Charry Ligia Constanza de, Carrasquilla Gabriel, Roca Sandra
Centro de Estudios e Investigación en Salud, Bogotá, Colombia.
Rev Salud Publica (Bogota). 2008 Aug-Oct;10(4):571-82. doi: 10.1590/s0124-00642008000400007.
Evaluating equity regarding early breast cancer detection by comparing real access to and opportunity for mammography screening according to women's social health insurance status.
A retrospective follow-up study was conducted on women receiving breast cancer treatment in Bogotá, Cali, Medellin, Bucaramanga and Barranquilla between January 2005 and June 2006. A survey was carried out for collecting data about real access to and the opportunity of having mammography screening. OR and 95% confidence intervals were calculated (adjusted by multivariate logistical regression models) for establishing differences according to health insurance status. Possible interactions were investigated through verisimilarity log-like test.
Women belonging to the contributory regime had a lower probability of real access to mammography screening for early detection of breast cancer than those affiliated to the subsidised regimen (OR=0,46; 0,26-0,72 95 %CI) and poor uninsured women (OR=0,36; 0,13-0,65 95 %CI). Educational level was also associated with real access to mammography, illiterate women having a lower probability of receiving mammography screening than literate women (OR=0,13; 0,02-0,30 95 %CI). Women having government-subsidised health insurance had a lower probability of accessing timely mammography screening (OR=0,10; 0,04-0,41 95 %CI).
Mammography screening for the early detection of breast cancer is not equitable and such inequality particularly affects the most vulnerable women.
通过比较不同社会医疗保险状况的女性实际获得乳腺钼靶筛查的机会，评估早期乳腺癌检测的公平性。
对2005年1月至2006年6月期间在波哥大、卡利、麦德林、布卡拉曼加和巴兰基亚接受乳腺癌治疗的女性进行回顾性随访研究。开展一项调查以收集有关实际获得乳腺钼靶筛查的机会的数据。计算比值比（OR）和95%置信区间（通过多变量逻辑回归模型进行调整），以确定根据健康保险状况的差异。通过似然对数检验研究可能的相互作用。
参保制度下的女性实际获得乳腺钼靶筛查以早期发现乳腺癌的概率低于补贴制度下的女性（OR = 0.46；95%CI为0.26 - 0.72）和未参保贫困女性（OR = 0.36；95%CI为0.13 - 0.65）。教育水平也与实际获得乳腺钼靶筛查相关，文盲女性接受乳腺钼靶筛查的概率低于识字女性（OR = 0.13；95%CI为0.02 - 0.30）。拥有政府补贴医疗保险的女性及时获得乳腺钼靶筛查的概率较低（OR = 0.10；95%CI为0.04 - 0.41）。
用于早期发现乳腺癌的乳腺钼靶筛查不公平，这种不平等尤其影响最脆弱的女性。
