Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, United Kingdom.
Epidemiol Rev. 2011;33:135-47. doi: 10.1093/epirev/mxq018. Epub 2011 May 17.
Cancer screening participation shows a strong, graded association with socioeconomic status (SES) not only in countries such as the United States, where insurance status can be a barrier for lower income groups, but also in the United Kingdom, where the National Health Service provides all health care to residents, including screening, for free. Traditionally, the literature on socioeconomic inequalities has focused on upstream factors, but more proximal (downstream) influences on screening participation also need to be examined, particularly those that address the graded nature of the association rather than focusing specifically on underserved groups. This review offers a framework that links some of the components and corollaries of SES (life stress, educational opportunities, illness experience) to known psychosocial determinants of screening uptake (beliefs about the value of early detection, fatalistic beliefs about cancer, self-efficacy). The aim is to explain why individuals from lower SES backgrounds perceive cancer screening tests as more threatening, more difficult to accomplish, and less beneficial. A better understanding of the mechanisms through which lower SES causes negative attitudes toward screening could facilitate the development of intervention strategies to reduce screening inequalities.
癌症筛查的参与度与社会经济地位（SES）之间存在很强的等级关联，这不仅在美国等国家如此，在这些国家中，保险状况可能是低收入群体的障碍，而且在英国也是如此，国民保健制度为居民提供包括筛查在内的所有医疗保健服务，都是免费的。传统上，关于社会经济不平等的文献主要集中在上游因素上，但也需要研究对筛查参与度的更接近（下游）的影响，特别是那些解决关联的等级性质的影响，而不是专门针对服务不足的群体。本综述提供了一个框架，将 SES 的一些组成部分和推论（生活压力、受教育机会、疾病经历）与已知的筛查接受度的心理社会决定因素（对早期发现价值的信念、对癌症的宿命论信念、自我效能感）联系起来。其目的是解释为什么来自 SES 背景较低的个体认为癌症筛查测试更具威胁性、更难以完成且收益较低。更好地了解 SES 导致对筛查的负面态度的机制，可以促进制定干预策略来减少筛查方面的不平等。
