Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
BMC Med Res Methodol. 2012 Apr 25;12:59. doi: 10.1186/1471-2288-12-59.
Ecological or survey based methods to investigate screening uptake rates are fraught with many limitations which can be circumvented by record linkage between Census and health services datasets using variations in breast screening attendance as an exemplar. The aim of this current study is to identify the demographic, socio-economic factors associated with uptake of breast screening.
Record linkage study: combining 2001 Census data within the Northern Ireland Longitudinal Study (NILS) with data relating to validated breast screening histories from the National Breast Screening System. A cohort was identified of 37,059 women aged 48-64 at the Census who were invited for routine breast screening in the three years following the Census. All cohort attributes were as recorded on the Census form.
The record linkage methodology enabled the records of almost 40,000 of those invited for screening to be analysed at an individual level, exceeding the largest published survey by a factor of ten. This produced a more robust analysis and demonstrated (in fully adjusted models) the lower uptake amongst non-married women and those in the lowest social class (OR 0.74; 95%CI 0.66, 0.82), factors that had not been reported earlier in the UK. In addition, with the availability of both individual and area information it was possible to show that the much lower screening uptake in urban areas is not due to differences in population composition suggesting unrecognised organisational problems.
Linkage of screening data to Census-based longitudinal studies is an efficient and powerful way to increase the evidence base on sources of variation in screening uptake within the UK.
基于生态学或调查的方法来研究筛查参与率存在许多局限性，这些局限性可以通过使用乳腺癌筛查参与率的变化，在人口普查和卫生服务数据集之间进行记录链接来规避。本研究的目的是确定与乳腺癌筛查参与率相关的人口统计学和社会经济因素。
记录链接研究：将 2001 年人口普查数据与国家乳腺癌筛查系统中验证的乳腺癌筛查史数据相结合，纳入北爱尔兰纵向研究（NILS）中。确定了一个队列，由 37059 名在人口普查时年龄在 48-64 岁的女性组成，她们在人口普查后的三年内被邀请进行常规乳腺癌筛查。所有队列属性均按人口普查表记录。
记录链接方法使几乎 40000 名被邀请进行筛查的人的记录能够在个体层面进行分析，超过了之前在英国发表的最大规模的调查的十倍。这产生了更稳健的分析，并证明了（在完全调整的模型中）未婚女性和社会阶层最低的女性参与率较低（OR 0.74；95%CI 0.66, 0.82），这些因素在英国以前没有报道过。此外，由于既有个人信息又有地区信息，因此可以表明城市地区较低的筛查参与率不是由于人口构成的差异造成的，这表明存在未被识别的组织问题。
将筛查数据与基于人口普查的纵向研究相链接是一种有效且强大的方法，可以增加英国筛查参与率变化来源的证据基础。
