County-level colposcopy attendance in China's national cervical cancer screening programme: a cross-sectional ecological study of Fujian province.
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OBJECTIVES: This study aims to analyse the county-level spatiotemporal disparities in colposcopy non-attendance rates and to explore their associated factors in Fujian, China. DESIGN: A county-level observational study. SETTING: This study was conducted using data from the Fujian Provincial Maternal and Child Health Information System and Statistical Yearbooks, from 2021 to 2023. PARTICIPANTS: Data from 60 counties in Fujian province across 3 years (2021-2023) were included, comprising 1080 county-age group-year observations. Counties from Xiamen Municipality were excluded due to data unavailability. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the county-level colposcopy non-attendance rate. Secondary outcomes included the Theil indices (measuring inequality) and the geographically varied associations of factors (eg, population density and transportation network density) with non-attendance. RESULTS: The average county-level colposcopy non-attendance rate in Fujian decreased from 24.41% in 2021 to 16.52% in 2023. The Theil-T and Theil-L indices of county-level non-attendance rates across the 3 years were 0.31 and 0.24, respectively. Lower population density was associated with higher rates of colposcopy non-attendance in the west of Fujian, while higher transportation network density and a larger per capita number of healthcare professionals were associated with higher rates of non-attendance, particularly in the west. Over time, the effects of these factors weakened. Three clusters of the coefficients were identified. CONCLUSIONS: While colposcopy non-attendance rates have declined in recent years in Fujian, the persistent geographical disparity shown in this study indicates the importance of addressing service and information gaps. It is likely helpful to integrate the information system and service delivery across counties in cervical screening programmes to address the effects of potentially higher mobility and low population density in western Fujian. Considering the geographically varied effects of such factors, we also suggested a classified approach be adopted to improve colposcopy attendance.