Participation in the national cervical screening programme among women from New South Wales, Australia, by place of birth and time since immigration: A data linkage analysis using the 45 and up study

Abstract

Objective Equitable elimination of cervical cancer in Australia within the next decade will require high National Cervical Screening Program (NCSP) participation by all subgroups of women. The aim of this study was to examine the participation of immigrants compared to Australian-born women. Methods Participation in the NCSP (≥1cytology test) over a 3-year (2010–2012) and 5-year (2008–2012) period, by place of birth and time since immigration was examined using individually linked data of 67,350 New South Wales (NSW) women aged ≥45 enrolled in the 45 and Up Study. Results Three-year cervical screening participation was 77.0% overall. Compared to Australian-born women (77.8%), 3-year participation was lower for women born in New Zealand (adjusted odds ratio 0.77, 95% confidence interval 0.69–0.87), Oceania (0.67, 0.51–0.89), Middle East/North Africa (0.76, 0.60–0.97), South-East Asia (0.72, 0.60–0.87), Chinese Asia (0.82, 0.69–0.97), Japan/South Korea (0.68, 0.50–0.94), and Southern/Central Asia (0.54, 0.43–0.67), but higher for women from Malta (2.85, 1.77–4.58) and South America (1.33, 1.01–1.75). Non-English-speaking-at-home women were less likely to be screened than English-speaking-at-home women (0.85, 0.78–0.93). Participation increased with years lived in Australia but remained lower in immigrant groups compared to Australian-born women, even after ≥20 years living in Australia. Similar results were observed for 5-year participation. Conclusions Women born in New Zealand, Oceania, and parts of Asia and the Middle East had lower NCSP participation, which persisted for ≥20 years post-immigration. The NCSP transition to primary HPV screening, and the introduction of the universal self-collection option in 2022, will offer new opportunities for increasing screening participation for these groups.