title: Uptake of atrial fibrillation screening aiming at stroke prevention: geo-mapping of target population and non-participation.
abstract: BACKGROUND
  In a screening study for silent atrial fibrillation (AF), which is a frequent source of cardiac emboli with ischemic stroke, the proportion of non-participants was considerable and their clinical profile differed from the participants' profile. We intended to geo-map the target population and non-participation in an attempt to understand factors related to screening uptake and, thereby, obtain useful information needed to intervene for improved uptake.
  
  
  METHODS
  In the municipality of Halmstad, Sweden, all residents born in 1934-1935 were invited to the screening study during April 2010 to February 2012. The total study group included 848 participants and 367 non-participants from 12 parishes. Geo-maps displaying participation, along with target-population-based geo-maps displaying proportion of immigrants and ischemic stroke incidence, were used.
  
  
  RESULTS
  Smoothed non-participation ratios (SmNPR) varied from 0.81 to 1.24 across different parishes (SmNRP=1 corresponds to the expected participation based on the total study group). Among high risk individuals, the geographical variation was more pronounced (SmNPR range 0.75-1.51). Two parishes with higher share of immigrants and elevated population-based ischemic stroke incidence showed markedly lower participation, particularly among high-risk individuals.
  
  
  CONCLUSIONS
  AF screening uptake varied evidently between parishes, particularly among high-risk individuals. Geo-mapping of target population and non-participation yielded useful information needed to intervene for improved screening uptake.
authors.affiliation: Department of Medicine, Halland Hospital, SE-301 85 Halmstad, Sweden. johan.engdahl@regionhalland.se
authors.forename: Johan
authors.initials: J
authors.lastname: Engdahl
authors.forename: Anders
authors.initials: A
authors.lastname: Holmén
authors.forename: Mårten
authors.initials: M
authors.lastname: Rosenqvist
authors.forename: Ulf
authors.initials: U
authors.lastname: Strömberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D002947:Cities; D054242:Emigrants and Immigrants / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D040362:Geographic Information Systems; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D010358:Patient Participation / Q000706:statistics & numerical data*; D011159:Population Surveillance; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*; D013548:Sweden / Q000453:epidemiology
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