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Spatial distribution of mammography adherence in a Swiss urban population and its association with socioeconomic status

José Luis Sandoval, Rebecca Himsl, Jean-Marc Theler, Jean-Michel Gaspoz, Stéphane Joost, Idris Guessous
doi: https://doi.org/10.1101/404673
José Luis Sandoval
1Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
2Department of General Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
3GIRAPH (Geographic Information Research and Analysis in Public Health) Lab, Geneva University Hospitals, Geneva and Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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Rebecca Himsl
1Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
3GIRAPH (Geographic Information Research and Analysis in Public Health) Lab, Geneva University Hospitals, Geneva and Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
4Laboratory of Geographical Information Systems (LASIG), School of Architecture, Civil and Environmental Engineering (ENAC), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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Jean-Marc Theler
1Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
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Jean-Michel Gaspoz
1Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
5Department of Ambulatory and Community Medicine, University of Lausanne, Lausanne, Switzerland
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Stéphane Joost
1Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
3GIRAPH (Geographic Information Research and Analysis in Public Health) Lab, Geneva University Hospitals, Geneva and Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
4Laboratory of Geographical Information Systems (LASIG), School of Architecture, Civil and Environmental Engineering (ENAC), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
6Institute of Social and Preventive Medicine (IUMSP), Division of chronic diseases (dMC), Lausanne University Hospital (CHUV), Lausanne, Switzerland
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Idris Guessous
1Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
3GIRAPH (Geographic Information Research and Analysis in Public Health) Lab, Geneva University Hospitals, Geneva and Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
5Department of Ambulatory and Community Medicine, University of Lausanne, Lausanne, Switzerland
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ABSTRACT

Purpose Local physical and social environment has a defining influence on individual behaviour and health-related outcomes. However, it remains undetermined if its impact is independent of individual socioeconomic status. In this study, we evaluated the spatial distribution of mammography adherence in the state of Geneva (Switzerland) using individual-level data and assessed its independence from socioeconomic status (SES).

Methods Geo-referenced individual-level data from the population-based cross-sectional Bus Santé study (n = 5,002) were used to calculate local indicators of spatial association (LISA) and investigate the spatial dependence of mammography adherence. Spatial clusters are reported without adjustment; adjusted for neighbourhood income and individual educational attainment; and demographic factors (age and Swiss nationality). The association between adjusted clusters and the proximity to the nearest screening centre was also evaluated.

Results Mammography adherence was not randomly distributed throughout Geneva with clusters geographically coinciding with known SES distributions. After adjustment for SES indicators, clusters were reduced to 56.2% of their original size (n = 1,033). Adjustment for age and nationality further reduced the number of individuals exhibiting spatially dependent behaviour (36.5% of the initial size). The identified SES-independent hot spots and cold-spots of mammography adherence were not explained by proximity to the nearest screening centre.

Conclusions SES and demographic factors play an important role in shaping the spatial distribution of mammography adherence. However, the spatial clusters persisted after confounder adjustment indicating that additional neighbourhood-level determinants could influence mammography adherence and be the object of targeted public health interventions.

Copyright 
The copyright holder for this preprint is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license.
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Posted August 31, 2018.
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Spatial distribution of mammography adherence in a Swiss urban population and its association with socioeconomic status
José Luis Sandoval, Rebecca Himsl, Jean-Marc Theler, Jean-Michel Gaspoz, Stéphane Joost, Idris Guessous
bioRxiv 404673; doi: https://doi.org/10.1101/404673
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Spatial distribution of mammography adherence in a Swiss urban population and its association with socioeconomic status
José Luis Sandoval, Rebecca Himsl, Jean-Marc Theler, Jean-Michel Gaspoz, Stéphane Joost, Idris Guessous
bioRxiv 404673; doi: https://doi.org/10.1101/404673

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