Socio-economic inequality of utilization of cancer testing in Europe: A cross-sectional study.

There are currently screening programmes for breast, cervical and colorectal cancer in many European countries. However, the uptake of cancer screening in general may vary within and between countries. The aim of this study is to assess the inequalities in testing utilization by socio-economic status and whether the amount of inequality varies across European regions. We conducted an analysis based on cross-sectional data from the second wave of the European Health Interview Survey from 2013 to 2015. We analysed the use of breast, cervical, and colorectal cancer testing by socio-economic position (household income, educational level and employment status), socio-demographic factors, self-perceived health and smoking behaviour, by using multinomial logistic models, and inequality measurement based on the Slope index of inequality (SII) and Relative index of inequality (RII). The results show that the utilization of mammography (Odds Ratio (OR) = 0.55, 95% confidence interval (95%CI):0.50-0.61), cervical smear tests (OR = 0.60, 95%CI:0.56-0.65) and colorectal testing (OR = 0.82, 95%CI:0.78-0.86) was overall less likely among individuals within a low household income compared to a high household income. Also, individuals with a non-EU country of birth, low educational level and being unemployed (or retired) were overall less likely to be tested. The income-based inequality in breast (SII = 0.191;RII = 1.260) and colorectal testing utilization (SII = 0.161;RII = 1.487) was the greatest in Southern Europe. For cervical smears, this inequality was greatest in Eastern Europe (SII = 0.122;RII = 1.195). We concluded that there is considerable inequality in the use of cancer tests in Europe, with inequalities associated with household income, educational level, employment status, and country of birth.

How to reverse first time donors to become regular donors? A questionnaire survey in Estonia.

BACKGROUND: Donating blood in Estonia is non-remunerated and voluntary. Estonian Blood Service system has four independent regional blood centres that are responsible for blood collection, processing, screening and distribution of blood components to hospitals for clinical use. STUDY DESIGN: This research was carried out as a questionnaire survey. A questionnaire was developed to study lapsing first time donors' (FTD) blood donation experience, intention and willingness to donate again. METHODS: A thousand five hundred and forty-six questionnaires were posted to donors who had one successful donation in 2010 and who had not returned to second donation till the year 2012. For data analysis routine statistical methods were used. To evaluate the most appropriate number of classes, based on previous experience and future expectations, latent class analysis was used. RESULTS: There were 453 respondents (29.3%). For the majority of aspects of blood donation experience the emotions were positive. Results of the study suggested that blood collection agencies should intervene to bolster donors' attitudes, perceived control, and identity as a donor during this crucial post-first donation period. CONCLUSION: First blood donation seems to have been a positive experience. Reasons leading to stopping blood donation should be studied further. Establishing a donor registry for Estonia would be essential to keep track of donors.

Does hormone replacement therapy affect the use of prescription medicines in postmenopausal women: experience from the Estonian Postmenopausal Hormone Therapy Trial [ISRCTN35338757].

OBJECTIVE: To determine how postmenopausal hormone therapy (HRT) is related to the use of other prescription medication. DESIGN: Follow up of a randomised controlled trial with a blind subtrial of hormone therapy versus placebo and a nonblind subtrial of open label hormone therapy versus nontreatment. POPULATION: A total of 1823 postmenopausal women aged 50-64 at the time of sampling participated in the trial from 1999 to 2004. METHODS: Use of prescription medication was identified by records in the central computerised database of the Estonian Health Insurance Fund. MAIN OUTCOME MEASURES: The use of 21 classes of prescription medication was compared in the hormone therapy arms and placebo or nontreatment trial arms. The influence of women's socio-economic characteristics on the intensity of concomitant medication use was also examined. RESULTS: The proportion of women using any prescription medication besides hormone therapy did not differ between the arms. However, the type of prescribed drugs varied between the arms. After combining data from both hormone therapy arms, for women using HRT the combined hazard ratio was 1.26 (95% CI: 1.05-1.53) for the use of calcium channel blockers, 1.48 (95% CI: 1.10-1.99) for local vaginal treatment, 0.70 (95% CI: 0.50-0.99) for hypnotics and sedatives and 0.77 (95% CI: 0.60-0.99) for selective serotonin reuptake inhibitors (SSRIs). Women who were older, who had a higher body mass index, who were unemployed and who lived outside the capital used more prescription drugs in comparison with others. CONCLUSIONS: Hormone therapy did not increase the overall use of prescription medication other than hormone therapy, but the types of drugs used in hormone therapy and nontherapy arms varied, with increased use of calcium channel blockers for hypertension and local vaginal treatments for vaginal candidiasis and decreased use of hypnotics, sedatives and SSRIs in the HRT arms.