Mandelblatt J S, Gold K, O'Malley A S, Taylor K, Cagney K, Hopkins J S, Kerner J
Department of Medicine, Lombardi Cancer Center, Institute for Health Care Policy and Research, Georgetown University School of Medicine, Washington, DC 20007, USA.
Prev Med. 1999 Apr;28(4):418-25. doi: 10.1006/pmed.1998.0446.
The aim of this study was to evaluate the relationships between age, health status, access to care, and breast and cervical cancer screening among multiethnic elderly and nonelderly women.
A structured telephone survey of a quota sample of 1,420 New York City women from four Hispanic groups (Columbian, Dominican, Puerto Rican, Ecuadorian) and three black groups (U.S., Caribbean, and Haitian) was performed. Outcome measures included "ever" and "recent" self-reported use of mammography, clinical breast examination (CBE), and Pap smears. Logistic regression models assessed the predictors of screening use.
Having a regular source of care significantly predicted all screening use for both elderly and nonelderly, controlling for ethnicity, sociodemographics, health status, access to care, proportion of life in the United States, and cancer attitudes. Elderly women (>/=65 years) were significantly less likely to have ever had (OR = 0.79, 95% CI 0.65-0. 96) and to have recently had (OR = 0.67, 95% CI 0.57-0.79) Pap smears than younger women, controlling for the other variables; being elderly also tended to be an independent predictor of ever and recent mammography and CBE use. Interestingly, there was a trend for health status to act differently in predicting Pap smear use for the two age groups. For younger women, being in poor health increased the odds of Pap smear screening, while for elderly women, being in good health increased the odds of screening.
Elderly women reported being screened less than younger women; interactions between health status and age need further exploration.
本研究旨在评估多种族老年和非老年女性的年龄、健康状况、医疗服务可及性与乳腺癌和宫颈癌筛查之间的关系。
对来自四个西班牙裔群体（哥伦比亚、多米尼加、波多黎各、厄瓜多尔）和三个黑人群体（美国、加勒比地区、海地）的1420名纽约市女性进行了配额抽样的结构化电话调查。结果指标包括自我报告的“曾经”和“最近”进行乳房X光检查、临床乳房检查（CBE）和巴氏涂片检查的情况。逻辑回归模型评估了筛查使用情况的预测因素。
在控制种族、社会人口统计学、健康状况、医疗服务可及性、在美国生活的比例和癌症态度后，有固定的医疗服务来源显著预测了老年和非老年女性的所有筛查使用情况。老年女性（≥65岁）进行巴氏涂片检查的“曾经”（比值比[OR]=0.79，95%置信区间[CI]0.65 - 0.96）和“最近”（OR = 0.67，95% CI 0.57 - 0.79）的可能性显著低于年轻女性；老年也是“曾经”和“最近”进行乳房X光检查和CBE使用情况的独立预测因素。有趣的是，在预测两个年龄组的巴氏涂片检查使用情况时，健康状况的作用存在趋势差异。对于年轻女性，健康状况差会增加巴氏涂片筛查的几率，而对于老年女性，健康状况好会增加筛查的几率。
老年女性报告的筛查次数少于年轻女性；健康状况与年龄之间的相互作用需要进一步探索。
