Spatial distribution of mammography uptake in a Swiss urban population and its association with socio-economic status

José Luis Sandoval, Rebecca Himsl, Jean-Marc Theler, Jean-Michel Gaspoz, Stéphane Joost and Idris Guessous.
Spatial distribution of mammography adherence in a Swiss urban population and its association with socioeconomic status., Cancer Medicine, October 2018, doi: 10.1002/cam4.1829.

Abstract

Objective: The local physical and social environment has a determining influence on individual behaviour and health. However, it remains to be determined whether its impact is independent of an individual's socioeconomic status. In this study, we evaluated the spatial distribution of mammography uptake in the canton of Geneva (Switzerland), using individual data, and assessed its independence from socio-economic status (SES).

Methods: Individual-level geo-referenced data from the Bus Santé population-based cross-sectional study (n = 5002) were used to calculate local indicators of spatial association (LISA) and investigate the spatial dependence of mammography uptake. Spatial clusters are presented without adjustment; with adjustment for neighbourhood income and individual education level; and with adjustment for demographic factors (age and Swiss nationality). The association between adjusted clusters and proximity to the nearest screening centre was also assessed.

Results: Mammography uptake was not randomly distributed across the canton of Geneva, with clusters coinciding geographically with known SES distributions. After adjustment for SES indicators, clusters were reduced to 56.2% of their initial size (n = 1033). Adjustment for age and nationality further reduced the number of individuals exhibiting spatially dependent behaviour (36.5% of initial size). The areas of high and low mammography uptake identified, independent of SES, were not explained by proximity to the nearest screening centre.

Conclusions: SES and demographic factors play an important role in the spatial distribution of mammography uptake. However, spatial clusters persisted after adjustment for confounding factors, indicating that additional determinants at the neighbourhood level could influence mammography uptake and be the focus of targeted public health interventions.

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