Personal Well-Being and National Determinants of Screening Mammography Among Women Over Fifty

Background - Over 1.5 million cancer deaths among women could be avoided annually by primary prevention measures such as screening mammography (SM). SM utilization varies across countries, and little research attempted to explain why. The objective of the study is to understand the individual and country-level variables that determine SM utilization and variation across countries. Methods - Three multilevel models are used to analyze the data from the SHARE database for 26,672 women aged 50 or over from 27 countries. The key individual variables investigated are the CASP quality-of-life (QOL) index, the EURO-D depression index, and the Subjective-Health index. Government health expenditure (GHE), measured as a percentage of GDP, was used as the country-level variable. Results – SM utilization varied from 5–67% in the countries examined. On the individual level, higher QOL, psychological status, and health status are positively correlated with SM utilization while on the country level, GHE is positively correlated with SM utilization. Surprisingly, the interaction between individual and country-level variables shows that while SM utilization positively correlates with higher psychological status and health status in high-GHE countries, there is a negative correlation in low-GHE countries and only a weak positive correlation in mid-level GHE countries. Conclusions – The study is the first to show that the association between enhanced physical and psychological well-being and SM utilization varies across countries according to GHE. The existence of negative correlations in low-GHE countries and positive correlations in high-GHE countries underscores the disparities that need to be addressed.