Direction de l'Analyse et de l'Évaluation des Systèmes de Soins et Services, Institut National de Santé Publique du Québec, , Québec, Québec, Canada.
J Epidemiol Community Health. 2013 Oct;67(10):861-7. doi: 10.1136/jech-2013-202614. Epub 2013 Jul 13.
This study evaluated the impact of distance between women's residences and designated screening centres (DSC) on participation in the Quebec Breast Cancer Screening Programme, whether this impact varied according to the rural-urban classification and the proportion of participants who used the DSC nearest to their home.
Travel distance between the residence of 833 856 women and the nearest DSC (n=85) was estimated. Data were obtained from administrative and screening programme databases. The analysis made use of a log-binomial regression model adjusting for age and material and social deprivation. The proportions of participants who used the DSC nearest to their residence were measured.
Compared to women living <2.5 km from a DSC, absolute decreases of 6.3% and 9.8% in participation rate were observed for distances of 50.0 to <75.0 km (rate ratios (RR)=0.88, 95% CI 0.86 to 0.89) and ≥75.0 km (RR=0.81, 95% CI 0.79 to 0.83), respectively. The lowest participation (42%) was observed in Montreal Island. The distance at which participation started to decrease materially varied according to rural-urban classification. Participation rates decreased at distances of ≥25.0 km in the Montreal suburbs and midsize cities, at ≥12.5 km in small cities and at ≥50.0 km in rural areas (interaction p<0.0001). The proportion of participants who had their mammography at the nearest DSC decreased with increasing distance.
Distance affects participation and this effect varies according to rural-urban classification. The lower participation in Montreal Island, where all women lived <12.5 km from a DSC, argues for a major impact of other characteristics or other dimensions of accessibility.
本研究评估了女性住所与指定筛查中心（DSC）之间的距离对参加魁北克乳腺癌筛查计划的影响，以及这种影响是否因城乡分类和使用离家最近的 DSC 的参与者比例而异。
估计了 833856 名女性住所与最近的 DSC（n=85）之间的旅行距离。数据来自行政和筛查计划数据库。该分析使用对数二项式回归模型进行调整，以调整年龄、物质和社会剥夺因素。测量了使用离家最近的 DSC 的参与者比例。
与居住在距离 DSC<2.5 公里的女性相比，距离为 50.0 至<75.0 公里（RR=0.88，95%CI 0.86 至 0.89）和≥75.0 公里（RR=0.81，95%CI 0.79 至 0.83）的女性，参与率分别下降了 6.3%和 9.8%。在蒙特利尔岛上，参与率最低（42%）。参与率开始显著下降的距离因城乡分类而异。在蒙特利尔郊区和中等城市，距离≥25.0 公里时参与率下降，在小城市和农村地区，距离≥12.5 公里和≥50.0 公里时参与率下降（交互作用 p<0.0001）。距离越远，选择离家最近的 DSC 进行乳房 X 光检查的参与者比例越低。
距离会影响参与度，这种影响因城乡分类而异。在所有女性都居住在距离 DSC<12.5 公里的蒙特利尔岛上，参与率较低，这表明其他特征或其他可达性维度可能产生了重大影响。
