Association of Regular Cervical Cancer Screening with Socioeconomic, COVID-19 Infection and Vaccine Status Among Japanese Population: Cohort Observational Study

Figures & data

Figure 1 Flow chart of this study, from entries into the Japan COVID-19 and Society Internet Survey, the number of individuals targeted for this study is documented alongside excluded participants.

Table 1 Characteristics of Eligible Women Depend on CCS Status Within the Last Two Years

	CCS within 2 Years				P-value
	Undergone Screening		Never had Screening
	n	%	n	%
Overall	5597	46.4	6469	53.6
Age (years)					<0.01
20–29	908	37.2	1533	62.8
30–39	1562	50.8	1511	49.2
40–49	1246	52.9	1111	47.1
50–59	997	48.7	1049	51.3
60–69	884	41.1	1265	58.9
Social background
Marital status					<0.01
Married	3936	51.2	3745	48.8
Single, divorced, widow	1661	37.9	2724	62.1
Employment status					<0.01
Unemployment, student	1832	40.9	2650	59.1
Employed	3765	49.6	3819	50.4
Education					<0.01
High school or less	1258	40.2	1869	59.8
College	1751	46.8	1992	53.2
University/graduate school	2588	49.8	2608	50.2
Household annual income					<0.01
<4 million yen	1168	38.1	1895	61.9
4–8 million yen	1975	50.1	1967	49.9
>8million yen	1316	58.9	920	41.1
Other/ no answer	1138	40.3	1687	59.7
Smoking					0.04
Never	4074	46.1	4756	53.9
Ex-smoker	1197	48.2	1287	51.8
Current	326	43.4	426	56.7
Alcohol					<0.01
None	2529	44.0	3217	56.0
Sometimes	2439	49.0	2542	51.0
Everyday	629	47.0	710	53.0

Abbreviation: CCS; cervical cancer screening.

Table 2 Characteristics of Eligible Women Depend on CCS Status with Health and COVID-19 Related Status

	CCS within 2 Years				P-value
	Undergone Screening		Never had Screening
	n	%	n	%
Health related status
Use of preventive care
General checkups
Yes	4643	60.4	3050	39.7	<0.01
No	954	21.8	3419	78.2
Breast cancer screening
Yes	3538	86.6	549	13.4	<0.01
No	1151	20.8	4387	79.2
Not applicable	908	37.2	1533	62.8
Counts of chronic conditions *a					0.33
0	4605	46.7	5250	53.3
1,2	932	45.1	1134	54.9
3,4	36	40.0	54	60.0
>4	24	43.6	31	56.4
Self-rated health					<0.01
Very good	1215	48.2	1308	51.8
Good	2159	50.1	2149	49.9
Fair	1521	42.7	2043	57.3
Bad	594	43.4	775	56.6
Very bad	108	35.8	194	64.2
COVID-19 related status
History of COVID-19 infection					<0.01
Yes	959	49.9	963	50.1
No	4638	45.7	5506	54.3
COVID-19 vaccination does					<0.01
Unvaccinated	512	34.2	987	65.8
1 or 2	956	46.9	1081	53.1
>3	4129	48.4	4401	51.6
FCV-19S					0.30
7–15	2042	45.4	2455	54.6
16–20	2049	47.4	2270	52.6
21–25	1253	46.3	1452	53.7
26–35	253	46.4	292	53.6

Notes: *,^aChronic conditions include hypertension, diabetes, asthma, chronic heart disease, stroke, chronic obstructive pulmonary disease, chronic kidney disease, hepatitis, cancer, and depression.

Abbreviations: CCS, cervical cancer screening; FCV-19S, fear of coronavirus-19 scales.

Table 3 Univariate and Multivariate Analysis Predicting Undergone Cervical Cancer Screening

	PR	P-value	APR	(95% CI)	P-value
History of COVID-19 infection
Yes	Ref.		Ref.
No	0.92	<0.01	0.99	0.95–1.03	0.57
Age (years)
20–29	0.70	<0.01	0.85	0.81–0.90	<0.01
30–39	0.96	0.14	0.97	0.93–1.01	0.11
40–49	Ref.		Ref.
50–59	0.92	<0.01	0.92	0.88–0.97	<0.01
60–69	0.78	<0.01	0.79	0.75–0.84	<0.01
Social background
Marital status
Married	Ref.		Ref.
Single, divorced, widow	0.74	<0.01	0.80	0.77–0.84	<0.01
Employment status
Unemployment, student	0.82	<0.01
Employed	Ref.
Education
High school or less	0.81	<0.01
college	0.94	<0.01
University/graduate school	Ref.
Household annual income
<4 million	0.65	<0.01	0.86	0.81–0.90	<0.01
4–8 million	0.85	<0.01	0.96	0.92–0.99	0.02
>8million	Ref.		Ref.
Other/ no answer	0.68	<0.01	0.87	0.83–0.91	<0.01
Smoking
None	1.06	0.15	1.03	0.96–1.10	0.47
Sometimes	1.11	0.02	1.03	0.96–1.11	0.39
Everyday	Ref.		Ref.
Alcohol
None	0.94	0.05
Sometimes	1.04	0.20
Everyday	Ref.
Health related status
Use of preventive care
General checkups
Yes	Ref.		Ref.
No	0.36	<0.01	0.45	0.42–0.47	<0.01
Breast cancer screening
Yes	Ref.
No	0.24	<0.01
Not applicable	0.43	<0.01
Self-rated health
Very good	Ref.		Ref.
Good	1.04	0.12	1.01	0.97–1.05	0.75
Fair	0.89	<0.01	0.95	0.91–0.99	0.03
Bad	0.90	<0.01	0.97	0.91–1.03	0.26
Very bad	0.74	<0.01	0.96	0.84–1.09	0.51
COVID-19 vaccination uptakes
Unvaccinated	0.71	<0.01	0.89	0.84–0.95	<0.01
1 or 2	0.97	0.24	1.03	0.99–1.08	0.11
>3	Ref.		Ref.
Counts of chronic condition
0	Ref.		Ref.
1,2	0.97	0.18	0.95	0.90–0.99	0.02
3,4	0.86	0.23	0.90	0.73–1.12	0.36
>4	0.93	0.66	1.31	1.02–1.68	0.03
FCV-19S
7–15	Ref.
16–20	1.04	0.06
21–25	1.02	0.45
26–35	1.02	0.65

Abbreviations: 95% CI, 95% confidence interval; APR, adjusted prevalence ratio; FCV-19S, fear of coronavirus-19 scales; PR, prevalence ratio; Ref., reference.