title: [Travel time and participation in breast cancer screening in a region with high population dispersion].
abstract: OBJECTIVE
  To analyze the association between travel time and participation in a breast cancer screening program adjusted for contextual variables in the province of Segovia (Spain).
  
  
  METHODS
  We performed an ecological study using the following data sources: the Breast Cancer Early Detection Program of the Primary Care Management of Segovia, the Population and Housing Census for 2001 and the municipal register for 2006-2007. The study period comprised January 2006 to December 2007. Dependent variables consisted of the municipal participation rate and the desired level of municipal participation (greater than or equal to 70%). The key independent variable was travel time from the municipality to the mammography unit. Covariables consisted of the municipalities' demographic and socioeconomic factors. We performed univariate and multivariate Poisson regression analyses of the participation rate, and logistic regression of the desired participation level.
  
  
  RESULTS
  The sample was composed of 178 municipalities. The mean participation rate was 75.2%. The desired level of participation (≥ 70%) was achieved in 119 municipalities (67%). In the multivariate Poisson and logistic regression analyses, longer travel time was associated with a lower participation rate and with lower participation after adjustment was made for geographic density, age, socioeconomic status and dependency ratio, with a relative risk index of 0.88 (95% CI: 0.81-0.96) and an odds ratio of 0.22 (95% CI: 0.1-0.47), respectively.
  
  
  CONCLUSIONS
  Travel time to the mammography unit may help to explain participation in breast cancer screening programs.
authors.affiliation: Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, España. aborda@isciii.es
authors.forename: Alfredo
authors.initials: A
authors.lastname: Borda
authors.forename: Belén
authors.initials: B
authors.lastname: Sanz
authors.forename: Laura
authors.initials: L
authors.lastname: Otero
authors.forename: Teresa
authors.initials: T
authors.lastname: Blasco
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: García-Gómez
authors.forename: Fuencisla
authors.initials: F
authors.lastname: de Andrés
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening; D008875:Middle Aged; D011156:Population Density; D013030:Spain; D013997:Time Factors; D014195:Travel / Q000706:statistics & numerical data*