title: Screening for cardiovascular disease risk factors in an urban low-income setting at baseline and post intervention: a prospective intervention study.
abstract: BACKGROUND
  Not all segments of society might have equal access to screening. We determined predictors for regular cardiovascular health screening at baseline amongst those of low socioeconomic status (SES) and evaluated the effectiveness of a 6-month intervention on screening in this group compared to a high-SES group.
  
  
  METHODS
  The study population involved all residents aged ≥ 40 years in two housing estates comprising owner-occupied housing (high SES) and rental flats (low SES) in Singapore. From 2009 to 2011, residents not being screened regularly at baseline for hypertension, diabetes, and dyslipidaemia were offered free and convenient blood pressure, fasting blood glucose, and lipid testing over 6 months. Chi-squared and multi-level logistic regression identified predictors of regular screening at baseline; likelihood ratio and Cox regression analysis identified predictors of screening participation post intervention.
  
  
  RESULTS
  Participation was 78.2% (1081/1383). At baseline, in the low-SES group, 41.7% (150/360), 38.8% (177/456), and 30.8% (128/416) had gone for regular hypertension, diabetes, and dyslipidaemia screening, respectively; compared with higher numbers in the high-SES group. Sociodemographic factors predicting regular screening in the low-SES community included being married and not smoking. Post intervention, screening rates rose significantly (p < 0.001) by similar proportions in both communities. Staying in a lower-SES community (adjusted relative risk (aRR) 0.61, 95% CI 0.37-0.99, p = 0.048) and having hypertension (aRR 0.45, 95% CI 0.18-0.98, p = 0.049) was associated with lower take-up; Chinese ethnicity (aRR 1.84, 95% CI 1.00-3.43, p = 0.050) and employment associated with higher take-up (aRR 1.57, 95% CI 1.03-2.60, p = 0.040).
  
  
  CONCLUSIONS
  Participation in cardiovascular health screening was poor amongst those of low SES; a 6-month intervention programme improved participation in this population.
authors.affiliation: National University of Singapore, National University Health System, Singapore.
authors.forename: Liang En
authors.initials: LE
authors.lastname: Wee
authors.forename: Gerald Choon-Huat
authors.initials: GC
authors.lastname: Koh
authors.forename: Wei Xin
authors.initials: WX
authors.lastname: Yeo
authors.forename: Run Ting
authors.initials: RT
authors.lastname: Chin
authors.forename: Jolene
authors.initials: J
authors.lastname: Wong
authors.forename: Branden
authors.initials: B
authors.lastname: Seow
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000517:prevention & control; D003256:Community Participation / Q000706:statistics & numerical data*; D003920:Diabetes Mellitus / Q000175:diagnosis; D050171:Dyslipidemias / Q000175:diagnosis; D005260:Female; D006293:Health Promotion; D006798:Housing / Q000145:classification; D006801:Humans; D006973:Hypertension / Q000175:diagnosis; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011203:Poverty; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D012846:Singapore; D012923:Social Class; D014505:Urban Population / Q000706:statistics & numerical data*