Explaining the rural–urban gap in cervical cancer screening among older women in India using Fairlie decomposition
1
Institute of Science, Banaras Hindu University, Varanasi, India
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Cervical cancer remains a leading cause of cancer-related mortality among women in India, yet screening uptake is extremely low, particularly among older women. Although rural–urban inequalities in preventive healthcare are well documented, the mechanisms underlying geographic disparities in cervical cancer screening among older women remain insufficiently understood. This study examines the rural–urban gap in recent cervical cancer screening and quantifies the contribution of socioeconomic, health, and contextual factors.
METHODS:
Data were drawn from the Longitudinal Ageing Study in India (LASI) Wave-1. The analytical sample included 35217 women aged 45 years and older. Multivariable logistic regression assessed the association between place of residence and recent cervical cancer screening after adjusting for demographic, socioeconomic, health, and healthcare-access factors. Fairlie decomposition was applied to quantify the extent to which observed characteristics explained the rural–urban difference in screening prevalence.
RESULTS:
National screening prevalence was alarmingly low at 1.2%. Urban women were four times more likely to report recent screening than rural women at 3.3% versus 0.8%. After extensive adjustment, urban residence remained a strong independent predictor of screening with an adjusted odds ratio of 2.15. Fairlie decomposition explained 59.8% of the 2.46 percentage point rural–urban gap. The largest contributors were indicators of service integration proxied by prior mammography at 33.1% and state-level contextual effects at 32.2%, followed by media exposure at 15.0%. General health system contact contributed negatively at -3.5%, indicating missed opportunities for screening within routine rural healthcare encounters.
CONCLUSIONS:
Rural disadvantage in cervical cancer screening among older women is driven less by individual characteristics and more by the absence of integrated preventive care pathways. Achieving cervical cancer elimination in India will require embedding screening within routine primary care and chronic disease services, with focused strategies for rural older women who remain structurally disconnected from preventive healthcare.
Cervical cancer remains a leading cause of cancer-related mortality among women in India, yet screening uptake is extremely low, particularly among older women. Although rural–urban inequalities in preventive healthcare are well documented, the mechanisms underlying geographic disparities in cervical cancer screening among older women remain insufficiently understood. This study examines the rural–urban gap in recent cervical cancer screening and quantifies the contribution of socioeconomic, health, and contextual factors.
METHODS:
Data were drawn from the Longitudinal Ageing Study in India (LASI) Wave-1. The analytical sample included 35217 women aged 45 years and older. Multivariable logistic regression assessed the association between place of residence and recent cervical cancer screening after adjusting for demographic, socioeconomic, health, and healthcare-access factors. Fairlie decomposition was applied to quantify the extent to which observed characteristics explained the rural–urban difference in screening prevalence.
RESULTS:
National screening prevalence was alarmingly low at 1.2%. Urban women were four times more likely to report recent screening than rural women at 3.3% versus 0.8%. After extensive adjustment, urban residence remained a strong independent predictor of screening with an adjusted odds ratio of 2.15. Fairlie decomposition explained 59.8% of the 2.46 percentage point rural–urban gap. The largest contributors were indicators of service integration proxied by prior mammography at 33.1% and state-level contextual effects at 32.2%, followed by media exposure at 15.0%. General health system contact contributed negatively at -3.5%, indicating missed opportunities for screening within routine rural healthcare encounters.
CONCLUSIONS:
Rural disadvantage in cervical cancer screening among older women is driven less by individual characteristics and more by the absence of integrated preventive care pathways. Achieving cervical cancer elimination in India will require embedding screening within routine primary care and chronic disease services, with focused strategies for rural older women who remain structurally disconnected from preventive healthcare.
| eISSN: | 2654-1459 |
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