Socio-demographic and cultural factors related to non-participation in the Dutch colorectal cancer screening programme

Hilliene J. van de Schootbrugge-Vandermeer, Iris Lansdorp-Vogelaar, Lucie de Jonge, Anneke J. van Vuuren, Evelien Dekker, Manon C. W. Spaander, Christian R. B. Ramakers, Iris D. Nagtegaal, Folkert J. van Kemenade, Monique E. van Leerdam, Esther Toes-Zoutendijk

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Abstract

Background: High participation rates are essential for a screening programme to be beneficial. To reach non-participants in a targeted manner, insight in characteristics of non-participants is needed. We investigated demographic differences between participants and non-participants in the Dutch faecal immunochemical test-based colorectal cancer (CRC) screening programme. Methods: In this population-based cohort study, we included all invitees for CRC screening in 2018 and 2019. Participation status, birth year, and sex were extracted from the Dutch national screening information system and linked to demographic characteristics from Statistics Netherlands, including migration background, level of education, socioeconomic category, household composition, and household income. A multivariable logistic regression was used to assess the association between demographic factors and participation. Results: A total of 4,383,861 individuals were invited for CRC screening in 2018 and 2019, of which 3,170,349 (72.3%) participated. Individuals were less likely to participate when they were single and/or living with others (single with other residents versus couple: odds ratio [OR] 0.34, 95% confidence interval [CI]: 0.31–0.38), had a migration background (e.g. Moroccan migrant versus Dutch background: OR 0.43, 95% CI: 0.42–0.44), or had a low income (lowest versus highest quintile: OR 0.45, 95% CI: 0.44–0.45). Although to a lesser extent, non-participation was also significantly associated with being male, being younger, receiving social welfare benefits and having a low level of education. Conclusion: We found that individuals who were single and/or living with others, immigrants from Morocco or individuals with low income were the least likely to participate in the Dutch CRC screening programme. Targeted interventions are needed to minimise inequities in CRC screening.
Original languageEnglish
Article number112942
JournalEuropean Journal of Cancer
Volume190
DOIs
Publication statusPublished - 1 Sept 2023

Keywords

  • Colorectal cancer
  • Colorectal cancer screening
  • Health inequities

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