Individual and Regional Determinants of Mammography Uptake

Background: Analysis of mammography utilization has traditionally been performed from an individual-level perspective. The purpose of this study was to explore the combined influence of individual- and regional-level determinants of mammography utilization.Methods: Logistic hierarchical multilevel modelling was used to investigate the influences of region of residence and individual characteristics on mammography utilization. Socio-economic status information about health planning regions was derived from the 1996 Canadian Census. Individual-level information was extracted from the 1996 National Population Health Survey.Results: After controlling for individual-level education, regions with fewer high school graduates had lower levels of mammography utilization. A cross-level interaction between regional-level education and individual-level social involvement was found. Other individual-level variables associated with screening confirmed previous literature findings.Conclusion: Our findings suggest that higher levels of participation in social activities modify the detrimental influence on mammography utilization of living in a less educated region. This challenges the current focus of mammography screening research on individual-level determinants of uptake. Multilevel, synergistic strategies to possibly achieve higher levels of screening should be considered by health promotion program planners.