Health Sciences Department, Gettysburg College, 300 N. Washington St., Campus Box 432, Gettysburg, PA 17325, USA.
Cancer Epidemiol Biomarkers Prev. 2011 Nov;20(11):2331-44. doi: 10.1158/1055-9965.EPI-11-0528. Epub 2011 Sep 13.
Despite a considerable number of studies describing the relationship between area-level socioeconomic conditions and mammography screening, definitive conclusions have yet to be drawn. The aim of this study was to examine the relationship between area-level socioeconomic position (SEP) and repeat mammography screening, using nationwide U.S. census SEP data linked to a nationally representative sample of women who participated in the 2005 National Health Interview Survey (NHIS).
An area-level SEP index using 2000 U.S. census tract data was constructed and categorized into quartiles, including information on unemployment, poverty, housing values, annual family income, education, and occupation. Repeat mammography utilization (dichotomous variable) was defined as having three mammograms over the course of 6 years (24-month interval), which must have included a recent mammogram (in past 2 years). Results were obtained by ordinary multivariable logistic regression for survey data. Women ages 46 to 79 years (n = 7,352) were included in the analysis.
In a model adjusted for sociodemographics, health care factors, and known correlates of mammography screening, women living in more disadvantaged areas had lower odds of engaging in repeat mammography than women living in the most advantaged areas [OR comparing quartile 4 (most disadvantaged) to quartile 1 (most advantaged) = 0.63; 95% confidence interval, 0.50-0.80].
The results of this nationwide study support the hypothesis that area-level SEP is independently associated with mammography utilization.
These findings underscore the importance of addressing area-level social inequalities, if uptake of mammography screening guidelines is to be realized across all social strata.
尽管有相当数量的研究描述了地区社会经济条件与乳房 X 光检查之间的关系，但仍未得出明确的结论。本研究旨在使用全国性的美国人口普查社会经济地位（SEP）数据，结合参与 2005 年全国健康访谈调查（NHIS）的具有代表性的女性样本，检验地区社会经济地位（SEP）与重复乳房 X 光检查之间的关系。
利用 2000 年美国人口普查区数据构建了一个地区社会经济地位指数，并将其分为四分位数，包括失业、贫困、住房价值、家庭年收入、教育和职业等信息。重复乳房 X 光利用率（二分变量）定义为在 6 年内进行了 3 次乳房 X 光检查（24 个月间隔），其中必须包括最近的一次乳房 X 光检查（过去 2 年）。使用普通多变量逻辑回归分析调查数据。分析纳入了年龄在 46 至 79 岁之间的女性（n=7352）。
在调整了社会人口统计学、医疗保健因素和已知乳房 X 光检查相关因素的模型中，生活在较不利地区的女性进行重复乳房 X 光检查的可能性低于生活在最有利地区的女性[比较四分位数 4（最不利）和四分位数 1（最有利）的比值比（OR）=0.63；95%置信区间，0.50-0.80]。
这项全国性研究的结果支持了这样的假设，即地区社会经济地位与乳房 X 光利用率独立相关。
这些发现强调了如果要在所有社会阶层中实现乳房 X 光检查指南的使用率，就必须解决地区社会不平等问题。
