Travel distance to the general practitioner and women's participation in cervical cancer screening in Denmark – A population-based cohort study, 2017
Previous studies found disparities in utilization of cervical cancer screening programs. Geographical distance to the screening location may affect women's participation. The aim of this study was to investigate the association between travel distance from residence to general practitioner, and invited women's participation in a national screening program for cervical cancer. Data were obtained from Danish national registers including all women invited to the screening program in 2017 (n = 341,708). Travel distance from residence to the general practitioner was calculated based on geocoded addresses and the road network. Multilevel logistic regression was used to calculate odds ratios (ORs) of participation with 95 % confidence intervals (CI). Based on 271,959 women with complete information, screening participation decreased from 67.7 % among women with a travel distance of 1.0-4.9 km to 61.1 % among women with ≥15.0 km. Adjusted for ethnicity, education, and age, women with ≥15.0 km to the general practitioner had 22 % lower odds of participation compared to those living 1.0-4.9 km away (OR = 0.78, 95 %CI [0.75;0.81]). Women with <1.0 km to the general practitioner had 10 % lower odds of participation (OR = 0.90, 95 %CI [0.88;0.93]). Sensitivity analysis indicated an exposure-response relationship when distance was ≥5 km, implying lower odds of participation with increasing distance above 5 km. Travel distance to the general practitioner was associated with participation in screening. Future initiatives should promote equal access to preventive health services focusing on women having a long travel distance to their general practitioner, as well as those living very close to their general practitioner.