Social predictors of non-attendance in an urban mammographic screening programme: A multilevel analysis

Abstract

Rate of non-attendance following invitation for breast cancer screening is related to several socioeconomic conditions. To what extent this reflects differences with regard to individual and environmental circumstances, respectively, has received little attention. The purpose of this study was to investigate the effect of individual socioeconomic and area-level determinants on variations in non-attendance among geographic areas in an urban mammographic service screening programme. The study population consisted of 32,119 women invited for mammographic screening in 1990-93, residing in 97 neighbourhoods in the city of Malmö in Sweden. The influence of the individual factors age, marital status, education, housing accommodation, household income, and area-level circumstances, e.g. rate of migration and rate of being gainfully employed, on the rate of non-attendance was assessed by multilevel analysis. Area rates of nonattendance ranged from 18% to 63%. Of the total variability in non-attendance, 4.3% was between neighbourhoods. This effect was significantly reduced when adjusting for the individual factors. The area-level factors, migration, and rate of being gainfully employed reduced and almost erased the neighbourhood variance in non-attendance. In addition to individual socioeconomic factors, area-level factors seem to be important determinants of neighbourhood rates of non-attendance in an urban mammographic screening programme. In a public health perspective neighbourhoods may be targeted in order to affect the problem of non-attendance in mammographic screening.