Litaker David, Tomolo Anne
Department of Medicine, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio 44106, USA.
J Womens Health (Larchmt). 2007 Jan-Feb;16(1):36-45. doi: 10.1089/jwh.2006.0090.
Disparities in breast cancer screening (BCS) exist within the United States. Although such factors as a woman's income and insurance status explain some differences, additional contributions related to local healthcare system characteristics or the social and economic context in which women live have not been fully explored.
Using data from a cross-sectional survey of Ohio residents, we assessed BCS in a state-representative sample of 2231 women between the ages of 50 and 69 years. Urbanization, the proportion of female-headed households (FHH), managed care activity, the number of primary care physicians (PCPs) per capita, and county designation as being medically underserved represented some of the contextual characteristics we examined. Using nested hierarchical logistic regression models, we evaluated the association of these characteristics with BCS before and after adjusting for respondents' characteristics.
The proportion of age-eligible women screened for breast cancer was 61.9% (n = 1383); county screening rates varied from 12.9% to 100% (mean 60.3%). Failure to complete high school, lower family income, and absence of continuous insurance, a usual source of care, or current employment were associated with lower BCS. After accounting for these characteristics, per capita PCPs (adjusted odds ratio [AOR] 1.05 (1.01, 1.10), p = 0.02) and the proportion of FHH (AOR 0.66 (0.44, 0.99), p = 0.045) remained independently associated with BCS.
Contextual characteristics independently associated with BCS identify areas in which women are at increased risk for delayed breast cancer diagnosis. The approach described here can inform the planning phase of regional, state, or federal initiatives to enhance BCS and reduce subsequent disparities in treatment outcomes.
美国国内存在乳腺癌筛查（BCS）差异。尽管女性收入和保险状况等因素能解释部分差异，但与当地医疗系统特征或女性生活的社会经济环境相关的其他影响因素尚未得到充分探究。
利用俄亥俄州居民横断面调查的数据，我们在一个具有全州代表性的样本中评估了2231名年龄在50至69岁之间女性的乳腺癌筛查情况。城市化、女性户主家庭（FHH）比例、管理式医疗活动、人均初级保健医生（PCP）数量以及被指定为医疗服务不足的县等是我们所考察的部分背景特征。我们使用嵌套分层逻辑回归模型，在调整受访者特征前后，评估了这些特征与乳腺癌筛查之间的关联。
符合年龄条件的女性接受乳腺癌筛查的比例为61.9%（n = 1383）；各县的筛查率从12.9%到100%不等（平均60.3%）。未完成高中学业、家庭收入较低以及没有连续保险、常规医疗服务来源或目前没有工作与较低的乳腺癌筛查率相关。在考虑这些特征后，人均初级保健医生数量（调整后的优势比[AOR]为1.05（1.01，1.10），p = 0.02）和女性户主家庭比例（AOR为0.66（0.44，0.99），p = 0.045）仍与乳腺癌筛查独立相关。
与乳腺癌筛查独立相关的背景特征确定了女性乳腺癌诊断延迟风险增加的领域。这里描述的方法可为区域、州或联邦加强乳腺癌筛查及减少后续治疗结果差异的倡议的规划阶段提供参考。
