与亚裔美国人结直肠癌、乳腺癌和宫颈癌筛查相关的患者及医疗服务提供者特征。
Patient and provider characteristics associated with colorectal, breast, and cervical cancer screening among Asian Americans.
作者信息
Thompson Caroline A, Gomez Scarlett Lin, Chan Albert, Chan John K, McClellan Sean R, Chung Sukyung, Olson Cliff, Nimbal Vani, Palaniappan Latha P
机构信息
Palo Alto Medical Foundation Research Institute, Palo Alto, California.
Cancer Prevention Institute of California, Fremont, California. Department of Epidemiology, Stanford University School of Medicine, Palo Alto, California.
出版信息
Cancer Epidemiol Biomarkers Prev. 2014 Nov;23(11):2208-17. doi: 10.1158/1055-9965.EPI-14-0487.
BACKGROUND
Routinely recommended screening for breast, cervical, and colorectal cancers can significantly reduce mortality from these types of cancer, yet screening is underutilized among Asians. Surveys rely on self-report and often are underpowered for analysis by Asian ethnicities. Electronic health records (EHR) include validated (as opposed to recall-based) rates of cancer screening. In this article, we seek to better understand cancer screening patterns in a population of insured Asian Americans.
METHODS
We calculated rates of compliance with cervical, breast, and colorectal cancer screening among Asians from an EHR population and compared them with non-Hispanic whites. We performed multivariable modeling to evaluate potential predictors (at the provider- and patient-level) of screening completion among Asian patients.
RESULTS
Aggregation of Asian subgroups masked heterogeneity in screening rates. Asian Indians and native Hawaiians and Pacific Islanders had the lowest rates of screening in our sample, well below that of non-Hispanic whites. In multivariable analyses, screening completion was negatively associated with patient-physician language discordance for mammography [OR, 0.81; 95% confidence interval (CI), 0.71-0.92] and colorectal cancer screening (OR, 0.79; CI, 0.72-0.87) and positively associated with patient-provider gender concordance for mammography (OR, 1.16; CI, 1.00-1.34) and cervical cancer screening (OR, 1.66; CI, 1.51-1.82). In addition, patient enrollment in online health services increased mammography (OR, 1.32; CI, 1.20-1.46) and cervical cancer screening (OR, 1.31; CI, 1.24-1.37).
CONCLUSIONS
Language- and gender-concordant primary care providers and culturally tailored online health resources may help improve preventive cancer screening in Asian patient populations.
IMPACT
This study demonstrates how the use of EHR data can inform investigations of primary prevention practices within the healthcare delivery setting.
背景
常规推荐的乳腺癌、宫颈癌和结直肠癌筛查可显著降低这些癌症类型导致的死亡率，但亚洲人群对筛查的利用不足。调查依赖自我报告，且针对亚洲族裔的分析往往缺乏足够的效力。电子健康记录（EHR）包含经过验证（而非基于回忆）的癌症筛查率。在本文中，我们试图更好地了解参保的亚裔美国人的癌症筛查模式。
方法
我们计算了EHR人群中亚裔的宫颈癌、乳腺癌和结直肠癌筛查依从率，并将其与非西班牙裔白人进行比较。我们进行多变量建模以评估亚洲患者中筛查完成情况的潜在预测因素（在医疗服务提供者和患者层面）。
结果
亚洲亚组的汇总掩盖了筛查率的异质性。在我们的样本中，印度裔亚洲人和夏威夷原住民及太平洋岛民的筛查率最低，远低于非西班牙裔白人。在多变量分析中，乳腺钼靶筛查（比值比[OR]，0.81；95%置信区间[CI]，0.71 - 0.92）和结直肠癌筛查（OR，0.79；CI，0.72 - 0.87）的筛查完成情况与医患语言不一致呈负相关，而乳腺钼靶筛查（OR，1.16；CI，1.00 - 1.34）和宫颈癌筛查（OR，1.66；CI，1.51 - 1.82）的筛查完成情况与医患性别一致呈正相关。此外，患者注册在线健康服务可提高乳腺钼靶筛查（OR，1.32；CI，1.20 - 1.46）和宫颈癌筛查（OR，1.31；CI，1.24 - 1.37）的比例。
结论
语言和性别匹配的初级保健提供者以及符合文化特点的在线健康资源可能有助于改善亚洲患者群体的癌症预防筛查。
影响
本研究展示了如何利用EHR数据为医疗服务环境中的一级预防实践调查提供信息。
Zotero 插件