Residential area and screening venue location features associated with spatial variation in breast cancer screening invitation response rates: an observational study in Greater Sydney, Australia

Breast cancer screening participation in women using mental health services in NSW, Australia: a population study

PURPOSE

Population screening programs have contributed to reduced breast cancer mortality, but disadvantaged or vulnerable groups may not have shared these improvements. In North American and European studies, women living with mental health conditions have reduced breast screening rates. There are no current Australasian data to support health system planning and improvement strategies.

METHODS

The New South Wales (NSW) BreastScreen program offers free screening to NSW women aged 50-74. We compared 2-year breast screening rates for mental health service users (n = 33,951) and other NSW women (n = 1,051,495) in this target age range, after standardisation for age, socioeconomic status and region of residence. Mental health service contacts were identified through linkage to hospital and community mental health data.

RESULTS

Only 30.3% of mental health service users participated in breast screening, compared with 52.7% of other NSW women (crude incidence rate ratio 0.57, 95% CI 0.56-0.59). Standardisation for age, socioeconomic disadvantage or rural residence did not alter this screening gap. Around 7000 fewer women received screening than would be expected from comparable population rates. Screening gaps were largest in women over 60 and in socioeconomically advantaged areas. Women with severe or persistent mental illness had slightly higher screening rates than other mental health service users.

CONCLUSIONS

Low breast cancer screening participation rates for NSW mental health service users suggest significant risk of later detection, possibly leading to more extensive treatment and premature mortality. Focussed strategies are needed to support greater breast screening participation for NSW women who use mental health services.

Exploring Disparities in Breast Cancer Screening: An Ecological Analysis of Australian Data

OBJECTIVE

The objective of this study is to analyse the socio-spatial patterns of breast cancer screening across Australian regions.

METHODS

The research is an ecological study. Data for breast screening participation and associated social and demographic factors are obtained from the Australian Institute of Health and Welfare and the Australian Bureau of Statistics. The unit of measurement for the analysis is spatially aggregated regions (Statistical Area 3). Geographically weighted regression is used to analyse the relationship between a dependent variable and one or more independent variables while considering the spatial or geographic relationships among the data points.

RESULTS

Globally, there was a significant (p<0.05) association between screening participation and income, English ability, education level, Indigenous background, and transport availability. The geographically weighted regression model represented an improved fit with a higher R2 (R2=0.89) and the Akaike information criterion (AIC) has improved, (AIC= 391.92). The Monte-Carlo tests for spatial variability were significant for all independent variables (p<0.05). Visually, there was marked spatial variation in the association between breast cancer screening rates and the significant independent variables from the global model.

CONCLUSION

The identification of significant spatial variability in the association between breast cancer screening participation and important social and demographic factors provides important input into the design of programs aimed at increasing participation in screening regimes.

Role of mammography accessibility, deprivation and spatial effect in breast cancer screening participation in France: an observational ecological study

BACKGROUND

The detection of cancer in its early latent stages can improve patients' chances of recovery and thereby reduce the overall burden of the disease. Our objectives were to investigate factors (geographic accessibility and deprivation level) affecting mammography screening participation variation and to determine how much geographic variation in participation rates can be explained by spillover effects between adjacent areas, while controlling for covariates.

METHODS

Mammography screening participation rates between 2015 and 2016 were calculated by census blocks (CB), for women aged 50-74 years, residing in Lyon metropolitan area. Global spatial autocorrelation tests were applied to identify the geographic variation of participation. Spatial regression models were used to incorporate spatial structure to estimate associations between mammography participation rate and the combined effect (geographic accessibility and deprivation level) adjusting for modes of travel and social cohesion.

RESULTS

The mammography participation rate was found to have a statistically significant and positive spatial correlation. The participation rate of one CB was significantly and positively associated with the participation rates of neighbouring CB. The participation was 53.2% in residential and rural areas and 46.6% in urban areas, p < 0.001. Using Spatial Lag models, whereas the population living in most deprived CBs have statistically significantly lower mammography participation rates than lower deprived ones, significant interaction demonstrates that the relation differs according to the degree of urbanization.

CONCLUSIONS

This study makes an important methodological contribution in measuring geographical access and understanding better the combined effect of deprivation and the degree of urbanization on mammography participation and other contextual factors that affect the decision of using mammography screening services -which is a critical component of healthcare planning and equity.

Associations between breast cancer screening participation and residential area sociodemographic features, geographic accessibility, and features of screening venue location in Greater Sydney, Australia

Breast cancer screening (BCS) participation rates are often suboptimal and vary geographically. Environmental features may influence BCS participation, but few studies have assessed this relationship. This study assessed the associations between BCS participation, residential area sociodemographic characteristics, distance to BCS venue, and venue location attributes. Data for 384,433 women residing in Greater Sydney, Australia, invited to BCS during 2011-2014 were spatially joined to their state suburb (SSC) (n = 800). SSC sociodemographic measures included women's median age, proportion women speaking English at home, full-time employed, and university educated; and proportion dwellings with motor-vehicles. Road network distance was calculated to each BCS venue. BCS venues were coded as co-located with bus-stop, train-station, hospital, general practitioner (GP), and shop. Hot spots were calculated to quantify spatial clustering of BCS participation. Multilevel logistic models were used to estimate the associations between environmental predictors and BCS participation, accounting for SSC-level clustering. BCS participation was 53.9% and spatially clustered. BCS was positively associated with SSC-level median age for women, proportions women speaking English and university educated, and dwellings with motor-vehicles. Distance to venue was inversely associated with BCS. Venue co-location with GP was positively associated and co-location with bus-stop, train-station, and shop, hospital were negatively associated with BCS. Residential sociodemographic features, geographic access, and venue location attributes are associated with BCS participation. These findings implicate the relevance of social and built environmental factors to programmatic aims to raise BCS participation. Additional research on venue location features is required to understand where best to site BCS venues.

Residential Area Sociodemographic and Breast Cancer Screening Venue Location Built Environmental Features Associated with Women's Use of Closest Venue in Greater Sydney, Australia

Understanding environmental predictors of women’s use of closest breast screening venue versus other site(s) may assist optimal venue placement. This study assessed relationships between residential-area sociodemographic measures, venue location features, and women’s use of closest versus other venues. Data of 320,672 Greater Sydney screening attendees were spatially joined to residential state suburbs (SSCs) (n = 799). SSC-level sociodemographic measures included proportions of: women speaking English at home; university-educated; full-time employed; and dwellings with motor-vehicles. A geographic information system identified each woman’s closest venue to home, and venue co-location with bus-stop, train-station, hospital, general practitioner, and shop(s). Multilevel logistic models estimated associations between environmental measures and closest venue attendance. Attendance at closest venue was 59.4%. Closest venue attendance was positively associated with SSC-level women speaking English but inversely associated with SSC-level women university-educated, full-time employed, and dwellings with motor-vehicles. Mobile venue co-location with general practitioner and shop was positively, but co-location with bus-stop and hospital was inversely associated with attendance. Attendance was positively associated with fixed venue co-location with train-station and hospital but inversely associated with venue co-location with bus-stop, general practitioner, and shop. Program planners should consider these features when optimising service locations to enhance utilisation. Some counterintuitive results necessitate additional investigation.