Wharam J Frank, Landon Bruce E, Xu Xin, Zhang Fang, Ross-Degnan Dennis
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (Drs Wharam, Zhang, and Ross-Degnan and Mr Xu); Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts (Dr Landon).
J Public Health Manag Pract. 2015 Sep-Oct;21(5):426-32. doi: 10.1097/PHH.0000000000000101.
Prior research suggests that mammography declined from 2000 to 2005 and that socioeconomic disparities remained wide.
To assess national trends and disparities in mammography among commercially insured women from 2001 to 2010.
DESIGN, SETTING, PARTICIPANTS: This study used a longitudinal time series design to examine mammography rates among 5.4 million US women aged 40 to 64 years from 2001 to 2010. Adjusted annual rates stratified by age group (40-49 years/50-64 years) and neighborhood-level socioeconomic characteristics including poverty and race/ethnicity were plotted. Mammography disparities were defined as the absolute percentage difference in adjusted screening rates between population subgroups in a given year. Trends in 2001-2010 screening rates and socioeconomic disparities were fitted as annual percentage changes (APCs) using join point analysis, which can determine changes in trends.
Annual and biennial mammogram.
Adjusted annual mammography rates among women aged 40 to 49 years increased from 38.5% to 45.5% (0.78% APC, P < .001) over the decade. Among women aged 50 to 64 years, 2001-2004 rates decreased from 49.7% to 47.4% (-0.78% APC, P = .035) and then increased to 51.8% by 2010 (APC of 0.80%, P < .001). Women aged 40 to 49 years had an unchanged high-low neighborhood poverty screening disparity of 11.0% over the decade (APC -0.05%, P = .508). The estimated white-black disparity decreased from 9.6% to 7.7% from 2001 to 2010 (-0.21% APC, P = .042). The white-Hispanic disparity decreased from 9.6% to 6.2% between 2001 and 2003 (APC -1.69%, P = .143) and then to 5.3% by 2010 (APC -0.14%, P = .343). Among women aged 50 to 64 years, estimated high-low poverty and white-black disparities declined (11.0%-9.5% [-0.16% APC, P = .026] and 8.6%-6.3% [-0.26% APC, P = .008], respectively) while the white-Hispanic disparity decreased from 14.9% to 5.4% between 2001 and 2003 (-4.77% APC, P = .023) and was 6.5% by 2010.
Mammography increased among women aged 40 to 49 years from 2001 to 2010 and after 2004 among women aged 50 to 64 years. Women from black and Hispanic neighborhoods experienced reduced disparities, but disparities by poverty level changed little.
先前的研究表明，2000年至2005年期间乳房X光检查率下降，社会经济差距依然很大。
评估2001年至2010年期间商业保险女性乳房X光检查的全国趋势和差异。
设计、地点、参与者：本研究采用纵向时间序列设计，以检查2001年至2010年期间540万年龄在40至64岁的美国女性的乳房X光检查率。绘制了按年龄组（40 - 49岁/50 - 64岁）以及包括贫困和种族/族裔在内的社区层面社会经济特征分层的调整后年率。乳房X光检查差异定义为给定年份中人群亚组之间调整后筛查率的绝对百分比差异。使用连接点分析将2001 - 2010年筛查率和社会经济差异的趋势拟合为年度百分比变化（APC），连接点分析可以确定趋势变化。
年度和两年一次的乳房X光检查。
在这十年间，40至49岁女性的调整后年度乳房X光检查率从38.5%升至45.5%（APC为0.78%，P <.001）。在50至64岁女性中，2001 - 2004年的检查率从49.7%降至47.4%（APC为 - 0.78%，P =.035），到2010年又升至51.8%（APC为0.80%，P <.001）。40至49岁的女性在这十年间高低邻里贫困筛查差异保持在11.0%不变（APC为 - 0.05%，P =.508）。从2001年到2010年，估计的白人与黑人之间的差异从9.6%降至7.7%（APC为 - 0.21%，P =.042）。2001年至2003年间，白人与西班牙裔之间的差异从9.6%降至6.2%（APC为 - 1.69%，P =.143），到2010年降至5.3%（APC为 - 0.14%，P =.343）。在50至64岁的女性中，估计的高低贫困差异和白人与黑人之间的差异有所下降（分别从11.0%降至9.5%[APC为 - 0.16%，P =.026]和从8.6%降至6.3%[APC为 - 0.26%，P =.008]），而2001年至2003年间白人与西班牙裔之间的差异从14.9%降至5.4%（APC为 - 4.77%，P =.023），到2010年为6.5%。
2001年至2010年期间，40至49岁女性的乳房X光检查率上升，2004年后50至64岁女性的检查率上升。来自黑人和西班牙裔社区的女性差异有所减少，但贫困水平导致的差异变化不大。
