The effect of neighborhood, socioeconomic status and a community-based program on multi-disease health screening in an Asian population: A controlled intervention study

ObjectivesWe studied whether individual socioeconomic and neighborhood factors such as living in a poor community independently affected health screening participation.MethodsWe studied 3 blocks of public-rental flats (the poorer neighborhood) adjacent to 3 blocks of owner-occupied public housing (the better-off neighborhood) in a precinct in Taman Jurong, Singapore. Demographic details and reasons for not having regular hypertension, diabetes mellitus, hyperlipidemia and colorectal cancer screening were collected from 2009 to 2010. An access-enhancing intervention was implemented in both neighborhoods to raise health screening rates.ResultsParticipation rates for rental flats and owner-occupied flats were 89.0% (356/400) and 70.2% (351/500) respectively. Living in a better-off neighborhood was independently associated with diabetes mellitus (66% vs. 35%, adjusted odds ratio (AOR) = 2.12, p < 0.01), hyperlipidemia (53% vs. 26%, AOR = 4.34, p < 0.01) and colorectal cancer screening (17% vs. 6%, AOR = 15.43, p < 0.01), as were individual socioeconomic factors such as employment, need for financial aid and household income. Uptake of all screening modalities significantly increased in the poorer neighborhood post-intervention (all p < 0.05). Cost was cited more commonly as a barrier to health screening in the poorer neighborhood.ConclusionDiffering neighborhoods within one geographical location, as well as individual socioeconomic factors, were independently associated with differences in health screening.

► Differing neighborhoods were associated with different health screening rates.
► These differences were independent of individual socioeconomic factors.
► An access-enhancing community-based program was introduced.
► The program increased multi-disease health screening rates in the poorer neighborhood.
► However, the program only increased hypertension screening in better-off neighborhood.