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毛利族裔错误分类对宫颈癌筛查覆盖率的影响。

The effect of Māori ethnicity misclassification on cervical screening coverage.

作者信息

Sandiford Peter, Salvetto Micol, Bramley Dale, Wong Samuel, Johnson Lannes

机构信息

Public Health Physician, Waitemata District Health Board, Auckland 0740, New Zealand.

出版信息

N Z Med J. 2013 Apr 5;126(1372):55-65.

Abstract

AIM

There is a large difference in the cervical screening coverage rate between Māori and European women in New Zealand. This paper examines the extent to which this difference is due to misclassification of ethnicity.

METHODS

Data from Waitemata District Health Board's two Primary Health Organisations (PHOs) was used to identify the population of Waitemata domiciled women aged 25-69 years eligible for cervical screening. Their cervical screening status was obtained from the National Cervical Screening Programme register (NCPS-R). Data from Auckland and Waitemata DHBs was used to determine the women's ethnicity in the National Health Index (NHI). Women who had withdrawn from the NCSP-R, women who were deceased and women for whom an NHI ethnicity code could not be obtained were excluded from the analysis. Ethnicity codes from the three sources (PHO registers, NCSP-R and NHI) were compared to identify women classified as non-Māori in the NCSP-R but Maori in either of the other two data sources. The effect on Maori cervical screening coverage rates of not counting these women was assessed.

RESULTS

Within the study population there was a total of 6718 women identified as Māori on the NCSP of whom 5242 had been screened within the last 3 years and 1476 who had not. In addition to these, there were 2075 women identified as Māori in either the PHO or NHI databases but not in the NCSP-R who had been screened within the preceding 3 years, and a further 2094 who had not been screened. There were also 797 women identified as Maori in the NHI or PHO datasets who were not on the NCSP-R (and therefore were not screened). If all screened women classified as Māori from any source were counted, Waitemata DHB's Māori screening coverage rate would rise from 49.3% to 68.8% (or to 61.0% and 63.2% respective if just PHO and NHI Māori were counted).

CONCLUSION

Misclassification of ethnicity could explain (in absolute terms) up to 19.5% of the 35.0% difference in cervical screening coverage rate between Māori and non-Māori , non-Pacific, non-Asian coverage in Waitemata District. Misclassification is likely to have similar effects on coverage estimates throughout New Zealand. Without improving the accuracy of ethnicity data in the NCSP-R it will be impossible for the country to achieve the target coverage rate of 80% among Māori.

摘要

目的

在新西兰,毛利族和欧洲族裔女性的宫颈癌筛查覆盖率存在很大差异。本文探讨了这种差异在多大程度上是由于族裔分类错误所致。

方法

利用怀塔玛塔地区卫生委员会下属两个初级卫生组织(PHO)的数据,确定居住在怀塔玛塔地区、年龄在25至69岁之间符合宫颈癌筛查条件的女性人群。她们的宫颈癌筛查状况来自国家宫颈癌筛查计划登记册(NCPS-R)。奥克兰和怀塔玛塔地区卫生委员会的数据用于确定国家健康指数(NHI)中这些女性的族裔。退出NCSP-R的女性、已故女性以及无法获取NHI族裔代码的女性被排除在分析之外。比较三个来源(PHO登记册、NCSP-R和NHI)的族裔代码,以确定在NCSP-R中被归类为非毛利族,但在其他两个数据源中的任何一个中被归类为毛利族的女性。评估了不将这些女性计算在内对毛利族宫颈癌筛查覆盖率的影响。

结果

在研究人群中,共有6718名女性在NCSP中被确定为毛利族,其中5242人在过去3年内接受了筛查,1476人未接受筛查。除此之外,在PHO或NHI数据库中被确定为毛利族但不在NCSP-R中的2075名女性在过去3年内接受了筛查,另有2094人未接受筛查。在NHI或PHO数据集中被确定为毛利族但不在NCSP-R中的还有797名女性(因此未接受筛查)。如果将所有来自任何来源被归类为毛利族的已筛查女性计算在内,怀塔玛塔地区卫生委员会的毛利族筛查覆盖率将从49.3%升至68.8%(如果仅计算PHO和NHI中的毛利族女性,则分别升至61.0%和63.2%)。

结论

族裔分类错误(从绝对值来看)可以解释怀塔玛塔地区毛利族与非毛利族、非太平洋岛民、非亚裔人群宫颈癌筛查覆盖率35.0%的差异中高达19.5%的部分。分类错误可能对新西兰各地的覆盖率估计产生类似影响。如果不提高NCSP-R中族裔数据的准确性,该国将无法实现毛利族80%的目标覆盖率。

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