Re-emergence of educational inequalities in cervical cancer mortality, Colombia 1998-2015

Aim of the study: To perform an in-depth evaluation of the trends and recent levels of inequalities in cervical cancer mortality in Colombia. Methods: Using Colombian national mortality statistics, we calculated age-standardized mortality rates (ASMR) as well as age-specific rates per 100,000 person-years, applying redistribution factors according to international recommendations. We imputed missing data for educational level. Multivariate Poisson regression models were constructed to incorporate age and educational level as independent variables. To assess changes in educational inequalities, we estimated the Relative Index of Inequality (RII). All estimates were also evaluated over time, resulting in estimated annual percent changes (EAPC). Results: Over time, cervical cancer mortality declined rapidly up to 2013 (EAPC = - 5.4%, ASMR 27.2 in 1998, 12.5 in 2013), after which ASMR stabilized. This pattern was present in all but the youngest age group and in all educational levels, but much stronger initial declines were observed among women with tertiary education (EAPC = - 8.3%) compared with those with primary (EAPC = - 4.0%) and secondary (EAPC = - 3.4%) educational levels. The overall RII was 6.77 (95%CI: 6.15, 7.47), varying from 3.5 for women aged 65 and over, to 8.5 in women aged 25-44. Significant increases in inequality were observed for middle-aged (EAPC = + 2.9%) and young (EAPC = + 2.4%). Conclusion: Cervical cancer mortality rates were highest at older ages, but inequalities are concentrated in the younger age groups - and increasing. Considering the recent stagnations in improvement in cervical cancer mortality as well as it inequalities, public policies addressed to reduce cervical cancer mortality are recently failing.