Hsia J, Kemper E, Kiefe C, Zapka J, Sofaer S, Pettinger M, Bowen D, Limacher M, Lillington L, Mason E
Department of Medicine, George Washington University, Washington, DC, USA.
Prev Med. 2000 Sep;31(3):261-70. doi: 10.1006/pmed.2000.0697.
Amid current changes in health care access across the United States, the importance of health insurance status and insurance type relative to demographic, actual, and perceived health variables as determinants of screening for breast, colorectal, and cervical cancer is uncertain. This analysis evaluates the hypothesis that health insurance independently predicts cancer screening in the Women's Health Initia tive Observational Study cohort.
Questionnaire data from 55,278 women en rolled in the Women's Health Initiative Observational Study between September 1994 and February 1997 were analyzed by multiple logistic regression to identify predictors of self-reported mammography within 2 years, Pap smear within 3 years, and stool guaiac or flexible sigmoidoscopy within 5 years.
Positive determinants of reporting cancer screening were age, ethnic origin, household income, educational level, family history of cancer, having a usual care provider, time since last provider visit, and insurance status and type. Smoking, diabetes, and, among older women, prior cardiovascular events were negative determinants of cancer screening. Among women younger than 65, lacking health insurance or having fee-for-service insurance was strongly associated with failure to report cancer screening, independently of having or using a usual care provider and of demographics, self-perceived health, and health characteristics. Among women 65 and older, those with Medicare alone were less likely, whereas those with Medicare + prepaid insurance were more likely, to report cancer screening.
In the Women's Health Initiative Obser vational Study, a large, diverse group of older women, health insurance type and status were among the most important determinants of cancer screening indepen dent of demographics, chronic health conditions, and self-perceived health characteristics.
在美国当前医疗保健可及性发生变化的情况下，医疗保险状况和保险类型相对于人口统计学、实际健康状况以及感知健康变量而言，作为乳腺癌、结直肠癌和宫颈癌筛查决定因素的重要性尚不确定。本分析评估了在女性健康倡议观察性研究队列中，医疗保险能独立预测癌症筛查这一假设。
对1994年9月至1997年2月期间纳入女性健康倡议观察性研究的55278名女性的问卷数据进行多因素逻辑回归分析，以确定在2年内进行自我报告的乳房X线摄影、3年内进行巴氏涂片检查以及5年内进行粪便隐血试验或乙状结肠镜检查的预测因素。
报告癌症筛查的积极决定因素包括年龄、种族、家庭收入、教育水平、癌症家族史、有常规护理提供者、距上次就诊的时间以及保险状况和类型。吸烟、糖尿病以及老年女性既往的心血管事件是癌症筛查的消极决定因素。在65岁以下的女性中，缺乏医疗保险或拥有按服务收费保险与未报告癌症筛查密切相关，这与是否有或使用常规护理提供者以及人口统计学、自我感知健康和健康特征无关。在65岁及以上的女性中，仅拥有医疗保险的女性报告癌症筛查的可能性较小，而拥有医疗保险+预付保险的女性报告癌症筛查的可能性较大。
在女性健康倡议观察性研究中，对于一大群多样化的老年女性而言，医疗保险类型和状况是癌症筛查最重要的决定因素之一，独立于人口统计学、慢性健康状况和自我感知的健康特征。
