Neighborhood deprivation is strongly associated with participation in a population-based health check

PLoS One. 2015 Jun 3;10(6):e0129819. doi: 10.1371/journal.pone.0129819. eCollection 2015.

Abstract

Background: We sought to examine whether neighborhood deprivation is associated with participation in a large population-based health check. Such analyses will help answer the question whether health checks, which are designed to meet the needs of residents in deprived neighborhoods, may increase participation and prove to be more effective in preventing disease. In Europe, no study has previously looked at the association between neighborhood deprivation and participation in a population-based health check.

Methods: The study population comprised 12,768 persons invited for a health check including screening for ischemic heart disease and lifestyle counseling. The study population was randomly drawn from a population of 179,097 persons living in 73 neighborhoods in Denmark. Data on neighborhood deprivation (percentage with basic education, with low income and not in work) and individual socioeconomic position were retrieved from national administrative registers. Multilevel regression analyses with log links and binary distributions were conducted to obtain relative risks, intraclass correlation coefficients and proportional change in variance.

Results: Large differences between neighborhoods existed in both deprivation levels and neighborhood health check participation rate (mean 53%; range 35-84%). In multilevel analyses adjusted for age and sex, higher levels of all three indicators of neighborhood deprivation and a deprivation score were associated with lower participation in a dose-response fashion. Persons living in the most deprived neighborhoods had up to 37% decreased probability of participating compared to those living in the least deprived neighborhoods. Inclusion of individual socioeconomic position in the model attenuated the neighborhood deprivation coefficients, but all except for income deprivation remained statistically significant.

Conclusion: Neighborhood deprivation was associated with participation in a population-based health check in a dose-response manner, in which increasing neighborhood deprivation was associated with decreasing participation. This suggests the need to develop preventive health checks tailored to deprived neighborhoods.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Denmark
  • Female
  • Humans
  • Life Style
  • Male
  • Mass Screening / economics*
  • Mass Screening / psychology
  • Mass Screening / statistics & numerical data*
  • Middle Aged
  • Multilevel Analysis
  • Myocardial Ischemia / diagnosis
  • Myocardial Ischemia / psychology
  • Patient Acceptance of Health Care / psychology
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Poverty*
  • Residence Characteristics
  • Unemployment / psychology
  • Unemployment / statistics & numerical data*

Grant support

This work was supported by the Danish Health Foundation (grant number 2010 B 131). http://www.helsefonden.dk/pages.asp?id=63. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.