老年癌症幸存者的预防保健
Preventive care in older cancer survivors.
作者信息
Lowenstein Lisa M, Ouellet Jennifer Andreozzi, Dale William, Fan Lin, Gupta Mohile Supriya
机构信息
James Wilmot Cancer Center, University of Rochester, Rochester, NY, USA.
Department of Medicine, Section of Geriatrics and Palliative Medicine, The University of Chicago, Chicago, IL, USA.
出版信息
J Geriatr Oncol. 2015 Mar;6(2):85-92. doi: 10.1016/j.jgo.2014.12.003. Epub 2014 Dec 24.
OBJECTIVE
To study factors that influence receipt of preventive care in older cancer survivors.
METHODS
We analyzed a nationally representative sample of 12,458 older adults from the 2003 Medicare Current Beneficiary Survey. Factors associated with non-receipt of preventive care were explored among cancer and non-cancer survivors, using logistic regression.
RESULTS
Among the cancer survivors, 1883 were diagnosed >1 year at survey completion. A cancer history was independently associated with receipt of mammogram (AOR = 1.57, 95% CI = 1.34-1.85), flu shot (AOR = 1.33, 95% CI = 1.16-1.53), measurement of total cholesterol in the previous six months (AOR = 1.20, 95% CI = 1.07-1.34), pneumonia vaccination (AOR = 1.33, 95% CI = 1.18-1.49), bone mineral density (BMD) testing (AOR = 1.38, 95% CI = 1.21-1.56), and lower endoscopy (AOR = 1.46, 95% CI = 1.29-1.65). However, receipt of preventive care was not optimal among older cancer survivors with only 51.2% of the female cancer survivors received a mammogram, 63.8% of all the cancer survivors received colonoscopy, and 42.5% had BMD testing. Among the cancer survivors, factors associated with non-receipt of mammogram included age ≥85 years (AOR = 0.43, 95% CI = 0.26-0.74), and scoring ≥three points on the Vulnerable Elders Survey-13 (AOR = 0.94, 95% CI = 0.80-1.00). Factors associated with non-receipt of colonoscopy included low education (AOR= 0.43, 95% CI = 0.27-0.68) and rural residence (AOR = 0.51, 95% CI = 0.34-0.77). Factors associated with non-receipt of BMD testing included age ≥70 (AOR = 0.59, 95% CI = 0.39-0.90), African American race (AOR = 0.51, 95% CI= 0.27-0.95), low education (AOR = 0.23, 95% CI = 0.14-0.38), and rural residence (AOR = 0.43, 95% CI = 0.27-0.70).
CONCLUSION
Although older cancer survivors are more likely to receive preventive care services than other older adults, factors other than health status considerations (e.g., education, rural residence) are associated with non-receipt of preventive care services.
目的
研究影响老年癌症幸存者接受预防性护理的因素。
方法
我们分析了2003年医疗保险当前受益人调查中12458名老年人的全国代表性样本。在癌症幸存者和非癌症幸存者中，采用逻辑回归探讨与未接受预防性护理相关的因素。
结果
在癌症幸存者中，1883人在调查完成时被诊断超过1年。癌症病史与接受乳房X光检查（比值比[AOR]=1.57，95%置信区间[CI]=1.34 - 1.85）、流感疫苗接种（AOR = 1.33，95% CI = 1.16 - 1.53）、前六个月总胆固醇测量（AOR = 1.20，95% CI = 1.07 - 1.34）、肺炎疫苗接种（AOR = 1.33，95% CI = 1.18 - 1.49）、骨密度（BMD）检测（AOR = 1.38，95% CI = 1.21 - 1.56）和低位内镜检查（AOR = 1.46，95% CI = 1.29 - 1.65）独立相关。然而，老年癌症幸存者接受预防性护理的情况并不理想，只有51.2%的女性癌症幸存者接受了乳房X光检查，63.8%的所有癌症幸存者接受了结肠镜检查，42.5%进行了BMD检测。在癌症幸存者中，与未接受乳房X光检查相关的因素包括年龄≥85岁（AOR = 0.43，95% CI = 0.26 - 0.74），以及在脆弱老年人调查 - 13中得分≥3分（AOR = 0.94，95% CI = 0.80 - 1.00）。与未接受结肠镜检查相关的因素包括低教育程度（AOR = 0.43，95% CI = 0.27 - 0.68）和农村居住（AOR = 0.51，95% CI = 0.34 - 0.77）。与未接受BMD检测相关的因素包括年龄≥70岁（AOR = 0.59，95% CI = 0.39 - 0.90）、非裔美国人种族（AOR = 0.51，95% CI = 0.27 - 0.95）、低教育程度（AOR = 0.23，95% CI = 0.14 - 0.38）和农村居住（AOR = 0.43，95% CI = 0.27 - 0.70）。
结论
尽管老年癌症幸存者比其他老年人更有可能接受预防性护理服务，但除了健康状况因素（如教育程度、农村居住）外，其他因素也与未接受预防性护理服务相关。
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