{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T17:02:37Z","timestamp":1790874157773,"version":"4.1.0"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":44,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001711","name":"Swiss National Science Foundation","doi-asserted-by":"publisher","award":["219687"],"award-info":[{"award-number":["219687"]}],"id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Colorectal cancer (CRC) screening has contributed to reducing CRC incidence and mortality in Europe. However, inequalities in screening persist, with lower participation among individuals with lower educational attainment. It remains unclear whether screening programmes can mitigate these inequalities. This study examined the impact of mailed faecal immunochemical test (FIT) programmes on screening participation and related educational inequalities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed repeated cross-sectional data from 202\u00a0976 respondents aged 50\u201374 in 24 European countries from the European Health Interview Survey (2014 and 2019), a nationally administered population-based survey. Outcomes were self-reported stool-based screening uptake (lifetime and past 2 years). Educational attainment was categorized into three levels (lower, middle, higher) based on ISCED-2011. We used a difference-in-differences design to compare changes in screening uptake between 2014 and 2019 in countries that implemented nationwide FIT programmes and countries that did not.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In countries that implemented FIT programmes, lifetime and past-2-year screening uptake increased by 28.3 (95% CI: 12.3\u201344.3) and 30.2 (95% CI: 13.8\u201346.6) percentage points (ppts), respectively, compared with countries without programmes. The increase was larger among individuals with middle than higher education, with an additional 8.9 (95% CI: 3.3\u201314.5) ppts for lifetime and 6.4 (95% CI: 1.5\u201311.2) ppts for past-2-year uptake, indicating a reduction in inequality between these groups. No reduction in inequality was observed between individuals with lower and higher education.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Mailed FIT programmes increased stool-based screening uptake and reduced inequalities between individuals with middle and higher education. To further promote equity in CRC screening, future initiatives should prioritize individuals with lower educational attainment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ije\/dyag222","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T19:15:39Z","timestamp":1789672539000},"source":"Crossref","is-referenced-by-count":0,"title":["Mailed faecal immunochemical test programmes and educational inequalities in colorectal cancer screening in Europe: a difference-in-differences analysis"],"prefix":"10.1093","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2223-592X","authenticated-orcid":false,"given":"Vladimir","family":"Jolidon","sequence":"first","affiliation":[{"name":"Population Health Laboratory (#PopHealthLab), University of Fribourg , Fribourg,","place":["Switzerland"]},{"name":"Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health , Boston, MA,","place":["United States"]},{"name":"Department of Sociological Studies, University of Sheffield , Sheffield,","place":["United Kingdom"]},{"name":"Institute of Sociological Research, University of Geneva , Geneva,","place":["Switzerland"]},{"name":"Swiss School of Public Health (SSPH+) , Zurich,","place":["Switzerland"]},{"name":"Swiss Centre of Expertise in Life Course Research (Centre LIVES) , Lausanne,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6034-2300","authenticated-orcid":false,"given":"Frerik","family":"Smit","sequence":"additional","affiliation":[{"name":"Population Health Laboratory (#PopHealthLab), University of Fribourg , Fribourg,","place":["Switzerland"]},{"name":"Swiss School of Public Health (SSPH+) , Zurich,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrijn","family":"Delaruelle","sequence":"additional","affiliation":[{"name":"Department of Sociology, Ghent University , Ghent,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelia","family":"Wagner","sequence":"additional","affiliation":[{"name":"Population Health Laboratory (#PopHealthLab), University of Fribourg , Fribourg,","place":["Switzerland"]},{"name":"Swiss School of Public Health (SSPH+) , Zurich,","place":["Switzerland"]},{"name":"Swiss Centre of Expertise in Life Course Research (Centre LIVES) , Lausanne,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernadette W A","family":"van der Linden","sequence":"additional","affiliation":[{"name":"Population Health Laboratory (#PopHealthLab), University of Fribourg , Fribourg,","place":["Switzerland"]},{"name":"Swiss School of Public Health (SSPH+) , Zurich,","place":["Switzerland"]},{"name":"Swiss Centre of Expertise in Life Course Research (Centre LIVES) , Lausanne,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9477-3236","authenticated-orcid":false,"given":"Piet","family":"Bracke","sequence":"additional","affiliation":[{"name":"Department of Sociology, Ghent University , Ghent,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sorana","family":"Toma","sequence":"additional","affiliation":[{"name":"Equity in (Primary) Health Care Unit, Department of Public Health and Primary Care, Ghent University , Ghent,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudine","family":"Burton-Jeangros","sequence":"additional","affiliation":[{"name":"Institute of Sociological Research, University of Geneva , Geneva,","place":["Switzerland"]},{"name":"Swiss School of Public Health (SSPH+) , Zurich,","place":["Switzerland"]},{"name":"Swiss Centre of Expertise in Life Course Research (Centre LIVES) , Lausanne,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"St\u00e9phane","family":"Cullati","sequence":"additional","affiliation":[{"name":"Population Health Laboratory (#PopHealthLab), University of Fribourg , Fribourg,","place":["Switzerland"]},{"name":"Institute of Sociological Research, University of Geneva , Geneva,","place":["Switzerland"]},{"name":"Swiss School of Public Health (SSPH+) , Zurich,","place":["Switzerland"]},{"name":"Swiss Centre of Expertise in Life Course Research (Centre LIVES) , Lausanne,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"2026100112163725100_dyag222-B1","author":"European Commission","year":"2026"},{"key":"2026100112163725100_dyag222-B2","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J Clin"},{"key":"2026100112163725100_dyag222-B3","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1097\/CEJ.0000000000000963","article-title":"Burden and risk factors of colorectal cancer in Europe from 1990 to 2021","volume":"35","author":"Zhang","year":"2026","journal-title":"Eur J Cancer Prev"},{"key":"2026100112163725100_dyag222-B4","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1186\/s12885-024-12054-7","article-title":"The association between organised colorectal cancer screening strategies and reduction of its related mortality: a systematic review and meta-analysis","volume":"24","author":"Ding","year":"2024","journal-title":"BMC Cancer"},{"key":"2026100112163725100_dyag222-B5","doi-asserted-by":"publisher","first-page":"100458","DOI":"10.1016\/j.lanepe.2022.100458","article-title":"Overall and stage-specific survival of patients with screen-detected colorectal cancer in European countries: a population-based study in 9 countries","volume":"21","author":"Cardoso","year":"2022","journal-title":"Lancet Reg Health Eur"},{"key":"2026100112163725100_dyag222-B6","doi-asserted-by":"publisher","first-page":"e032773","DOI":"10.1136\/bmjopen-2019-032773","article-title":"Colorectal cancer screening with faecal testing, sigmoidoscopy or colonoscopy: a systematic review and network meta-analysis","volume":"9","author":"Jodal","year":"2019","journal-title":"BMJ Open"},{"key":"2026100112163725100_dyag222-B7","doi-asserted-by":"publisher","first-page":"1002","DOI":"10.1016\/S1470-2045(21)00199-6","article-title":"Colorectal cancer incidence, mortality, and stage distribution in European countries in the colorectal cancer screening era: an international population-based study","volume":"22","author":"Cardoso","year":"2021","journal-title":"Lancet Oncol"},{"key":"2026100112163725100_dyag222-B8","author":"Council of the European Union","year":"2022"},{"key":"2026100112163725100_dyag222-B9","doi-asserted-by":"publisher","first-page":"100920","DOI":"10.1016\/j.lanepe.2024.100920","article-title":"Utilization of colorectal cancer screening tests across European countries: a cross-sectional analysis of the European health interview survey 2018\u20132020","volume":"41","author":"Ola","year":"2024","journal-title":"Lancet Reg Health Eur"},{"key":"2026100112163725100_dyag222-B10","volume-title":"Report on the Implementation of the Council Recommendation on Cancer Screening (Second Report).","author":"Ponti","year":"2017"},{"key":"2026100112163725100_dyag222-B11","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1016\/j.ypmed.2018.10.021","article-title":"Population health interventions to improve colorectal cancer screening by fecal immunochemical tests: a systematic review","volume":"118","author":"Issaka","year":"2019","journal-title":"Prev Med"},{"key":"2026100112163725100_dyag222-B12","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1007\/s10654-025-01247-4","article-title":"Recent trends in self-reported utilization of colonoscopy and fecal occult blood test in Europe: analysis of the European Health Interview Surveys 2013\u20132015 and 2018\u20132020","volume":"40","author":"Ola","year":"2025","journal-title":"Eur J Epidemiol"},{"key":"2026100112163725100_dyag222-B13","doi-asserted-by":"publisher","first-page":"101733","DOI":"10.1016\/j.pmedr.2022.101733","article-title":"Socio-economic inequality of utilization of cancer testing in Europe: a cross-sectional study","volume":"26","author":"Bozhar","year":"2022","journal-title":"Prev Med Rep"},{"key":"2026100112163725100_dyag222-B14","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1093\/eurpub\/ckv148","article-title":"Colorectal cancer screening participation: a systematic review","volume":"26","author":"Wools","year":"2016","journal-title":"Eur J Public Health"},{"key":"2026100112163725100_dyag222-B15","doi-asserted-by":"publisher","first-page":"817222","DOI":"10.3389\/fonc.2022.817222","article-title":"Determinants of non-participation in population-based breast cancer screening: a systematic review and meta-analysis","volume":"12","author":"Ding","year":"2022","journal-title":"Front Oncol"},{"key":"2026100112163725100_dyag222-B16","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1093\/ije\/dyq003","article-title":"Socio-economic inequalities in breast and cervical cancer screening practices in Europe: influence of the type of screening program","volume":"39","author":"Palencia","year":"2010","journal-title":"Int J Epidemiol"},{"key":"2026100112163725100_dyag222-B17","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1186\/s12939-021-01548-6","article-title":"Cervical cancer screening programs and their context-dependent effect on inequalities in screening uptake: a dynamic interplay between public health policy and welfare state redistribution","volume":"20","author":"De Prez","year":"2021","journal-title":"Int J Equity Health"},{"key":"2026100112163725100_dyag222-B18","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1007\/s00038-017-1045-7","article-title":"The education gradient in cancer screening participation: a consistent phenomenon across Europe?","volume":"63","author":"Willems","year":"2018","journal-title":"Int J Public Health"},{"key":"2026100112163725100_dyag222-B19","doi-asserted-by":"publisher","first-page":"107388","DOI":"10.1016\/j.ypmed.2022.107388","article-title":"Neighborhood socioeconomic status and the effectiveness of colorectal cancer screening outreach with mailed fecal immunochemical tests within a safety net healthcare system in San Francisco, CA: a subgroup analysis of a randomized controlled trial","volume":"167","author":"McClellan","year":"2023","journal-title":"Prev Med"},{"key":"2026100112163725100_dyag222-B20","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1186\/s13063-019-4027-7","article-title":"Moderators of the effectiveness of an intervention to increase colorectal cancer screening through mailed fecal immunochemical test kits: results from a pragmatic randomized trial","volume":"21","author":"O\u2019Connor","year":"2020","journal-title":"Trials"},{"key":"2026100112163725100_dyag222-B21","doi-asserted-by":"publisher","first-page":"100229","DOI":"10.1016\/j.jcpo.2020.100229","article-title":"Impact of organized colorectal cancer screening programs on screening uptake and screening inequalities: a study of systematic- and patient-reliant programs in Canada","volume":"24","author":"Blair","year":"2020","journal-title":"J Cancer Policy"},{"key":"2026100112163725100_dyag222-B22","author":"EUROSTAT","year":"2018"},{"key":"2026100112163725100_dyag222-B23","doi-asserted-by":"publisher","first-page":"1409","DOI":"10.3390\/cancers12061409","article-title":"Utilisation of colorectal cancer screening tests in European Countries by type of screening offer: results from the European Health Interview Survey","volume":"12","author":"Cardoso","year":"2020","journal-title":"Cancers"},{"key":"2026100112163725100_dyag222-B24","doi-asserted-by":"publisher","first-page":"1212","DOI":"10.1111\/1467-9566.13791","article-title":"Lack of social support, gender and colorectal cancer screening participation across Europe: how do screening programmes mitigate the effect of social support for men and women?","volume":"46","author":"Jolidon","year":"2024","journal-title":"Sociol Health Illn"},{"key":"2026100112163725100_dyag222-B25","author":"OECD","year":"2023"},{"key":"2026100112163725100_dyag222-B26","author":"Rossini","year":"2018"},{"key":"2026100112163725100_dyag222-B27","doi-asserted-by":"crossref","DOI":"10.1515\/9781400829828","volume-title":"Mostly Harmless Econometrics: An Empiricist\u2019s Companion","author":"Angrist","year":"2009"},{"key":"2026100112163725100_dyag222-B28","doi-asserted-by":"publisher","first-page":"488","DOI":"10.1097\/EDE.0b013e3181a819a1","article-title":"Overadjustment bias and unnecessary adjustment in epidemiologic studies","volume":"20","author":"Schisterman","year":"2009","journal-title":"Epidemiology"},{"key":"2026100112163725100_dyag222-B29","doi-asserted-by":"publisher","first-page":"107522","DOI":"10.1016\/j.ypmed.2023.107522","article-title":"Interventions to increase colorectal cancer screening adherence in low-income settings within the United States: a systematic review and meta-analysis","volume":"172","author":"Rubin","year":"2023","journal-title":"Prev Med"},{"key":"2026100112163725100_dyag222-B30","doi-asserted-by":"publisher","first-page":"812776","DOI":"10.3389\/fpubh.2022.812776","article-title":"Revisiting the effects of organized mammography programs on inequalities in breast screening uptake: a multilevel analysis of nationwide data from 1997 to 2017","volume":"10","author":"Jolidon","year":"2022","journal-title":"Front Public Health"},{"key":"2026100112163725100_dyag222-B31","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1177\/0969141316664757","article-title":"Rapid review of evaluation of interventions to improve participation in cancer screening services","volume":"24","author":"Duffy","year":"2017","journal-title":"J Med Screen"},{"key":"2026100112163725100_dyag222-B32","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1016\/S0140-6736(15)01154-X","article-title":"Effects of evidence-based strategies to reduce the socioeconomic gradient of uptake in the English NHS Bowel Cancer Screening Programme (ASCEND): four cluster-randomised controlled trials","volume":"387","author":"Wardle","year":"2016","journal-title":"Lancet"},{"key":"2026100112163725100_dyag222-B33","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1093\/tbm\/ibz081","article-title":"Ways to use interventions to increase participation in mail-out bowel cancer screening: a systematic review and meta-analysis","volume":"10","author":"Myers","year":"2020","journal-title":"Transl Behav Med"},{"key":"2026100112163725100_dyag222-B34","doi-asserted-by":"publisher","first-page":"66","DOI":"10.25646\/6228","article-title":"European Health Interview Survey (EHIS) 2 - background and study methodology","volume":"4","author":"Hintzpeter","year":"2019","journal-title":"J Health Monit"},{"key":"2026100112163725100_dyag222-B35","author":"EUROSTAT","year":"2022"}],"container-title":["International Journal of Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ije\/article-pdf\/55\/5\/dyag222\/71561075\/dyag222.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ije\/article-pdf\/55\/5\/dyag222\/71561075\/dyag222.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T16:21:58Z","timestamp":1790871718000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ije\/article\/doi\/10.1093\/ije\/dyag222\/8859244"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,18]]},"references-count":35,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,8,18]]}},"URL":"https:\/\/doi.org\/10.1093\/ije\/dyag222","relation":{},"ISSN":["0300-5771","1464-3685"],"issn-type":[{"value":"0300-5771","type":"print"},{"value":"1464-3685","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,10]]},"published":{"date-parts":[[2026,8,18]]},"article-number":"dyag222"}}