Women’s barriers for contacting general practice when experiencing gynecological cancer symptoms: a population-based study

Abstract Background A prerequisite for general practitioners (GPs) being able to refer patients with gynecological cancer alarm symptoms for further investigations is that individuals present the symptoms to the GP. Not all symptoms are presented to the GP, and knowledge of barriers for healthcare-seeking is sparse. The aim of this study was to analyze associations between age, socioeconomic status, and common barriers (“being too embarrassed”, “being too busy”, “worried about wasting the doctors time” and “worried what the GP might find”) towards GP contact with gynecological alarm symptoms. Methods Nationwide population-based study in Denmark based on a random sample of 51 090 women aged 20 years or older. A web-based questionnaire regarding experience of four predefined alarm symptoms of gynecological cancer, decisions about contact to GPs, and barriers towards GP contact was distributed. Information about socioeconomic status was collected from Statistics Denmark. Results A total of 26 466 women (54.5%) completed the questionnaire. The proportion of women with no contact to the GP varied between 64.6% and 78.1% for postmenopausal bleeding and pain during intercourse, respectively. Between 32.3% (bleeding during intercourse) and 45.3% (postmenopausal bleeding) of the women reported no barriers for GP contact. The proportions of reported barriers ranged from 7.5% for being too embarrassed (pelvic pain) to 26.8% for being too busy (bleeding during intercourse). Women aged 40–59 years had lower odds of reporting “being too embarrassed” and “worried about wasting the GP´s time”, while women aged 60 + years of age had lower odds of reporting “being too busy” compared to the youngest age group. Women in the highest income groups had lower odds of reporting “being too embarrassed” and “wasting the GP´s time” compared to those with a low income, while those with high educational level had lower odds of reporting “being too embarrassed” and “worried what the GP might find” compared to those with low educational level. Conclusions More than half of the respondents with no contact to the GP, reported one or more barriers towards GP contact. Lower age and socioeconomic status were significantly associated with higher odds of reporting barriers. As this may explain the differences in healthcare seeking behavior, healthcare planners, policy makers and clinicians should be aware of these findings.

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Gynecological cancer alarm symptoms: is contact with specialist care associated with lifestyle and socioeconomic status? A population-based study

Acta Obstetricia Et Gynecologica Scandinavica ◽

10.1111/aogs.12927 ◽

2016 ◽

Vol 95 (9) ◽

pp. 976-983 ◽

Cited By ~ 6

Author(s):

Kirubakaran Balasubramaniam ◽

Pernille Ravn ◽

Rene D. Christensen ◽

Jens Søndergaard ◽

Dorte E. Jarbøl

Keyword(s):

Socioeconomic Status ◽

Gynecological Cancer ◽

Population Based ◽

Specialist Care ◽

Population Based Study

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Socioeconomic status, lifestyle factors and asthma prevalence: results from a population-based study in Sweden

Scandinavian Journal of Public Health ◽

10.1177/14034948211060821 ◽

2021 ◽

pp. 140349482110608

Author(s):

Anu Molarius ◽

Mikael Hasselgren

Keyword(s):

Socioeconomic Status ◽

Educational Level ◽

Physical Inactivity ◽

Population Sample ◽

Age Groups ◽

Population Based ◽

Lifestyle Factors ◽

Asthma Prevalence ◽

Population Based Study ◽

Random Population Sample

Aim: To examine differences in the prevalence of self-reported diagnosed asthma by socioeconomic status and the contribution of lifestyle factors to these differences. Methods: The study was based on 28,531 persons aged 18 years or older who answered a survey questionnaire sent to a random population sample in mid-Sweden in 2017. The overall response rate was 44%. Socioeconomic status was measured with educational level and economic difficulties, and lifestyle factors with physical activity, smoking, snuff use, risk-drinking of alcohol and obesity. The associations between socioeconomic status and asthma were analysed using multivariate logistic regression. Results: The overall asthma prevalence was 9% among women and 7% in men and decreased with increasing age. Educational level was not independently associated with asthma, but a statistically significant odds ratio (with 95% confidence intervals) for the prevalence of asthma was observed for economic difficulties 1.5 (1.3–1.7). Also, physical inactivity 1.2 (1.1–1.3) and obesity 1.6 (1.4–1.8) were associated with increased asthma prevalence. Smoking and risk-drinking were not statistically significantly associated with asthma whereas snuff users had a higher prevalence of asthma among women. Adjusting for lifestyle factors did not affect the association between socioeconomic status and asthma. Conclusions: In this population-based study, self-reported diagnosed asthma was independently associated with economic difficulties but not with educational level. Lifestyle factors did not explain the association between economic difficulties and asthma prevalence. This applies to both men and women as well as younger and older age groups.

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Educational level and socioeconomic status in patients born with congenital diaphragmatic hernia: A population-based study

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2019.12.018 ◽

2020 ◽

Vol 55 (11) ◽

pp. 2293-2296

Author(s):

Carmen Mesas Burgos ◽

Elin Öst ◽

Henrik Ehrén ◽

Björn Frenckner

Keyword(s):

Socioeconomic Status ◽

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Educational Level ◽

Population Based ◽

Population Based Study

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Lifestyle, socioeconomic status and healthcare seeking among women with gynaecological cancer alarm symptoms: a combined questionnaire-based and register-based population study

BMJ Open ◽

10.1136/bmjopen-2018-021815 ◽

2018 ◽

Vol 8 (7) ◽

pp. e021815 ◽

Cited By ~ 3

Author(s):

Kirubakaran Balasubramaniam ◽

Sandra Elnegaard ◽

Sanne Rasmussen ◽

Peter Fentz Haastrup ◽

René dePont Christensen ◽

...

Keyword(s):

Socioeconomic Status ◽

Educational Level ◽

Lifestyle Factors ◽

Gynaecological Cancer ◽

High Educational Level ◽

Postmenopausal Bleeding ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Recent Onset ◽

High Educational

ObjectivesTo determine the proportion of contacts to general practitioner (GP) with recent onset gynaecological cancer alarm symptoms (pelvic pain, postmenopausal bleeding, bleeding during intercourse or pain during intercourse) and to analyse the associations between lifestyle factors, socioeconomic status and GP contact for these symptoms.DesignCross-sectional survey combined with data from national registers.SettingThe general Danish population.ParticipantsA total of 25 866 non-pregnant women ≥20 years completed the survey. Women reporting at least one of four gynaecological alarm symptoms within the preceding 6 months form the study base (n=2957).ResultsThe proportion of women reporting GP contact ranged from 21.1% (pain during intercourse) to 32.6% (postmenopausal bleeding). Women aged 60+ years had higher odds of reporting GP contact for at least one of the four gynaecological cancer alarm symptoms compared with those aged 20–39 years (OR 2.56, 95% CI 1.69 to 3.89), and immigrants had higher odds of reporting GP contact for at least one of the symptoms (OR 1.56, 95% CI 1.13 to 2.15) compared with ethnic Danish individuals. Among those reporting postmenopausal bleeding and/or bleeding during intercourse, women in the age group 60+ years had higher odds of reporting GP contact compared with those aged 20–39 years (OR 2.79, 95% CI 1.33 to 5.87). A high educational level (>12 years) was positively associated with reporting GP contact for postmenopausal bleeding and/or bleeding during intercourse compared with a low educational level (<10 years) (OR 2.23, 95% CI 1.19 to 4.19). No associations were found with lifestyle factors.ConclusionsFew women contacted their GP with recent onset gynaecological cancer alarm symptoms. Higher age, being immigrant and higher educational level increased the odds of GP contact. Future studies should explore the reasons for these findings as this may aid in prompting early diagnosis and thereby improve the prognosis of gynaecological cancer.

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Neighbourhood maternal socioeconomic status indicators and risk of congenital heart disease

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03512-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Qun Miao ◽

Sandra Dunn ◽

Shi Wu Wen ◽

Jane Lougheed ◽

Jessica Reszel ◽

...

Keyword(s):

Socioeconomic Status ◽

Congenital Heart Disease ◽

Heart Disease ◽

Household Income ◽

Congenital Heart ◽

Population Based ◽

Income Poverty ◽

Lower Odds ◽

Logistic Regression Models ◽

Chd Risk

Abstract Background This study aimed to examine the relationships between various maternal socioeconomic status (SES) indicators and the risk of congenital heart disease (CHD). Methods This was a population-based retrospective cohort study, including all singleton stillbirths and live births in Ontario hospitals from April 1, 2012 to March 31, 2018. Multivariable logistic regression models were performed to examine the relationships between maternal neighbourhood household income, poverty, education level, employment and unemployment status, immigration and minority status, and population density and the risk of CHD. All SES variables were estimated at a dissemination area level and categorized into quintiles. Adjustments were made for maternal age at birth, assisted reproductive technology, obesity, pre-existing maternal health conditions, substance use during pregnancy, rural or urban residence, and infant’s sex. Results Of 804,292 singletons, 9731 (1.21%) infants with CHD were identified. Compared to infants whose mothers lived in the highest income neighbourhoods, infants whose mothers lived in the lowest income neighbourhoods had higher likelihood of developing CHD (adjusted OR: 1.29, 95% CI: 1.20–1.38). Compared to infants whose mothers lived in the neighbourhoods with the highest percentage of people with a university or higher degree, infants whose mothers lived in the neighbourhoods with the lowest percentage of people with university or higher degree had higher chance of CHD (adjusted OR: 1.34, 95% CI: 1.24–1.44). Compared to infants whose mothers lived in the neighbourhoods with the highest employment rate, the odds of infants whose mothers resided in areas with the lowest employment having CHD was 18% higher (adjusted OR: 1.18, 95% CI: 1.10–1.26). Compared to infants whose mothers lived in the neighbourhoods with the lowest proportion of immigrants or minorities, infants whose mothers resided in areas with the highest proportions of immigrants or minorities had 18% lower odds (adjusted OR: 0.82, 95% CI: 0.77–0.88) and 16% lower odds (adjusted OR: 0.84, 95% CI: 0.78–0.91) of CHD, respectively. Conclusion Lower maternal neighbourhood household income, poverty, lower educational level and unemployment status had positive associations with CHD, highlighting a significant social inequity in Ontario. The findings of lower CHD risk in immigrant and minority neighbourhoods require further investigation.

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The mediating effect of lifestyles on the association between social factors and DNA methylation

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.230 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

A Maugeri ◽

M Barchitta ◽

G Favara ◽

C La Mastra ◽

MC La Rosa ◽

...

Keyword(s):

Physical Activity ◽

Dna Methylation ◽

Socioeconomic Status ◽

Mediterranean Diet ◽

Educational Level ◽

Methylation Level ◽

Mediating Effect ◽

High Educational Level ◽

Age Related ◽

High Educational

Abstract Background Social disadvantage and unhealthy lifestyles may induce molecular changes associated with aging and age-related diseases. For instance, previous studies reported socioeconomic difference in DNA methylation, which in turn led to aberrant gene expression and genome instability. Socioeconomic status (SES) alone, however, does not completely explain this difference, and further studies are needed to unveil what factors contribute to it. Methods We conducted a cross-sectional study on 349 Italian women, aged 25-64 years, to assess SES differences in LINE-1 methylation level - a surrogate marker of global DNA methylation - and to examine the mediating effect of lifestyles (i.e. diet, smoking habits, physical activity, and weight status). Educational level was used as SES indicator. The adherence to Mediterranean diet (MD) was assessed by the Mediterranean Diet Score (MDS). Leukocyte LINE-1 methylation was assessed by pyrosequencing. Mediation analysis was conducted using the PROCESS macro for the SPSS software. Results We first observed that women with high educational level were more likely to be normal weight (p < 0.001) and to adhere to MD (p = 0.018), and less likely to perform physical activity (p = 0.012) than their less educated counterpart. Moreover, age-adjusted linear regression demonstrated that LINE-1 methylation level increased with increasing educational level (β = 0.016; SE = 0.003; p < 0.001). In line, mediation analysis demonstrated an indirect effect of high educational level on LINE-1 methylation through the adherence to MD (β = 0.003; 95%CI=0.001-0.006). Specifically, the mediator could account for 9.5% of the total effect. None of the other lifestyles, instead, exhibited a significant mediating effect. Conclusions To our knowledge, this is the first study demonstrating the mediation of diet in the relationship between SES and DNA methylation. Thus, our findings add even more value to the promotion of healthy dietary habits among social disadvantaged people. Key messages Social disadvantage is associated with epigenetic changes related to aging and age-related diseases. Adherence to the Mediterranean diet might mediate the association between socioeconomic status and DNA methylation.

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