title: Does the Neighborhood Area of Residence Influence Non-Attendance in an Urban Mammography Screening Program? A Multilevel Study in a Swedish City.
abstract: OBJECTIVE
  The public health impact of population-based mammography screening programs depends on high participation rates. Thus, monitoring participation rates, as well as understanding and considering the factors influencing attendance, is important. With the goal to acquire information on the appropriate level of intervention for increasing screening participation our study aimed to (1) examine whether, over and above individual factors, the neighborhood of residence influences a woman's mammography non-attendance, and (2) evaluate, whether knowing a woman's neighborhood of residence would be sufficient to predict non-attendance.
  
  
  METHODS
  We analyze all women invited to mammography screening in 2005-09, residing in the city of Malmö, Sweden. Information regarding mammography screening attendance was linked to data on area of residence, demographic and socioeconomic characteristics available from Statistics Sweden. The influence of individual and neighborhood factors was assessed by multilevel logistic regression analysis with 29,901 women nested within 212 neighborhoods.
  
  
  RESULTS
  The prevalence of non-attendance among women was 18.3%. After adjusting for individual characteristics, the prevalence in the 212 neighborhoods was 3.6%. Neighborhood of residence had little influence on non-attendance. The multilevel analysis indicates that 8.4% of the total individual differences in the propensity of non-attendance were at the neighborhood level. However, when adjusting for specific individual characteristics this general contextual effect decreased to 1.8%. This minor effect was explained by the sociodemographic characteristic of the neighborhoods. The discriminatory accuracy of classifying women according to their non-attendance was 0.747 when considering only individual level variables, and 0.760 after including neighborhood level as a random effect.
  
  
  CONCLUSIONS
  Our results suggest that neighborhoods of residence in Malmö, Sweden (as defined by small-area market statistics (SAMS) areas) do not condition women's participation in population based mammography screening. Thus, interventions should be directed to the whole city and target women with a higher risk of non-attendance.
authors.affiliation: Department of Translational Medicine, Diagnostic Radiology, Lund University, Skåne University Hospital, Malmö, Sweden.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Lagerlund
authors.affiliation: Unit for Social Epidemiology, Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden.
authors.forename: Juan
authors.initials: J
authors.lastname: Merlo
authors.affiliation: Unit for Social Epidemiology, Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden.
authors.forename: Raquel Pérez
authors.initials: RP
authors.lastname: Vicente
authors.affiliation: Department of Translational Medicine, Diagnostic Radiology, Lund University, Skåne University Hospital, Malmö, Sweden.
authors.forename: Sophia
authors.initials: S
authors.lastname: Zackrisson
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D019540:Area Under Curve; D002947:Cities; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening; D008875:Middle Aged; D055361:Multilevel Analysis; D012372:ROC Curve; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D013548:Sweden / Q000453:epidemiology