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Small-area spatio-temporal analyses of participation rates in the mammography screening program in the city of Dortmund (NW Germany)

  • Background The population-based mammography screening program (MSP) was implemented by the end of 2005 in Germany, and all women between 50 and 69 years are actively invited to a free biennial screening examination. However, despite the expected benefits, the overall participation rates range only between 50 and 55 %. There is also increasing evidence that belonging to a vulnerable population, such as ethnic minorities or low income groups, is associated with a decreased likelihood of participating in screening programs. This study aimed to analyze in more detail the intra-urban variation of MSP uptake at the neighborhood level (i.e. statistical districts) for the city of Dortmund in northwest Germany and to identify demographic and socioeconomic risk factors that contribute to non-response to screening invitations. Methods The numbers of participants by statistical district were aggregated over the three periods 2007/2008, 2009/2010, and 2011/2012. Participation rates were calculated as numbers of participants per female resident population averaged over each 2-year period. Bayesian hierarchical spatial models extended with a temporal and spatio-temporal interaction effect were used to analyze the participation rates applying integrated nested Laplace approximations (INLA). The model included explanatory covariates taken from the atlas of social structure of Dortmund. Results Generally, participation rates rose for all districts over the time periods. However, participation was persistently lowest in the inner city of Dortmund. Multivariable regression analysis showed that migrant status and long-term unemployment were associated with significant increases of non-attendance in the MSP. Conclusion Low income groups and immigrant populations are clustered in the inner city of Dortmund and the observed spatial pattern of persistently low participation in the city center is likely linked to the underlying socioeconomic gradient. This corresponds with the findings of the ecological regression analysis manifesting socioeconomically deprived neighborhoods as risk factors for low attendance in the MSP. Spatio-temporal surveillance of participation in cancer screening programs may be used to identify spatial inequalities in screening uptake and plan spatially focused interventions.

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Metadaten
Author:Dorothea LemkeORCiD, Shoma Barbara BerkemeyerORCiD, Volker Mattauch, Oliver HeidingerORCiD, Edzer PebesmaORCiD, Hans Werner HenseORCiD
Title (English):Small-area spatio-temporal analyses of participation rates in the mammography screening program in the city of Dortmund (NW Germany)
URN:urn:nbn:de:bsz:959-opus-37760
DOI:https://doi.org/10.1186/s12889-015-2520-9
ISSN:1471-2458
Parent Title (English):BMC Public Health
Document Type:Working Paper
Language:English
Year of Completion:2015
Release Date:2023/01/06
Tag:Cancer registry; Ecological study; Epidemiology; INLA; Mammography screening; Participation rates; Public Health; Spatio-temporal modelling
Page Number:9
Faculties:Fakultät AuL
DDC classes:600 Technik, Medizin, angewandte Wissenschaften / 610 Medizin, Gesundheit
Review Status:Veröffentlichte Fassung/Verlagsversion
Licence (German):License LogoCreative Commons - CC BY - Namensnennung 4.0 International