Risk of late cervical cancer screening according to prosperity and medical density in daily frequented neighborhoods in Greater Paris.

Abstract Background: The consideration of multiple spaces frequented daily by individuals is attracting interest for the analysis of socioterritorial health and healthcare inequalities in light of the high daily mobility in urban settings and the increasing availability of mobility data. Our objective was to estimate the associations between attributes of daily frequented neighborhoods and delayed cervical smear tests in the Greater Paris area. Methods: Data were extracted from the 2010 SIRS cohort survey. Participants could report three neighborhoods (residence, work, and the next most regularly frequented). All multivariate analyses were conducted: simple multilevel logistic regression models, cross-classified multilevel logistic regression models were used to simultaneously consider the three types of neighborhoods studied (residential, work or study, visit) with active and mobile women. Finally, associations with socioeconomic and medical diversity scores (adjusted for the five individual characteristics) were estimated by logistic regression models that took sampling design into consideration. Results: One-quarter of the women reported that they had not had a smear test in the previous three years. After adjusting for individual characteristics, there was a significant association between the socioeconomic and medical diversity scores for the multiple neighborhoods frequented and the risk of a delayed smear test. Women who reside and work in poor neighborhoods and whose next most regularly frequented neighborhood was also poor had a significantly higher risk of late cervical cancer screening. Conclusions: In the characterization of social and territorial inequalities in healthcare, social epidemiology and health geography show a growing interest in considering multiple spaces frequented daily by individuals. A cumulative exposure score, such as the one presented here, may be a relevant approach for analyzing their effects. Keywords: Multilevel analysis, neighborhood, daily mobility, cancer prevention, cervical cancer, social inequalities, Paris area