title: Non-attendance of mammographic screening: the roles of age and municipality in a population-based Swedish sample.
abstract: BACKGROUND
  Inequality in health and health care is increasing in Sweden. Contributing to widening gaps are various factors that can be assessed by determinants, such as age, educational level, occupation, living area and country of birth. A health care service that can be used as an indicator of health inequality in Sweden is mammographic screening. The non-attendance rate is between 13 and 31 %, while the average is about 20 %. This study aims to shed light on three associations: between municipality and non-attendance, between age and non-attendance, and the interaction of municipality of residence and age in relation to non-attendance.
  
  
  METHODS
  The study is based on data from the register that identifies attenders and non-attenders of mammographic screening in a Swedish county, namely the Radiological Information System (RIS). Further, in order to provide a socio-demographic profile of the county's municipalities, aggregated data for women in the age range 40-74 in 2012 were retrieved from Statistics Sweden (SCB), the Public Health Agency of Sweden, the National Board of Health and Welfare, and the Swedish Social Insurance Agency. The sample consisted of 52,541 women. Analysis conducted of the individual data were multivariate logistic regressions, and pairwise chi-square tests.
  
  
  RESULTS
  The results show that age and municipality of residence associated with non-attendance of mammographic screening. Municipality of residence has a greater impact on non-attendance among women in the age group 70 to 74. For most of the age categories there were differences between the municipalities in regard to non-attendance to mammographic screening.
  
  
  CONCLUSIONS
  Age and municipality of residence affect attendance of mammographic screening. Since there is one sole and pre-selected mammographic screening facility in the county, distance to the screening facility may serve as one explanation to non-attendance which is a determinant of inequity. From an equity perspective, lack of equal access to health and health care influences facility utilization.
authors.affiliation: Division of Public Health Sciences, School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE-721 23, Västerås, Sweden. maria.norfjord.zidar@mdh.se.
authors.forename: Maria Norfjord
authors.initials: MN
authors.lastname: Zidar
authors.affiliation: Division of Public Health Sciences, School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE-721 23, Västerås, Sweden.|Centre for Clinical Research, County Council of Västmanland and Uppsala University, Uppsala, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Larm
authors.affiliation: Division of Public Health Sciences, School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE-721 23, Västerås, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Tillgren
authors.affiliation: Division of Public Health Sciences, School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE-721 23, Västerås, Sweden.
authors.forename: Sharareh
authors.initials: S
authors.lastname: Akhavan
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013548:Sweden