Objectives: to compare Pap test and mammography uptake in 2005 and 2013 between Italian and immigrant women residing in Italy and to evaluate factors associated with probability of being up-to-date with screening testing in immigrant women.
Design: cross-sectional study based on data of "Multipurpose survey on health and use of health services" conducted in 2005 and 2013 by the Italian National Institute of Statistics (Istat).
Setting and participants: the analysis includes the interviews of women included in the target age group for Pap test (25-64 years: No. 32,831) and mammography (50- 69 years: No. 16,459). Women resident in Italy with foreign citizenship are defined as "immigrants".
Main outcome measures: standardized prevalence rates of women self-reporting having had a Pap test and a mammography in the absence of symptoms "at least once in a lifetime"; standardized prevalence ratio of up-to-date test uptake according to recommendation, i.e., in the last three years for Pap test and two years for mammography. A logistic regression model has been built to evaluate the association between up-to-date test uptake and demographic, socioeconomic, behavioural, and health service utilization factors in immigrant women.
Results: prevalence of Pap test and mammography uptake was lower in immigrants, both in 2005 and 2013. This difference reduced in 2013 due to a stronger increase in immigrants than in Italians, except for mammography. The increase in Pap test uptake among immigrant women was stronger in North-Eastern (+26,4%) and Central Italy (+26,4%), while in Southern Italy and in the Islands the increase was stronger among Italian women. Test uptake in immigrants increases with longer length of stay in Italy for both tests. Among immigrants (No. 2,601), Pap test uptake was higher in women who: had a preventive examination in the previous month (OR: 2.13); have an Italian partner (OR: 1.72); have been staying in Italy for more than 13 years; are graduated (OR: 1.87); perceive their economic resources as adequate or optimal (OR: 1.39); come from the Americas (68% more if compared to Africans). As regards mammography uptake in immigrants (No. 636), associated factors are: having had a preventive examination in the previous month (OR: 3.35); having high educational level (OR: 2.51); perceiving economic resources as adequate or optimal (OR: 1.75).
Conclusion: this study shows that there is a lower screening uptake in immigrant women, as observed in other studies conducted both in Italy and in industrialized Countries, even with longer history of immigration. In the South of Italy, the uptake is very low also for Italian women, with prevalence lower than immigrants in Northern Italy. This phenomenon suggests that high accessibility to screening facilities is effective in increasing uptake in both Italian and immigrant women. The decreasing trend in differences with longer lengths of stay, the improvement in 2013 compared to 2005, and the advantage of women with Italian partners suggest a positive effect of integration on preventive behaviours, even if there are differences between immigrants' areas of origin.