Neighborhood deprivation and risk of cervical cancer morbidity and mortality: a multilevel analysis from Sweden.

OBJECTIVES To analyze whether there is an association between neighborhood deprivation and cervical cancer morbidity and mortality, beyond individual level characteristics. DESIGN The entire Swedish population aged 25 to 74, a total of 1.9 million women, were followed from January 1, 1990, until hospital admission due to cervical cancer during the study period, or the end of the study on December 31, 2008. Multilevel logistic regression was used in the analysis with individual level characteristics (age, marital status, family income, education, immigration status, urban/rural status, mobility, comorbidities, parities, and number of partners) at the first level and level of neighborhood deprivation at the second level. Neighborhood deprivation was measured at small area market statistics level by the use of an index. RESULTS There was a strong association between level of neighborhood deprivation and cervical cancer morbidity and mortality. In the full model, which took account of the individual level characteristics, the risks of cervical cancer morbidity and mortality were 1.25 and 1.36, respectively, in the most deprived neighborhoods. The between neighborhood variance was over twice the standard error, indicating significant differences in cervical cancer morbidity and mortality between neighborhoods. CONCLUSIONS This study is the largest to date of the influences of neighborhood deprivation on cervical cancer morbidity and mortality. The results suggest that neighborhood characteristics affect cervical cancer morbidity and mortality independently of individual level sociodemographic characteristics. Both individual and neighborhood level approaches are important in health care policies.