Area-level socioeconomic position and repeat mammography screening use: results from the 2005 National Health Interview Survey
Menée aux Etats-Unis, cette étude évalue l'association entre le statut socio-économique à l'échelle d'une zone géographique et l'usage régulier de mammographies de dépistage
Background: Despite a considerable number of studies describing the relationship between area-level socioeconomic conditions and mammography screening, definitive conclusions have yet to be drawn. The aim of this study was to examine the relationship between area-level socioeconomic position (SEP) and repeat mammography screening using nation-wide U.S. census SEP data linked to a nationally representative sample of women who participated in the 2005 National Health Interview Survey (NHIS). Methods: An area-level SEP index using 2000 U.S. census tract data was constructed and categorized into quartiles, including information on unemployment, poverty, housing values, annual family income, education, and occupation. Repeat mammography utilization (dichotomous variable) was defined as having three mammograms over the course of six years (24 month interval), which must have included a recent mammogram (in past two years). Results were obtained by ordinary multivariable logistic regression for survey data. Women ages 46-79 (n=4,352) were included in the analysis. Results: In a model adjusted for socio-demographics, health care factors, and known correlates of mammography screening, women living in more disadvantaged areas had lower odds of engaging in repeat mammography than women living in the most advantaged areas [odds ratio (OR) comparing quartile 4 (most disadvantaged) to Quartile 1 (most advantaged): 0.63; 95% confidence interval (CI): 0.50, 0.80]. Conclusion: The results of this national-wide study support the hypothesis that area-level SEP is independently associated with mammography utilization. Impact: These findings underscore the importance of addressing area-level social inequalities, if uptake of mammography screening guidelines is to be realized across all social strata.