Morbidity as a Predictor for Participation in the Danish National Mammography Screening Program: A Cross-Sectional Study

Figures & data

Figure 1 Flowchart of study population.

Table 1 Included Diagnosis with ICD-10 Code in Charlson Comorbidity Index (CCI) According to Their Respective Weight

CCI Weight	Diagnosis	ICD-10 Code
1
	Myocardial infarction	I21, I22, I23
	Congestive heart failure	I50, I110, I130, I132
	Peripheral vascular disease	I70, I71, I72, I73, I74, I77
	Cerebrovascular disease	I60-I69, G45, G46
	Dementia	F00-F03, F051, G30
	Chronic pulmonary disease	J40-J47, J60-J67, J684, J701, J703, J841, J920, J961, J982, J983
	Connective tissue disease	M05, M06, M08, M09, M30, M31, M32, M33, M34, M35, M36, D86
	Ulcer disease	K221, K25-K28
	Mild liver disease	B18, K700-K703, K709, K71, K73, K74, K760
	Diabetes I and II	E100, E101, E109, E110, E111, E119
2
	Hemiplegia	G81, G82
	Moderate to severe renal disease	I12, I13, N00-N05, N07, N11, N14, N17-N19, Q61
	Diabetes with end organ	E102-E108, E112-E118
	Any tumor^a	C00-C75^a
	Leukemia	C91-C95
	Lymphoma	C81-C85, C88, C90, C96
3
	Moderate to severe liver disease	B150, B160, B162, B190, K704, K72, K766, I85
6
	Metastatic solid tumor	C76-C80
	AIDS	B21-B24

Note: ^aBreast cancer excluded (C50).

Table 2 The Distribution of Participants and Non-Participants Stratified by Age Group, Region, and Charlson Comorbidity Index (CCI). N= 650,003

	Participants N (% Column)	Non-Participants N (% Column)	Participation % Row
All women	519,009 (100)	130,994 (100)	79.8
Age group
50–54 years	144,250 (27.8)	34,890 (26.6)	80.5
55–59 years	133,506 (25.7)	30,657 (23.4)	81.3
60–64 years	139,742 (26.9)	33,554 (25.6)	80.6
65–69 years	101,511 (19.6)	31,893 (24.4)	76.1
Region
Capital	137,401 (26.5)	47,704 (36.4)	74.2
Central Denmark	113,818 (21.9)	30,939 (23.6)	78.6
North Denmark	57,942 (11.2)	15,803 (12.1)	78.6
Zealand	87,189 (16.8)	18,438 (14.1)	82.5
Southern Denmark	122,659 (23.6)	18,110 (13.8)	87.1
CCI
0	437,432 (84.3)	104,106 (79.5)	80.8
1–2	72,649 (14.0)	21,879 (16.7)	76.9
≥3	8,928 (1.7)	5,009 (3.8)	64.1

Table 3 Prevalence Proportion Ratio (PR) of Screening by Age Group, Region, and Charlson Comorbidity Index (CCI). N= 650,003

	Unadjusted PR (95% CI)	Model 1 PR (95% CI)	Model 2 PR (95% CI)
Age
50–54 years	1 (ref)	-	1 (ref)
55–59 years	1.01 (1.01–1.01)	-	1.01 (1.01–1.01)
60–64 years	1.00 (0.99–1.00)	-	1.01 (1.00–1.01)
65–69 years	0.94 (0.94–0.95)	-	0.95 (0.95–0.96)
Region
Capital	1 (ref)	1 (ref)	1 (ref)
Central Denmark	1.06 (1.06–1.06)	1.06 (1.05–1.06)	1.06 (1.05–1.06)
North Denmark	1.06 (1.05–1.06)	1.06 (1.05–1.06)	1.06 (1.05–1.06)
Zealand	1.11 (1.11–1.12)	1.11 (1.11–1.12)	1.11 (1.11–1.12)
Southern Denmark	1.17 (1.17–1.18)	1.17 (1.17–1.18)	1.17 (1.17–1.18)
CCI
0	1 (ref)	1 (ref)	1 (ref)
1–2	0.95 (0.95–0.96)	0.96 (0.95–0.96)	0.96 (0.95–0.96)
≥3	0.79 (0.78–0.80)	0.80 (0.79–0.81)	0.80 (0.79–0.81)

Notes: Model 1: Region and CCI adjusted for age group. Model 2: Mutually adjusted.

Table 4 Unadjusted and Adjusted Prevalence Proportion Ratios (PR) for Participation by Selected Diseases and Years Since Diagnosis, Using No Disease as the Reference. Diseases are Separated by Charlson Comorbidity Index (CCI) Weight. N=650,003

	Participation Total N=519,009 N (% column)	Non-participation Total N=130,994 N (% column)	Unadjusted PR (95% CI)	Model 1 PR (95% CI)	Model 2 PR (95% CI)
CCI weight 1
Myocardial infarction
Yes	4,065 (0.78)	1,403 (1.07)	0.93 (0.92 - 0.95)	0.94 (0.92 - 0.95)	0.98 (0.97 - 1.00)
<1 years	719 (0.14)	260 (0.20)	0.92 (0.89 - 0.95)	0.93 (0.89 - 0.96)	0.97 (0.94 - 1.01)
1-2 years	993 (0.19)	353 (0.27)	0.92 (0.89 - 0.95)	0.93 (0.90 - 0.96)	0.97 (0.94 - 1.01)
3-4 years	857 (0.17)	302 (0.23)	0.93 (0.89 - 0.96)	0.94 (0.91 - 0.97)	0.98 (0.95 - 1.02)
5-10 years	1,496 (0.29)	488 (0.37)	0.94 (0.92 - 0.97)	0.95 (0.93 - 0.97)	0.99 (0.97 - 1.02)
Congestive heart failure
Yes	3,006 (0.58)	1,492 (1.14)	0.84 (0.82 - 0.85)	0.85 (0.83 - 0.86)	0.90 (0.88 - 0.92)
<1 years	808 (0.16)	439 (0.34)	0.81 (0.78 - 0.84)	0.82 (0.79 - 0.86)	0.88 (0.84 - 0.92)
1-2 years	851 (0.16)	425 (0.32)	0.83 (0.80 - 0.87)	0.85 (0.81 - 0.88)	0.90 (0.86 - 0.93)
3-4 years	548 (0.11)	263 (0.20)	0.85 (0.81 - 0.89)	0.85 (0.82 - 0.90)	0.91 (0.87 - 0.95)
5-10 years	799 (0.15)	365 (0.28)	0.86 (0.83 - 0.89)	0.86 (0.83 - 0.90)	0.91 (0.88 - 0.95)
Peripheral vascular disease
Yes	6,392 (1.23)	2,318 (1.77)	0.92 (0.91 - 0.93)	0.92 (0.91 - 0.93)	0.95 (0.94 - 0.96)
<1 years	1,507 (0.29)	550 (0.42)	0.92 (0.89 - 0.94)	0.92 (0.90 - 0.95)	0.96 (0.93 - 0.98)
1-2 years	1,730 (0.33)	717 (0.55)	0.88 (0.86 - 0.91)	0.89 (0.87 - 0.91)	0.92 (0.90 - 0.95)
3-4 years	1,196 (0.23)	480 (0.37)	0.89 (0.87 - 0.92)	0.89 (0.87 - 0.92)	0.93 (0.90 - 0.95)
5-10 years	1,959 (0.38)	571 (0.44)	0.97 (0.95 - 0.99)	0.97 (0.95 - 0.99)	0.99 (0.97 - 1.01)
Cerebrovascular disease
Yes	13,228 (2.55)	4,810 (3.67)	0.92 (0.91 - 0.92)	0.92 (0.92 - 0.93)	0.95 (0.94 - 0.96)
<1 years	2,750 (0.53)	1,268 (0.97)	0.86 (0.84 - 0.87)	0.86 (0.84 - 0.88)	0.89 (0.88 - 0.91)
1-2 years	3,714 (0.72)	1,413 (1.08)	0.91 (0.89 - 0.92)	0.91 (0.90 - 0.93)	0.94 (0.92 - 0.95)
3-4 years	2,696 (0.52)	918 (0.70)	0.93 (0.91 - 0.95)	0.94 (0.92 - 0.96)	0.96 (0.95 - 0.98)
5-10 years	4,068 (0.78)	1,211 (0.92)	0.96 (0.95 - 0.98)	0.97 (0.96 - 0.98)	0.99 (0.97 - 1.00)
Dementia
Yes	463 (0.09)	556 (0.42)	0.57 (0.53 - 0.61)	0.58 (0.54 - 0.62)	0.60 (0.56 - 0.64)
<1 years	130 (0.03)	181 (0.14)	0.52 (0.46 - 0.60)	0.53 (0.47 - 0.61)	0.56 (0.49 - 0.63)
1-2 years	139 (0.03)	186 (0.14)	0.54 (0.47 - 0.61)	0.54 (0.48 - 0.61)	0.56 (0.50 - 0.64)
3-4 years	82 (0.02)	97 (0.07)	0.57 (0.49 - 0.67)	0.58 (0.49 - 0.68)	0.60 (0.52 - 0.71)
5-10 years	112 (0.02)	92 (0.07)	0.69 (0.61 - 0.78)	0.70 (0.62 - 0.79)	0.72 (0.64 - 0.81)
Chronic pulmonary disease
Yes	19,359 (3.73)	7,229 (5.52)	0.91 (0.90 - 0.92)	0.92 (0.91 - 0.92)	0.93 (0.93 - 0.94)
<1 years	4,836 (0.93)	2,292 (1.75)	0.85 (0.83 - 0.86)	0.85 (0.84 - 0.87)	0.88 (0.86 - 0.89)
1-2 years	5,275 (1.02)	1,938 (1.48)	0.91 (0.90 - 0.93)	0.92 (0.91 - 0.93)	0.94 (0.92 - 0.95)
3-4 years	3,615 (0.70)	1,226 (0.94)	0.93 (0.92 - 0.95)	0.94 (0.92 - 0.95)	0.95 (0.94 - 0.97)
5-10 years	5,633 (1.09)	1,773 (1.35)	0.95 (0.94 - 0.96)	0.96 (0.95 - 0.97)	0.97 (0.96 - 0.98)
Connective tissue disease
Yes	11,204 (2.16)	2,708 (2.07)	1.01 (1.00 - 1.02)	1.01 (1.00 - 1.02)	1.03 (1.02 - 1.04)
<1 years	3,175 (0.61)	834 (0.64)	0.99 (0.98 - 1.01)	1.00 (0.99 - 1.02)	1.02 (1.00 - 1.04)
1-2 years	3,264 (0.63)	777 (0.59)	1.01 (1.00 - 1.03)	1.01 (1.00 - 1.03)	1.03 (1.01 - 1.04)
3-4 years	2,004 (0.39)	439 (0.34)	1.03 (1.01 - 1.05)	1.03 (1.01 - 1.05)	1.05 (1.03 - 1.07)
5-10 years	2,761 (0.53)	658 (0.50)	1.01 (1.00 - 1.03)	1.01 (1.00 - 1.03)	1.03 (1.01 - 1.04)
Ulcer disease
Yes	5,015 (0.97)	2,089 (1.59)	0.88 (0.87 - 0.90)	0.89 (0.87 - 0.90)	0.92 (0.90 - 0.93)
<1 years	705 (0.14)	340 (0.26)	0.84 (0.81 - 0.88)	0.85 (0.81 - 0.88)	0.88 (0.84 - 0.92)
1-2 years	1,120 (0.22)	485 (0.37)	0.87 (0.85 - 0.90)	0.87 (0.85 - 0.90)	0.91 (0.88 - 0.94)
3-4 years	1,030 (0.20)	444 (0.34)	0.87 (0.85 - 0.90)	0.88 (0.85 - 0.91)	0.91 (0.88 - 0.94)
5-10 years	2,160 (0.42)	820 (0.63)	0.91 (0.89 - 0.93)	0.91 (0.89 - 0.93)	0.93 (0.91 - 0.95)
Mild liver disease
Yes	3,131 (0.60)	1,670 (1.27)	0.82 (0.80 - 0.83)	0.82 (0.81 - 0.84)	0.87 (0.85 - 0.88)
<1 years	804 (0.15)	520 (0.40)	0.76 (0.73 - 0.79)	0.77 (0.73 - 0.80)	0.82 (0.78 - 0.86)
1-2 years	815 (0.16)	468 (0.36)	0.79 (0.76 - 0.83)	0.80 (0.77 - 0.83)	0.84 (0.81 - 0.88)
3-4 years	597 (0.12)	304 (0.23)	0.83 (0.79 - 0.87)	0.83 (0.80 - 0.87)	0.87 (0.83 - 0.91)
5-10 years	915 (0.18)	378 (0.29)	0.89 (0.85 - 0.92)	0.89 (0.86 - 0.93)	0.92 (0.89 - 0.96)
Diabetes I and II
Yes	13,429 (2.59)	4,974 (3.80)	0.91 (0.90 - 0.92)	0.91 (0.91 - 0.92)	0.96 (0.95 - 0.97)
<1 years	3,875 (0.75)	1,603 (1.22)	0.88 (0.87 - 0.90)	0.89 (0.87 - 0.90)	0.94 (0.93 - 0.96)
1-2 years	4,479 (0.86)	1,530 (1.17)	0.93 (0.92 - 0.95)	0.93 (0.92 - 0.94)	0.98 (0.96 - 0.99)
3-4 years	2,579 (0.50)	886 (0.68)	0.93 (0.91 - 0.95)	0.93 (0.92 - 0.95)	0.98 (0.96 - 1.00)
5-10 years	2,496 (0.48)	955 (0.73)	0.90 (0.89 - 0.92)	0.91 (0.89 - 0.93)	0.94 (0.93 - 0.96)
CCI weight 2
Hemiplegia
Yes	407 (0.08)	309 (0.24)	0.71 (0.67 - 0.76)	0.71 (0.67 - 0.76)	0.74 (0.70 - 0.79)
<1 years	92 (0.02)	95 (0.07)	0.62 (0.53 - 0.71)	0.62 (0.54 - 0.72)	0.65 (0.57 - 0.75)
1-2 years	118 (0.02)	76 (0.06)	0.76 (0.68 - 0.85)	0.77 (0.69 - 0.86)	0.80 (0.72 - 0.89)
3-4 years	93 (0.02)	67 (0.05)	0.73 (0.64 - 0.83)	0.72 (0.64 - 0.83)	0.76 (0.67 - 0.86)
5-10 years	104 (0.02)	71 (0.05)	0.74 (0.66 - 0.84)	0.74 (0.66 - 0.84)	0.77 (0.68 - 0.87)
Moderate to severe renal disease
Yes	2,495 (0.48)	1,074 (0.82)	0.87 (0.86 - 0.89)	0.88 (0.86 - 0.90)	0.93 (0.91 - 0.95)
<1 years	731 (0.14)	455 (0.35)	0.77 (0.74 - 0.81)	0.78 (0.74 - 0.81)	0.83 (0.79 - 0.87)
1-2 years	721 (0.14)	266 (0.20)	0.91 (0.88 - 0.95)	0.92 (0.88 - 0.95)	0.97 (0.93 - 1.01)
3-4 years	441 (0.09)	162 (0.12)	0.92 (0.87 - 0.96)	0.92 (0.88 - 0.97)	0.97 (0.92 - 1.01)
5-10 years	602 (0.12)	191 (0.15)	0.95 (0.91 - 0.99)	0.96 (0.92 - 0.99)	0.98 (0.95 - 1.02)
Diabetes with end organ
Yes	5,144 (0.99)	2,467 (1.88)	0.84 (0.83 - 0.86)	0.85 (0.84 - 0.87)	0.91 (0.90 - 0.93)
<1 years	1,371 (0.26)	789 (0.60)	0.79 (0.77 - 0.82)	0.81 (0.78 - 0.83)	0.88 (0.85 - 0.91)
1-2 years	1,622 (0.31)	779 (0.59)	0.84 (0.82 - 0.87)	0.85 (0.83 - 0.88)	0.91 (0.89 - 0.94)
3-4 years	1,210 (0.23)	501 (0.38)	0.88 (0.86 - 0.91)	0.90 (0.87 - 0.92)	0.95 (0.92 - 0.98)
5-10 years	941 (0.18)	398 (0.30)	0.88 (0.85 - 0.91)	0.88 (0.85 - 0.92)	0.93 (0.90 - 0.97)
Any tumor^a
Yes	14,237 (2.74)	4,585 (3.50)	0.95 (0.94 - 0.95)	0.95 (0.94 - 0.96)	0.98 (0.97 - 0.99)
<1 years	3,807 (0.73)	2,036 (1.55)	0.81 (0.80 - 0.83)	0.82 (0.81 - 0.84)	0.86 (0.85 - 0.88)
1-2 years	3,842 (0.74)	1,002 (0.76)	0.99 (0.98 - 1.01)	1.00 (0.98 - 1.01)	1.03 (1.01 - 1.04)
3-4 years	2,573 (0.50)	609 (0.46)	1.01 (0.99 - 1.03)	1.01 (1.00 - 1.03)	1.03 (1.01 - 1.05)
5-10 years	4,015 (0.77)	938 (0.72)	1.01 (1.00 - 1.03)	1.02 (1.00 - 1.03)	1.03 (1.02 - 1.05)
Leukemia
Yes	503 (0.10)	160 (0.12)	0.95 (0.91 - 0.99)	0.96 (0.92 - 1.00)	0.97 (0.93 - 1.01)
<1 years	194 (0.04)	83 (0.06)	0.88 (0.81 - 0.95)	0.88 (0.81 - 0.95)	0.90 (0.83 - 0.97)
1-2 years	198 (0.04)	45 (0.03)	1.02 (0.96 - 1.08)	1.03 (0.97 - 1.10)	1.04 (0.98 - 1.10)
3-4 years	52 (0.01)	14 (0.01)	0.99 (0.87 - 1.12)	1.00 (0.88 - 1.13)	1.02 (0.90 - 1.16)
5-10 years	59 (0.01)	18 (0.01)	0.96 (0.85 - 1.09)	0.97 (0.86 - 1.09)	0.98 (0.87 - 1.10)
Lymphoma
Yes	1,234 (0.24)	463 (0.35)	0.91 (0.88 - 0.94)	0.92 (0.89 - 0.94)	0.95 (0.92 - 0.98)
<1 years	431 (0.08)	219 (0.17)	0.83 (0.79 - 0.88)	0.83 (0.79 - 0.88)	0.86 (0.82 - 0.91)
1-2 years	421 (0.08)	133 (0.10)	0.95 (0.91 - 1.00)	0.96 (0.91 - 1.00)	1.00 (0.95 - 1.04)
3-4 years	190 (0.04)	57 (0.04)	0.96 (0.90 - 1.03)	0.98 (0.91 - 1.05)	1.02 (0.95 - 1.09)
5-10 years	192 (0.04)	54 (0.04)	0.98 (0.91 - 1.04)	0.98 (0.92 - 1.05)	1.01 (0.95 - 1.08)
CCI weight 3
Moderate to severe liver disease
Yes	577 (0.11)	397 (0.30)	0.74 (0.70 - 0.78)	0.75 (0.71 - 0.79)	0.87 (0.82 - 0.92)
<1 years	191 (0.04)	156 (0.12)	0.69 (0.63 - 0.76)	0.69 (0.63 - 0.76)	0.81 (0.74 - 0.89)
1-2 years	177 (0.03)	109 (0.08)	0.77 (0.71 - 0.85)	0.78 (0.71 - 0.85)	0.91 (0.83 - 0.99)
3-4 years	101 (0.02)	69 (0.05)	0.74 (0.66 - 0.84)	0.75 (0.66 - 0.85)	0.88 (0.77 - 0.99)
5-10 years	108 (0.02)	63 (0.05)	0.79 (0.71 - 0.89)	0.80 (0.71 - 0.90)	0.92 (0.82 - 1.02)
CCI weight 6
Metastatic solid tumor
Yes	1,081 (0.21)	846 (0.65)	0.70 (0.67 - 0.73)	0.70 (0.68 - 0.73)	0.73 (0.70 - 0.76)
<1 years	370 (0.07)	510 (0.39)	0.53 (0.49 - 0.57)	0.53 (0.49 - 0.57)	0.54 (0.50 - 0.59)
1-2 years	294 (0.06)	180 (0.14)	0.78 (0.72 - 0.83)	0.78 (0.73 - 0.84)	0.81 (0.75 - 0.87)
3-4 years	176 (0.03)	71 (0.05)	0.89 (0.82 - 0.97)	0.89 (0.82 - 0.96)	0.92 (0.85 - 1.00)
5-10 years	241 (0.05)	85 (0.07)	0.93 (0.87 - 0.99)	0.93 (0.87 - 0.99)	0.95 (0.89 - 1.02)
AIDS
Yes	76 (0.02)	69 (0.05)	0.66 (0.56 - 0.77)	0.66 (0.57 - 0.78)	0.69 (0.60 - 0.81)
<1 years	24 (0.01)	28 (0.02)	0.58 (0.43 - 0.78)	0.58 (0.44 - 0.78)	0.62 (0.47 - 0.82)
1-2 years	34 (0.01)	21 (0.02)	0.77 (0.63 - 0.95)	0.79 (0.64 - 0.97)	0.82 (0.67 - 1.01)
3-4 years	8 (0.00)	11 (0.01)	0.53 (0.31 - 0.89)	0.54 (0.32 - 0.91)	0.55 (0.32 - 0.92)
5-10 years	10 (0.00)	9 (0.01)	0.66 (0.43 - 1.01)	0.67 (0.43 - 1.03)	0.68 (0.44 - 1.05)

Notes: Model 1: Adjusted for region and age group. Model 2: Adjusted for region, age group, and prevalence of any other CCI-disease. ^aBreast cancer excluded. Reference is no disease.