Half of Portugal's Over-Fifties Have Had a Colonoscopy in Ten Years, and the Share Runs From 37 Percent Without Schooling to 56 Percent With a Degree

Just over half of everyone in Portugal aged 50 or more has had a colonoscopy in the past ten years. The figure is 51.4 percent, and the interesting part is not the average but the spread underneath it: 37.3 percent among people with no schooling at all, and 55.9 percent among people with a degree.

That gap comes from a release published on Tuesday by the Instituto Nacional de Estatística (National Statistics Institute, or INE), which takes the Inquérito Nacional de Saúde 2025 (2025 National Health Survey) and drills into one part of it: access to care. The survey itself went to a sample of 22,000 dwellings across the country and forms Portugal's contribution to the European Health Interview Survey. Its headline results came out in June. Tuesday's release is the detail.

Two different kinds of prevention, two opposite gradients

The most striking thing in the data is that education does not push all preventive care in the same direction. It depends entirely on who has to do the work.

Take the three things a nurse or a GP can do to you in the room. Blood pressure measured in the previous twelve months: 73.9 percent of adults nationally, but 80.2 percent among those with no schooling and 73.1 percent among graduates. Blood glucose: 64.9 percent nationally, 75.1 percent with no schooling, 62.6 percent with a degree. Cholesterol: 65.8 percent, 77.2 percent and 63.1 percent respectively. On all three, the less educated are checked more often, not less. Retired people are checked most of all, above 83 percent on every measure, because they are in the surgery regularly for something else.

Now take the tests you have to be referred for, book, prepare for and turn up to. Colonoscopy runs from 37.3 percent with no schooling to 55.9 percent with a degree. Cervical cytology, among women aged 20 to 69 in the previous three years, runs from 63.2 percent with basic schooling to 72.8 percent with higher education. Dental appointments in the previous twelve months run from 46.4 percent with no schooling to 76.7 percent with a degree, a thirty-point spread and the widest in the release.

Mammography is the exception that clarifies the rule. Among women aged 50 to 69, 79.7 percent had one in the previous two years, and the education gradient is nearly flat: 78.9 percent with basic schooling, 83.1 percent with secondary, 81.7 percent with higher. Breast screening in Portugal is the one programme that reaches out and invites people by name, and it is the one where the education gradient largely disappears.

Work, not age, separates the women

The employment split is sharper still on women's screening. For cervical cytology, 72.7 percent of employed women had one in three years, against 60.6 percent of unemployed women, 51.8 percent of retired women and 43.8 percent of other inactive women. For mammography the same ordering holds but the range is narrower, 82.8 percent employed down to 68.5 percent other inactive.

Colonoscopy also tracks work status: 48.1 percent of employed people aged 50 and over, 40.3 percent of unemployed people, and 55.2 percent of retired people, who are older and therefore likelier to have been sent.

What else the release found

A third of adults (33.2 percent) took a medicine without a prescription in the two weeks before the interview, against 60.1 percent who took a prescribed one. Non-prescribed use peaks at 40.4 percent among 35 to 44 year olds and is lowest, at 18.7 percent, among the over-85s. Regionally it is highest in the Algarve (38.6 percent) and Greater Lisbon (38.0 percent) and lowest in the Alentejo (26.2 percent).

Among people who take a prescribed medicine regularly, the conditions are led by high blood pressure (27.0 percent of adults) and cholesterol or triglycerides (24.4 percent), followed by chronic pain (16.8), insomnia (14.7), anxiety (12.1), diabetes (10.5) and depression (9.3).

Nearly 3.5 million people went to a hospital without being admitted in the twelve months before interview, and 790,129 were admitted. Almost 30 percent of employed people missed at least one day of work for health reasons, 32.8 percent of women against 27.2 percent of men.

What this means for residents of Portugal

• Nobody is going to chase you for a colonoscopy. The numbers say plainly that bowel screening in Portugal depends on the patient pushing. If you are over 50, that conversation with your médico de família is one you start.
• The dentist is the clearest cost signal in the whole release. Dental care sits largely outside the Serviço Nacional de Saúde (National Health Service), and a thirty-point gap by education is what that looks like in practice.
• Registering with a health centre pays off twice. The blood pressure, glucose and cholesterol figures are high precisely because people who attend regularly get measured incidentally. Attendance is the mechanism.
• These are self-reported figures. The survey records what people say they had and when, not what a clinical record shows, and small subgroups are suppressed where the sample is too thin.

Portugal has been extending organised screening elsewhere, including a pilot lung cancer programme at two hospitals funded by tobacco tax. Portugal's screening programmes were built on the assumption that free at the point of use would be enough. On mammography, where the letter arrives, it broadly is. On the tests that wait for you to ask, it is not.