Examining regional variation in the use of cancer screening in Germany

Vogt, Verena; Siegel, Martin; Sundmacher, Leonie

doi:10.1016/j.socscimed.2014.03.033

Cited by 50 publications

(67 citation statements)

References 41 publications

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“…Our results support a role for social influence in explaining regional “spillover” effects in cancer screening behaviors documented by Vogt et al (2014). Future research should further characterize, quantify, and test the causality of direct social influence (endogenous effects) as a potential mechanism driving spatial dependence in health behaviors.…”

Section: Discussionsupporting

confidence: 70%

“…While the role of social influence on cancer screening is not completely understood, significant prior research indicates spatial variation in screening behaviors (Doubeni et al, 2012, Lian et al, 2008, Mobley et al, 2010, Shariff-Marco et al, 2013, Vogt et al, 2014) that could, in part, be caused by interactions among neighbors. Further, the CRC intervention we examine is inherently spatial in nature because it uses mailed invitations (i.e.…”

Section: Introductionmentioning

confidence: 99%

“…At the same time, despite a robust literature documenting spatial and geographic differences (Doubeni et al, 2012, Lian et al, 2008, Mobley et al, 2010, Shariff-Marco et al, 2013, Vogt et al, 2014), the mechanisms driving spatial variations in cancer screening behavior are poorly understood. Therefore, in a study of a geographically-based RCT designed to increase colorectal cancer (CRC) screening, we applied spatial econometric methods to test for spatial dependence and the existence of correlated, exogenous and endogenous neighborhood effects.…”

Section: Introductionmentioning

confidence: 99%

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Neighborhood effects in a behavioral randomized controlled trial

et al. 2014

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Randomized controlled trials (RCTs) of interventions intended to modify health behaviors may be influenced by neighborhood effects which can impede unbiased estimation of intervention effects. Examining a RCT designed to increase colorectal cancer (CRC) screening (N=5,628), we found statistically significant neighborhood effects: average CRC test use among neighboring study participants was significantly and positively associated with individual patient’s CRC test use. This potentially important spatially-varying covariate has not previously been considered in a RCT. Our results suggest that future RCTs of health behavior interventions should assess potential social interactions between participants, which may cause intervention arm contamination and may bias effect size estimation.

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Section: Discussionsupporting

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Neighborhood effects in a behavioral randomized controlled trial

et al. 2014

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“…This might have contributed to our finding that there was no regional variation in health check attendance. A study which examined the use of cancer screening in Germany, for instance, revealed that screening rates are higher in areas with higher physician density [62]. Psychological factors, such as health beliefs, and contextual factors, such as regional physician density, were not considered in the analysis.…”

Section: Discussionmentioning

confidence: 99%

Determinants of health check attendance in adults: findings from the cross-sectional German Health Update (GEDA) study

et al. 2014

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BackgroundIn Germany, adult health checks are carried out in the primary care setting for early detection of chronic conditions, such as cardiovascular diseases, diabetes, and kidney disease. This study aims to examine the social, behavioural, and health-related determinants of health check attendance among eligible adults in Germany.MethodsData were derived from the cross-sectional German Health Update (GEDA) study, a national health survey among adults in Germany carried out by the Robert Koch Institute. Analyses were restricted to respondents with statutory health insurance aged 35 years or older (n = 26,555). Logistic regression models were fitted to estimate associations between health check attendance and factors selected on the basis of Andersen’s Behavioral Model of Health Services Use.ResultsAfter mutual adjustment, higher health check attendance was associated with a higher age, higher socioeconomic status, being married, stronger social support, physical activity, non-smoking, greater fruit and vegetable consumption, and higher use of outpatient care in both sexes. In women, higher attendance was related to alcohol consumption and having company health insurance (BKK) after multiple adjustment. In men, higher attendance was associated with better self-rated health after adjusting for all other factors.ConclusionsThe findings of this study suggest that people with an unfavourable risk factor profile, such as socioeconomically disadvantaged groups, smokers, physically inactive people, and persons with a low fruit and vegetable intake, are less likely to have health checks than those with a more favourable risk profile. Health checks carried out in the primary care setting should be evaluated for their effects on population health and health inequality.

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“…Auch hier geben aktuelle Daten aus DEGS Aufschluss über neuere Entwicklungen und bestätigen eine geringere Teilnahme unterer Statusgruppen an sämtlichen Krebsfrüherkennungs-untersuchungen (KFU) und weiterhin wenig soziale Unterschiede hinsichtlich Impfungen [26,27]. Dagegen weicht eine regionale ökologische Studie anhand von Daten der Kassenärztlichen Bundesvereinigung (KBV) davon ab und zeigt ein eher inkonsistentes Bild zur ungleichen Inanspruchnahme von KFU [28] [16].…”

Section: Introductionunclassified

Soziale Unterschiede in der ambulanten und stationären Versorgung

Klein

Knesebeck

2015

Bundesgesundheitsbl.

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There is controversy about social disparities in healthcare services in Germany, but a differentiated analysis regarding various dimensions of healthcare is lacking. This narrative review intends to summarize conceptually the current state of research and draw subsequent conclusions. Separated into access, utilization and quality, the findings of social inequality in outpatient and inpatient care in Germany are summarized. Besides the common individual indicators of socioeconomic status (SES), regional deprivation and health insurance status are also included. Despite methodical diversity, the results show that healthcare inequalities due to SES exist, but not universally. Furthermore, there is a differentiated pattern respecting separate dimensions of healthcare. Concerning access (e.g. waiting times, co-payments) lower status groups and patients covered by statutory health insurance are deprived. Higher utilization becomes apparent among higher status groups and privately insured patients in terms of specialist consultations and prevention services. The findings regarding quality of process and outcome differ depending on quality indicator and disease. In different dimensions of medical healthcare, social disparities still exist, though the impact on health remains unclear for some types of healthcare inequalities. Moreover, it is often difficult to conclude from unequal outcome quality the inequalities of healthcare. Depending on access, utilization and quality, separate interventions for reducing these disparities are to be introduced.

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Examining regional variation in the use of cancer screening in Germany

Cited by 50 publications

References 41 publications

Neighborhood effects in a behavioral randomized controlled trial

Neighborhood effects in a behavioral randomized controlled trial

Determinants of health check attendance in adults: findings from the cross-sectional German Health Update (GEDA) study

Soziale Unterschiede in der ambulanten und stationären Versorgung

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