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Intersectional social-economic inequalities in breast cancer screening in India: analysis of the National Family Health Survey.

Background: Breast cancer incidence rates are increasing in developing countries including India. With 1.3 million new cases of cancer been diagnosed annually, breast cancer is the most common women's cancer in India. India's National Family Health Survey (NFHS-4) data 2015-2016 shows that only 9.8%...

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Published in:BMC Women's Health Vol. 21; no. 1; pp. 1 - 10
Main Authors: Negi, Jyotsna, Nambiar, Devaki
Format: research Journal Article
Published: BioMed Central 9/7/2021
Online Access:View this record in EBSCOhost
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        14726874
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      dt: 9/7/2021
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      pub: BioMed Central
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        152316941
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        NLM34493267
        152316941
        10.1186/s12905-021-01464-5
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        atl: Intersectional social-economic inequalities in breast cancer screening in India: analysis of the National Family Health Survey.
      aug:
        au:
          Negi, Jyotsna
          Nambiar, Devaki
        affil: Independent Consultant, 62 Stratford Rd, 94707, Kensington, California, USA
      sug:
        subj:
          Breast Neoplasms Epidemiology
          Breast Neoplasms Diagnosis
          Early Detection of Cancer
          Adult
          Middle Age
          India
          Socioeconomic Factors
          Human
          Female
          Surveys
          Young Adult
          Adolescence
          Comparative Studies
          Multicenter Studies
          Evaluation Research
          Validation Studies
          Social Readjustment Rating Scale
          Adult: 19-44 years
          Middle Aged: 45-64 years
          Adolescent: 13-18 years
          Female
      ab: Background: Breast cancer incidence rates are increasing in developing countries including India. With 1.3 million new cases of cancer been diagnosed annually, breast cancer is the most common women's cancer in India. India's National Family Health Survey (NFHS-4) data 2015-2016 shows that only 9.8% of women between the ages of 15 and 49 had ever undergone breast examination (BE). Further, access to screening and treatment is unequally distributed, with inequalities by socio-economic status. It is unclear, however, if socio-economic inequalities in breast examination are similar across population subgroups.Methods: We compared BE coverage in population sub-groups categorised by place of residence, religion, caste/tribal groups, education levels, age, marital status, and employment status in their intersection with economic status in India. We analysed data for 699,686 women aged 15-49 using the NFHS-4 data set conducted during 2015-2016. Descriptive (mean, standard errors, and confidence intervals) of women undergoing BE disaggregated by dimensions of inequality (education, caste/tribal groups, religion, place of residence) and their intersections with wealth were computed with national weights using STATA 12. Chi-square tests were performed to assess the association between socio-demographic factors and breast screening. Additionally, the World Health Organisation's Health Equity Assessment Toolkit Plus was used to compute summary measures of inequality: Slope index for inequality (SII) and Relative Concentration Indices (RCI) for each intersecting dimension.Results: BE coverage was concentrated among wealthier groups regardless of other intersecting population subgroups. Wealth-related inequalities in BE coverage were most pronounced among Christians (SII; 20.6, 95% CI: 18.5-22.7), married (SII; 14.1, 95% CI: 13.8-14.4), employed (SII: 14.6, 95%CI: 13.9, 15.3), and rural women (SII; 10.8, 95% CI: 10.5-11.1). Overall, relative summary measures (RCI) were consistent with our absolute summary measures (SII).Conclusions: Breast examination coverage in India is concentrated among wealthier populations across population groups defined by place of residence, religion, age, employment, and marital status. Apart from this national analysis, subnational analyses may also help identify strategies for programme rollout and ensure equity in women's cancer screening.
      pubtype: Academic Journal
      doctype:
        research
        Journal Article
      ougenre: Article
    language: English
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