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Small-area variation in screening for cancer, glucose and cholesterol in Ontario: a cross-sectional study
Kimberly A Fernandes1, Rinku Sutradhar1, Cornelia M Borkhoff1
1Institute for Clinical Evaluative Sciences (Fernandes, Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Dalla Lana School of Public Health (Sutradhar, Borkhoff, Rabeneck, Paszat); St. Michael's Hospital (Baxter, Lofters); Institute of Health Policy, Management and Evaluation (Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); University of Toronto (Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Cancer Care Ontario (Rabeneck); Sunnybrook Health Sciences Centre (Tinmouth), Toronto, Ont.
Background:
Screening for cervical, breast and colon cancers, and elevations of cholesterol and glucose, reduces premature cause-specific mortality from these cancers and circulatory diseases. Despite primary care reforms and incentives, and promotion of cancer-screening programs among individuals, participation is suboptimal. We aimed to examine participation as of Dec. 31, 2011, by factors of deprivation, demographics and primary care at the small-area level.
Methods:
From health care administrative databases, we identified people eligible for each screening test, and their participation, in each dissemination area (referred to as small areas, n = 18 950) in Ontario. We calculated rates for each test among small areas (overall and stratified by demographic, socioeconomic and primary care descriptors) and stratified by sex for all tests combined. We loaded all data into a geographic information system. Funnel plots were generated showing the percentage of eligible people who completed screening for all tests by small area, stratified by sex. Overall and stratified screening prevalence ratios were calculated among small areas.
Results:
Among small areas, the mean and SD for participation in all tests combined was 31.6% (SD 11.0%) for women and 41.2% (SD 12.0%) for men. Screening prevalence among small areas, for each test and for all tests combined, overall and stratified by sex, declined with decreasing percentage with high school completion, decreasing socioeconomic quintile, and decreasing percentage with an identifiable primary care physician.
Interpretation:
Our results show that the rate of participation in all eligible screening tests among small areas is much lower than the rate of participation in any one particular test. This finding has implications for the design and implementation of strategies to improve rates of screening.
