Neighborhood socioeconomic position and mammography screening: Results from the 2005 National Health Interview Survey

Objective: Socioeconomic and racial/ethnic disparities in breast cancer mortality persist despite years of investigation aimed at understanding the underlying mechanisms. While much of the research has focused on individual-level risk factors, recent studies have highlighted the potential role of contextual neighborhood influences. The aim of this study was to examine the relationship between neighborhood socioeconomic position (SEP) and repeat mammography screening in a national sample of women from the National Health Interview Survey (NHIS). Methods: With assistance from the Research Data Center of the National Center for Health Statistics, 2000 U.S. census tract data were linked to the 2005 NHIS. We constructed a neighborhood SEP index categorized into quartiles, including information on tract-level unemployment, poverty, housing values, annual household income, education, and occupation. Women ages 46-79 (n=6,590) were included in the analysis. Women were considered adherent to recommended screening guidelines if they had had a recent mammogram (in past 2 years) and 3 mammograms over the course of the 6 years (24 month interval). Multivariable logistic regression using survey weights was conducted to assess these relationships. Results: In a model adjusted for socio-demographics, health care factors, and known correlates of mammography screening, women living in more disadvantaged neighborhoods had lower odds of engaging in repeat mammography. The adjusted odds ratio comparing the most disadvantaged census tracts (quartile 4) compared to the most advantaged census tracts (Quartile 1) was 0.59 (0.47, 0.75). Conclusion: The results underscore the importance of addressing community factors in reducing social inequalities in the mammography screening process.