title: The effect of neighborhood, socioeconomic status and a community-based program on multi-disease health screening in an Asian population: a controlled intervention study.
abstract: OBJECTIVE
  We studied whether individual socioeconomic and neighborhood factors such as living in a poor community independently affected health screening participation.
  
  
  METHODS
  We studied 3 blocks of public-rental flats (the poorer neighborhood) adjacent to 3 blocks of owner-occupied public housing (the better-off neighborhood) in a precinct in Taman Jurong, Singapore. Demographic details and reasons for not having regular hypertension, diabetes mellitus, hyperlipidemia and colorectal cancer screening were collected from 2009 to 2010. An access-enhancing intervention was implemented in both neighborhoods to raise health screening rates.
  
  
  RESULTS
  Participation rates for rental flats and owner-occupied flats were 89.0% (356/400) and 70.2% (351/500) respectively. Living in a better-off neighborhood was independently associated with diabetes mellitus (66% vs. 35%, adjusted odds ratio (AOR)=2.12, p<0.01), hyperlipidemia (53% vs. 26%, AOR=4.34, p<0.01) and colorectal cancer screening (17% vs. 6%, AOR=15.43, p<0.01), as were individual socioeconomic factors such as employment, need for financial aid and household income. Uptake of all screening modalities significantly increased in the poorer neighborhood post-intervention (all p<0.05). Cost was cited more commonly as a barrier to health screening in the poorer neighborhood.
  
  
  CONCLUSIONS
  Differing neighborhoods within one geographical location, as well as individual socioeconomic factors, were independently associated with differences in health screening.
authors.affiliation: Department of Epidemiology and Public Health, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore,16 Medical Drive, Singapore. u0801139@nus.edu.sg
authors.forename: Liang En
authors.initials: LE
authors.lastname: Wee
authors.forename: Gerald Choon-Huat
authors.initials: GC
authors.lastname: Koh
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D015179:Colorectal Neoplasms / Q000175:diagnosis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood; D003955:Diagnostic Tests, Routine / Q000523:psychology* / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood; D006973:Hypertension / Q000175:diagnosis; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012846:Singapore; D012959:Socioeconomic Factors