{
  "abstract": "Background Social inequalities in cancer screening participation are well documented. However, previous research has examined dimensions of screening inequalities, such as gender, education, and employment, separately, without considering how these factors interact. This study goes beyond individual determinants to investigate how multiple combinations of social characteristics shape colorectal cancer (CRC) screening uptake across population subgroups. Further, we exploit a quasi-experimental setting resulting from the implementation of national CRC screening programmes in four European countries between 2014 and 2019 to evaluate their impact on screening uptake across different subgroups.Methods We analysed data from two consecutive waves (2014 and 2019) of the European Health Interview Survey (n = 216,857; 24 countries) using Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA), an innovative method for investigating inequalities across multiple social conditions. Screening uptake was assessed across 48 subgroups defined by sex (man, woman), education level (low, middle, high), living arrangement (living alone, not living alone), employment (employed, not employed), and health status (with, without long-standing health problems). To assess the impact of CRC screening programmes, we combined MAIHDA with a difference-in-differences (DiD) analysis, incorporating random slopes for the DiD term to capture variations in screening uptake across subgroups.Results In 2014, the five subgroups with the lowest CRC screening uptake (8–10 percentage points below the population average) consisted of individuals with lower education levels, living alone, employed, and without health problems. In countries that implemented screening programmes, overall uptake increased by 26 percentage points (DiD coefficient). Four subgroups with lower education, not living alone, and without health problems experienced an additional 8–9 percentage points increase, while two subgroups with lower education and employment, which had the lowest uptake in 2014, had a 6 percentage points higher increase. However, among three subgroups of individuals living alone with the lowest uptake in 2014, screening participation did not increase beyond the population average following programme implementation.Discussion CRC screening programmes increased uptake in several subgroups with lower screening participation, contributing to a reduction in inequalities, particularly among those with lower education levels and without long-standing health problems. However, some subgroups of individuals living alone did not experience a comparable increase, stressing persistent disparities and the need for targeted interventions to address screening barriers. This study is the first to combine MAIHDA and difference-in-differences methods, introducing a novel approach to identifying granular inequalities and evaluating public health interventions.",
  "authors": [
    {
      "affiliations": [
        "Department of Sociological Studies, University of Sheffield, Sheffield, UK"
      ],
      "name": "Vladimir Jolidon"
    },
    {
      "affiliations": [
        "Sheffield Methods Institute, University of Sheffield, Sheffield, UK"
      ],
      "name": "Andrew Bell"
    },
    {
      "affiliations": [
        "Department of Sociological Studies, University of Sheffield, Sheffield, UK"
      ],
      "name": "Daniel Holman"
    }
  ],
  "title": "P100 Inequalities in colorectal cancer screening participation in Europe: the impact of screening programmes across population subgroups in a quasi-experimental study",
  "uid": "240fec56-ea4b-5cac-b70c-0c9902852c9f"
}