Social determinants of health and inequality analysis in cervical and breast cancer screening uptake among women in the united states: a nationally representative population study

Cervical and breast cancer are major malignant tumors threatening women’s health. Standardized screening can reduce the disease burden. However, social determinants of health (SDoH) significantly influence screening behaviors, leading to pronounced disparities in screening uptake and health equity. This study aimed to explore the associations between SDoH and cervical and breast cancer screening uptake among women in the United States (US) and to quantify absolute and relative inequalities in screening uptake overall and across urban–rural and racial/ethnic strata. This study was based on nationally representative cross-sectional data from seven cycles of the US Health Information National Trends Survey (HINTS), with the study population restricted to individuals recommended for screening by the United States Preventive Services Task Force (USPSTF) guidelines. Eight SDoH indicators were selected. Weighted multivariable logistic regression analysis was performed to assess associations between SDoH indicators and screening uptake. The Slope Index of Inequality (SII), the Relative Index of Inequality (RII), and the Relative Concentration Index (RCI) were used to quantify the magnitude of health inequalities, with further stratified analyses conducted by urban–rural residence and race/ethnicity. The weighted prevalence of cervical and breast cancer screening was 81.42% and 79.46%, respectively. Household income, insurance status, having a regular healthcare provider, and healthcare visits in the past 12 months were associated with both cancer screenings. Urban–rural residence and marital status were only associated with cervical cancer screening. Inequality analyses revealed that screening uptake for both cancers was concentrated among advantaged groups, with a greater inequality observed for breast cancer screening. Healthcare visits in the past 12 months represented the largest and most consistent inequality-related dimension for both cervical and breast cancer screening. Stratified analyses indicated that screening inequality was more pronounced among rural women and varied across racial/ethnic groups. SDoH were associated with cervical and breast cancer screening uptake among US women, and screening inequalities for both cancers exhibited notable structural disparities and variations across population subgroups. These findings may help identify women at risk of under-screening and inform stratified approaches to improve screening access, reduce screening disparities, and promote equity in cervical and breast cancer screening.