Socioeconomic deprivation, travel distance, location of service, and uptake of breast cancer screening in North Derbyshire, UK.
OBJECTIVE
This study examined the association between socioeconomic deprivation, travel distance, urban-rural status, location and type of screening unit, and breast screening uptake. Screening was provided at 13 locations--1 fixed and 12 mobile (3 at non-health locations).


METHODS
The study examined data from 1998 to 2001 for 34 868 women aged 50-64 years, calculated road travel distance, used 1991 enumeration district level Townsend socioeconomic deprivation scores, and a ward level urban-rural classification.


RESULTS
Odds of attendance for screening decreased with increasing socioeconomic deprivation, with an adjusted odds ratio of 0.64 (95%CI 0.59 to 0.70) in the most deprived relative to the least deprived category. 87% of women lived within 8 km of their screening location. The odds ratio for a 10 km increase in distance was 0.87 (95%CI 0.79 to 0.95). The odds ratios were 1.18 (95%CI 1.08 to 1.28) for screening at a non-health relative to a health location, 1.00 (95%CI 0.94 to 1.07) for the fixed site relative to the mobile unit and 1.00 (95%CI 0.91 to 1.09) for mainly rural relative to mainly urban areas.


CONCLUSIONS
Socioeconomic inequality in breast screening uptake seems to persist in an established service. There was a small decrease with increasing distance, no difference between fixed and mobile units, and no difference between urban and rural areas but uptake seemed to be higher at non-health sites. Further work is needed to identify effective methods of decreasing socioeconomic inequalities in uptake and to confirm if non-health locations are associated with higher screening uptake.
Maheswaran
Ravi
R
Public Health GIS Unit, School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK. r.maheswaran@sheffield.ac.uk
Pearson
Tim
T
Jordan
Hannah
H
Black
David
D
D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D004739:England; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000458:organization & administration; D008875:Middle Aged; D008952:Mobile Health Units; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012423:Rural Health; D012959:Socioeconomic Factors; D014195:Travel; D014504:Urban Health