Cervical cancer screening across 19 European countries: trends and ecological correlates, 2013-2023

Background

Despite the 85% desirable participation level set by European guidelines, EU cervical screening averaged only 55% in 2022. Ecological evidence integrating socioeconomic, health-system, well-being and epidemiological domains in one model is scarce.

Methods

Ecological pooled time-series analysis of cervical screening coverage rates (SCRs) in women aged 20-69 in 19 European countries, 2013-2023, using OECD, Eurostat, World Bank and UNICEF data. Pooled and country-specific linear/quadratic OLS regressions tested time trends. Univariate logit-normal regressions with bootstrap 95% CIs tested associations with 20 predictors in four domains: socioeconomic, healthcare-system, health/well-being, epidemiological.

Results

Coverage patterns shifted geographically. SCRs ranged from 5.7% (Romania) to 80.5% (Sweden) in 2013, with a comparable spread in 2023. Only Czechia, Finland, Ireland, Slovenia and Sweden maintained the 70% threshold; none reached 85%. The pooled trend was flat. Four countries had an increasing trend (Finland, Latvia, Lithuania, Norway), five high-income countries declined (Denmark, Hungary, Iceland, Netherlands, UK). Cross-sectional analyses found significant associations with educational attainment, income inequality and self-reported screening, and—to our knowledge novel ecologically—a subjective well-being indicator: higher population-level negative affect was associated with lower coverage. No association emerged with healthcare spending or HPV vaccination.

Conclusions

European cervical screening stagnated and remained unevenly distributed over 2013-2023, with declines in some high-income systems. Beyond educational and economic inequalities, population-level negative affect appears as a candidate ecological correlate warranting further study. Multimodal strategies reaching the target population (invitations, reminders, HPV self-sampling, outreach) and policies on socioeconomic and well-being determinants may help advance European goals.

Key messages

• Cervical screening coverage stagnated across 19 European countries in 2013-2023; population-level negative affect emerged as a candidate ecological correlate beyond classic determinants.

• Cervical screening policy in Europe should integrate socioeconomic and well-being determinants alongside organised delivery to reduce persistent cross-country inequities.