Richard H. Glazier|Maria I. Creatore|Piotr Gozdyra|Flora I. Matheson|Leah S. Steele|Eleanor Boyle|Rahim Moineddin
Geographic methods for understanding and responding to disparities in mammography use in Toronto, Canada
St. Michael's Hospital|St. Michael's Hospital|St. Michael's Hospital|St. Michael's Hospital|St. Michael's Hospital|St. Michael's Hospital|University of Toronto
use spatial epidemiologic analyses understand disparities mammography use formulate interventions increase uptake lowincome highrecent immigration areas toronto canadawe compared mammography rates four incomeimmigration census tract groups data obtained 1996 canadian census 2000 physician billing claims risk ratios linear regression multilayer maps spatial analysis used examine utilization area women age 45 64 yearsresidential population inner city toronto canada 1996 population 780000women age 45 64 residing torontos inner city year 2000among 113762 women age 45 64 27435 24 received mammogram 2000 91542 80 seen physician 21 women mammogram least advantaged group low incomehigh immigration compared 27 advantaged group high incomelow immigration risk ratio 079 95 confidence interval 075 084 multilayer maps demonstrated low incomehigh immigration band running torontos inner city low mammography rates within band substantial geographic clustering study variableswe found marked variation mammography rates area lowest rates associated low income high immigration spatial patterns identified areas low mammography low physician visit rates appropriate outreach public education interventions also identified areas low mammography high physician visit rates appropriate interventions targeted physicians