Department of Geography, College of Geosciences, Texas A&M University, College Station, Texas.
Department of Computer Science & Engineering, Dwight Look College of Engineering, Texas A&M University, College Station, Texas.
J Rural Health. 2017 Sep;33(4):382-392. doi: 10.1111/jrh.12202. Epub 2016 Aug 24.
Multiple intrapersonal and structural barriers, including geography, may prevent women from engaging in cervical cancer preventive care such as screening, diagnostic colposcopy, and excisional precancer treatment procedures. Geographic accessibility, stratified by rural and nonrural areas, to necessary services across the cervical cancer continuum of preventive care is largely unknown.
Health care facility data for New Mexico (2010-2012) was provided by the New Mexico Human Papillomavirus Pap Registry (NMHPVPR), the first population-based statewide cervical cancer screening registry in the United States. Travel distance and time between the population-weighted census tract centroid to the nearest facility providing screening, diagnostic, and excisional treatment services were examined using proximity analysis by rural and nonrural census tracts. Mann-Whitney test (P < .05) was used to determine if differences were significant and Cohen's r to measure effect.
Across all cervical cancer preventive health care services and years, women who resided in rural areas had a significantly greater geographic accessibility burden when compared to nonrural areas (4.4 km vs 2.5 km and 4.9 minutes vs 3.0 minutes for screening; 9.9 km vs 4.2 km and 10.4 minutes vs 4.9 minutes for colposcopy; and 14.8 km vs 6.6 km and 14.4 minutes vs 7.4 minutes for precancer treatment services, all P < .001).
Improvements in cervical cancer prevention should address the potential benefits of providing the full spectrum of screening, diagnostic and precancer treatment services within individual facilities. Accessibility, assessments distinguishing rural and nonrural areas are essential when monitoring and recommending changes to service infrastructures (eg, mobile versus brick and mortar).
多种内在的和结构性的障碍，包括地理位置，可能会阻碍妇女参与宫颈癌预防保健，如筛查、诊断性阴道镜检查和切除癌前病变治疗程序。跨越宫颈癌预防保健连续体的必要服务在地理上的可及性，按农村和非农村地区进行分层，在很大程度上是未知的。
新墨西哥州（2010-2012 年）的医疗设施数据由新墨西哥 HPV 巴氏 Registry（NMHPVPR）提供，这是美国第一个基于人群的全州范围的宫颈癌筛查登记处。使用接近度分析，根据农村和非农村普查区，检查了从人口加权的普查区质心到提供筛查、诊断和切除治疗服务的最近设施的旅行距离和时间。采用 Mann-Whitney 检验（P<0.05）确定差异是否显著，采用 Cohen's r 衡量效应。
在所有宫颈癌预防保健服务和年份中，与非农村地区相比，居住在农村地区的妇女在地理上的可及性负担明显更大（筛查分别为 4.4 公里对 2.5 公里和 4.9 分钟对 3.0 分钟；阴道镜检查分别为 9.9 公里对 4.2 公里和 10.4 分钟对 4.9 分钟；癌前病变治疗服务分别为 14.8 公里对 6.6 公里和 14.4 分钟对 7.4 分钟，所有 P<0.001）。
改善宫颈癌预防措施应考虑在单个设施内提供全面的筛查、诊断和癌前病变治疗服务的潜在益处。在监测和建议服务基础设施的变化时，可及性和区分农村和非农村地区的评估是至关重要的（例如，移动与实体）。
