; 0.95] | 0.97 | [0.95; 0.99] | 0.99 | [0.99; 1.00] | 0.99 | [0.96; 1.01] |
| High | 339,559 | 1.00 | - | 0.95 | [0.93; 0.96] | 0.95 | [0.94; 0.97] | 1.00 | [0.99; 1.00] | 1.00 | [0.98; 1.03] |
| Frequent | 358,642 | 1.00 | - | 0.94 | [0.93; 0.95] | 0.98 | [0.96; 0.99] | 0.99 | [0.98; 0.99] | 1.00 | [0.98; 1.03] |
-
ISCED = International Standard Classification of Education.
-
*
Adjusted for month, year and age at invitation.
Additional files
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Supplementary file 1
Proportion of women participating in mammography screening in Denmark within 90 d since invitation from 2016 to 2021.
- https://cdn.elifesciences.org/articles/83541/elife-83541-supp1-v2.xlsx
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Supplementary file 2
Proportion of women participating in mammography screening in Denmark within 180 d since invitation from 2016 to 2021.
- https://cdn.elifesciences.org/articles/83541/elife-83541-supp2-v2.xlsx
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Supplementary file 3
Proportion of women participating in mammography screening in Denmark within 365 d since invitation from 2016 to 2021.
- https://cdn.elifesciences.org/articles/83541/elife-83541-supp3-v2.xlsx
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Supplementary file 4
Prevalence ratios and 95% confidence intervals of participation in mammography screening in Denmark within 90 d since invitation from 2016 to 2021.
- https://cdn.elifesciences.org/articles/83541/elife-83541-supp4-v2.xlsx
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Supplementary file 5
Prevalence ratios and 95% confidence intervals of participation in mammography screening in Denmark within 180 d since invitation from 2016 to 2021.
- https://cdn.elifesciences.org/articles/83541/elife-83541-supp5-v2.xlsx
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MDAR checklist
- https://cdn.elifesciences.org/articles/83541/elife-83541-mdarchecklist1-v2.pdf
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Nationwide mammography screening participation in Denmark during the COVID-19 pandemic: An observational study
eLife 12:e83541.
https://doi.org/10.7554/eLife.83541
