The impact of car ownership and public transport usage on cancer screening coverage: Empirical evidence using a spatial analysis in England

Chao Wang

doi:10.1016/j.jtrangeo.2016.08.012

Abstract

A spatial analysis has been conducted in England, with the aim to examine the impact of car ownership and public transport usage on breast and cervical cancer screening coverage. District-level cancer screening coverage data (in proportions) and UK census data have been collected and linked. Their effects on cancer screening coverage were modelled by using both non-spatial and spatial models to control for spatial correlation.Significant spatial correlation has been observed and thus spatial model is preferred. It is found that increased car ownership is significantly associated with improved breast and cervical cancer screening coverage. Public transport usage is inversely associated with breast cancer screening coverage; but positively associated with cervical cancer screening. An area with higher median age is associated with higher screening coverage. The effects of other socio-economic factors such as deprivation and economic activity have also been explored with expected results. Some regional differences have been observed, possibly due to unobserved factors.Relevant transport and public health policies are thus required for improved coverage. While restricting access to cars may lead to various benefits in public health, it may also result in worse cancer screening uptake. It is thus recommended that careful consideration should be taken before implementing policy interventions.

Highlights

Screening is an important tool to detect cancer at early stage and is estimated to save thousands of lives in England every year (Public Health Outcomes Framework, 2014)
Al. (2010) found that geographic access measured by density of general practitioners and gynaecologists within an area has little impact on cervical screening overall after average income was adjusted in France
The objective of this paper is to explore the impact of car ownership and public transport on cancer screening uptake by employing a spatial analysis within England, while controlling for ethnicity, age profile and other relevant socio-economic factors

Summary

Introduction

Screening is an important tool to detect cancer at early stage and is estimated to save thousands of lives in England every year (Public Health Outcomes Framework, 2014). A number of factors have been identified to have an impact on screening uptake in previous studies, such as deprivation (measured by employment, car ownership, and accommodation arrangement) and distance to screening locations (Maheswaran et al, 2006) The latter is often viewed as a part of broader spatial or geographic accessibility issue (Neutens, 2015), which this paper sought to focus on. Focusing on colorectal cancer screening in the USA, Mobley et al (2010) found better geographic access measured by distance to closest facility is associated with poorer screening in 12 states while improved screening in 19 states, after adjusting area-wide deprivation. Their study did not look at the effect of car ownership, and it is probably the access to cars play an important role, considering there is usually strong correlation between car ownership and deprivation

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