title: Neighborhood deprivation is strongly associated with participation in a population-based health check.
abstract: BACKGROUND
  We sought to examine whether neighborhood deprivation is associated with participation in a large population-based health check. Such analyses will help answer the question whether health checks, which are designed to meet the needs of residents in deprived neighborhoods, may increase participation and prove to be more effective in preventing disease. In Europe, no study has previously looked at the association between neighborhood deprivation and participation in a population-based health check.
  
  
  METHODS
  The study population comprised 12,768 persons invited for a health check including screening for ischemic heart disease and lifestyle counseling. The study population was randomly drawn from a population of 179,097 persons living in 73 neighborhoods in Denmark. Data on neighborhood deprivation (percentage with basic education, with low income and not in work) and individual socioeconomic position were retrieved from national administrative registers. Multilevel regression analyses with log links and binary distributions were conducted to obtain relative risks, intraclass correlation coefficients and proportional change in variance.
  
  
  RESULTS
  Large differences between neighborhoods existed in both deprivation levels and neighborhood health check participation rate (mean 53%; range 35-84%). In multilevel analyses adjusted for age and sex, higher levels of all three indicators of neighborhood deprivation and a deprivation score were associated with lower participation in a dose-response fashion. Persons living in the most deprived neighborhoods had up to 37% decreased probability of participating compared to those living in the least deprived neighborhoods. Inclusion of individual socioeconomic position in the model attenuated the neighborhood deprivation coefficients, but all except for income deprivation remained statistically significant.
  
  
  CONCLUSIONS
  Neighborhood deprivation was associated with participation in a population-based health check in a dose-response manner, in which increasing neighborhood deprivation was associated with decreasing participation. This suggests the need to develop preventive health checks tailored to deprived neighborhoods.
authors.affiliation: Research Centre for Prevention and Health, Capital Region of Denmark, Glostrup, Denmark; Harvard School of Public Health. Department of Social and Behavioral Sciences, Boston, Massachusetts, United States of America.
authors.forename: Anne Mette
authors.initials: AM
authors.lastname: Bender
authors.affiliation: Harvard School of Public Health. Department of Social and Behavioral Sciences, Boston, Massachusetts, United States of America.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
authors.affiliation: Research Centre for Prevention and Health, Capital Region of Denmark, Glostrup, Denmark; Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark; Faculty of Medicine, University of Aalborg, Aalborg, Denmark.
authors.forename: Torben
authors.initials: T
authors.lastname: Jørgensen
authors.affiliation: Research Centre for Prevention and Health, Capital Region of Denmark, Glostrup, Denmark; Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Charlotta
authors.initials: C
authors.lastname: Pisinger
mesh_terms: D000328:Adult; D000368:Aged; D003718:Denmark; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000523:psychology / Q000706:statistics & numerical data*; D008875:Middle Aged; D055361:Multilevel Analysis; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D011203:Poverty; D012111:Residence Characteristics; D014478:Unemployment / Q000523:psychology / Q000706:statistics & numerical data*