Determinants of mammography use in rural and urban regions of Canada.

INTRODUCTION National guidelines advocate biennial mammography screening for asymptomatic women aged 50-69 years. Unfortunately many women do not abide by such recommendations, and evidence indicates that compliance rates are lower in rural areas. METHODS We estimated logistic regression models using data from the Canadian Community Health Survey for 2002/03 and 2004/05. We identified the extent of regional variation within and between Canadian provinces using a new and more detailed set of rural indicators based on economic zones of influence, after accounting for a range of demographic and socio-economic factors. RESULTS The odds of asymptomatic women aged 50-69 years having undergone mammography during the previous 2 years were significantly lower for those residing in relatively remote and rural areas than for those residing in census metropolitan areas (odds ratio [OR] 0.58, confidence interval [CI] 0.42-0.80). This was also true of women residing in certain other rural areas that had some limited labour market attachment to larger urban areas (OR 0.81, CI 0.70-0.93), but there were no significant differences between smaller and larger urban areas. We also found variation in mammography use among women living in rural and urban areas across provinces. CONCLUSION Mammography use is significantly lower in rural and remote areas, even after a range of other demographic and socio-economic factors are accounted for. One important factor underpinning this result appears to be differences in attitude about the importance of regular mammography screening between women residing in rural and urban areas. Information campaigns raising awareness about the importance of mammography screening should be targeted, in particular, at women residing in rural and remote areas.