Residential area and screening venue location features associated with spatial variation in breast cancer screening invitation response rates: an observational study in Greater Sydney, Australia

Abstract

Objectives: Participation in breast cancer screening (BCS) varies at the small-area level, which may reflect environmental influences. This study assessed small-area variation in BCS invitation response rates (IRRs) and associations between small-area BCS IRR, sociodemographic factors, BCS venue distance and venue location features in Greater Sydney, Australia.

Methods: BCS IRR data for 2011-2012 were compiled for 9528 Australian Bureau of Statistics Statistical Area Level 1 (SA1) units (n=227 474 women). A geographial information system was used to extract SA1-level sociodemographic features (proportions of women speaking English at home, full-time employed and university educated, and proportion of dwellings with motor vehicles), SA1-level distance to closest venue(s) (expressed as quartiles), and closest venue(s) colocated with bus stops, train station, hospital, general practitioner and shops. Associations between area-level features, BCS venue distance, venue location features and IRR were estimated using ordinary least square-type spatial lag models including area education as a covariate.

Results: BCS IRR varied across SA1s (mean=59.8%, range: 0%-100%), with notable spatial autocorrelation (Moran's I=0.803). BCS IRR was positively associated with greater SA1-level proportion of women speaking English at home (β=2.283, 95% CI 2.024 to 2.543), women's education (in the model including speaking English at home β=0.454, 95% CI 0.211 to 0.697), dwellings with motor vehicles (β=1.836, 95% CI 1.594 to 2.078), greater distance to venue (eg, most distant quartile compared with closest: β=6.249, 95% CI 5.489 to 7.008), and BCS venue colocated with shops (β=0.762, 95% CI 0.273 to 1.251). Greater SA1-level women employment (β=-0.613, 95% CI -0.898 to -0.328) and venue colocated with train station (β=-1.889, 95% CI -2.376 to -1.402) or hospital (β=-0.677, 95% CI -1.164 to -0.189) were inversely related to BCS IRR.

Conclusions: Small-area variation in BCS IRR exists for Greater Sydney and is strongly related to sociodemographic factors that, together with BCS venue location features, could inform targeted attempts to improve IRR.

Keywords: epidemiology; preventive medicine; public health.