Neighborhood-Level Socioeconomic Predictors of Nonadherence to Mammography Screening Guidelines

Abstract

As neighborhood context is increasingly recognized as an important predictor of health outcomes and health behaviors, this analysis sought to determine the relationship between neighborhood-level socioeconomic status (SES) and regular mammography screening behavior. One thousand four hundred fifty-one women ages 40 to 79 years who obtained an ''index'' screening mammogram at one of five urban hospitals in Connecticut between October 1996 and January 1998 were enrolled in this prospective study. The logistic regression analysis includes the 1,229 women [484 African-American (39%) and 745 White (61%)] who completed telephone interviews at baseline and followup (average 29.4 months later) and for whom the study outcome, nonadherence to age-specific mammography screening guidelines, was ascertained. Neighborhoodlevel SES was determined using 1990 census tract information. Neighborhood-level SES variables (quartiles) were associated with nonadherence for AfricanAmerican women [neighborhood-level education and composite socioeconomic position index (SEP Index)] and White women (neighborhood-level crowding and neighborhood-level assets). Using race-specific categorizations reflective of individual-level SES distributions, the SEP Index and neighborhood-level education were associated with nonadherence to mammography screening guidelines for African-American women (marginally significant for White women), independent of individual-level SES and other known predictors of mammography screening use [AfricanAmerican women: SEP Index odds ratio (OR), 3.55; 95% confidence interval (95% CI), 1.

Racial and Geographic Differences in Mammography Screening in St. Louis City: A Multilevel Study

“…Previous studies have reported individual-level risk factors and census-tract socioeconomic effect on mammography use. 7,8,[22][23][24][25][26][27]29,30,[32][33][34]43 In our study, system-level barriers to mammography and heavy smoking were associated with mammography use among white and African American women. Personal-experience barriers to mammography and no physician recommendation also were independently associated with mammography screening among white women.…”

Who participates in the gastric cancer screening and on‐time rescreening in the National Cancer Screening Program? A population‐based study in Korea

“…Overall, in other countries, people with a lower socioeconomic status are less likely to participate in screening programs. (24,28,29) Since lower socioeconomic status reduces the use of cancer-screening programs, (30)(31)(32) continuous efforts are needed to reduce the socioeconomic disparities in the use of screening programs.…”

Neighborhood-level Influences on Delays in Diagnostic Follow-up from Mammography Screening in African-American Women: A Systematic Review

“…Twelve of the 17 studies (67%) examined relationships between residence in disadvantaged neighborhoods and Socio-Economic Status (SES) (age ≥ 45 years, lower education and median household income, and lack of insurance) and delays in diagnostic follow-up from abnormal MS or late-diagnosis of breast cancer [17,[20][21][22][23][24][25][26][27][28]. Three studies examined racial segregation on delays in diagnostic follow-up [18,21,29]; while two studies examined relationships between raciallysegregated neighborhoods and lack of primary care providers and radiologists on later-stage diagnosis of breast cancer. The remaining studies investigated public transportation travel time (commuter intensity), location of MS facilities, safety/crimes, and late-diagnosis of breast cancer between racial/ethnic groups [18,19,24,28].…”

“…Several studies found that female-headed households or single status with less education and/or living in neighborhoods described as crowded, disadvantaged, economically-distressed or medicallyunderserved area with higher levels of unemployment and workingclass Black residents influenced late-diagnosis of breast cancer across race/ethnicities [20][21][22][23][24]29].…”

“…Using data from a prospective study, Dailey et al [21] examined the effects of neighborhood-level SES predictors on non-adherence to regular MS guidelines in 1,451 African-American and White women age 40 to 79 years who had obtained an "index" MS at one of five urban hospitals. After the initial screening, 85% or 1,229 women participated in a 45-minute baseline and follow-up telephone interview (average 29.4 months later).…”