Abstract
PurposeLocal physical and social environment has a defining influence on individual behavior and health‐related outcomes. However, it remains undetermined if its impact is independent of individual socioeconomic status. In this study, we evaluated the spatial distribution of mammography adherence in the state of Geneva (Switzerland) using individual‐level data and assessed its independence from socioeconomic status (SES).MethodsGeoreferenced individual‐level data from the population‐based cross‐sectional Bus Santé study (n = 5002) were used to calculate local indicators of spatial association (LISA) and investigate the spatial dependence of mammography adherence. Spatial clusters are reported without adjustment; adjusted for neighborhood income and individual educational attainment; and demographic factors (age and Swiss nationality). The association between adjusted clusters and the proximity to the nearest screening center was also evaluated.ResultsMammography adherence was not randomly distributed throughout Geneva with clusters geographically coinciding with known SES distributions. After adjustment for SES indicators, clusters were reduced to 56.2% of their original size (n = 1033). Adjustment for age and nationality further reduced the number of individuals exhibiting spatially dependent behavior (36.5% of the initial size). The identified SES‐independent hot spots and cold spots of mammography adherence were not explained by proximity to the nearest screening center.ConclusionsSES and demographic factors play an important role in shaping the spatial distribution of mammography adherence. However, the spatial clusters persisted after confounder adjustment indicating that additional neighborhood‐level determinants could influence mammography adherence and be the object of targeted public health interventions.
Highlights
Breast cancer is the most common neoplasm in high‐income countries,[1] and mammography screening has been shown to contribute to its early detection
socioeconomic status (SES) and demographic factors play an important role in shaping the spatial distribution of mammography adherence
The spatial clusters persisted after confounder adjustment indicating that additional neighborhood‐level determinants could influence mammography adherence and be the object of targeted public health interventions
Summary
Breast cancer is the most common neoplasm in high‐income countries,[1] and mammography screening has been shown to contribute to its early detection. Mammography screening adherence, like other health‐related outcomes, can be affected by individual factors (eg, age, income, and education) and by environmental characteristics, such as neighborhood context.[7] Physical characteristics of the neighborhood, including infrastructure quality and housing conditions, may influence the health of its inhabitants.[8] individual social capital and social networks can contribute to different patterns of health outcomes.[9,10,11]. Studies investigating the influence of neighboring effects on mammography adherence are mainly ecological in nature and have considered artificial geographic groupings (neighborhoods, counties, zip codes, etc) rather than the geographic distance between individuals
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