Durham Danielle D, Robinson Whitney R, Lee Sheila S, Wheeler Stephanie B, Reeder-Hayes Katherine E, Bowling J Michael, Olshan Andrew F, Henderson Louise M
Department of Epidemiology, UNC Gillings School of Public Health, The University of North Carolina at Chapel Hill, North Carolina.
Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, North Carolina.
Cancer Epidemiol Biomarkers Prev. 2016 Nov;25(11):1474-1482. doi: 10.1158/1055-9965.EPI-16-0148.
Insurance may lengthen or inhibit time to follow-up after positive screening mammography. We assessed the association between insurance status and time to initial diagnostic follow-up after a positive screening mammogram.
Using 1995-2010 data from a North Carolina population-based registry of breast imaging and cancer outcomes, we identified women with a positive screening mammogram. We compared receipt of follow-up within 60 days of screening using logistic regression and evaluated time to follow-up initiation using Cox proportional hazards regression.
Among 43,026 women included in the study, 73% were <65 years and 27% were 65+ years. Median time until initial diagnostic follow-up was similar by age group and insurance status. In the adjusted model for women <65, uninsured women experienced a longer time to initiation of diagnostic follow-up [HR, 0.47; 95% confidence interval (CI), 0.25-0.89] versus women with private insurance. There were increased odds of these uninsured women not meeting the Centers for Disease Control and Prevention guideline for follow-up within 60 days (OR, 1.59; 95% CI, 1.31-1.94). Among women ages 65+, women with private insurance experienced a faster time to follow-up (adjusted HR, 2.09; 95% CI, 1.27-3.44) than women with Medicare and private insurance. Approximately 10% of women had no follow-up by 365 days.
We found differences in time to initial diagnostic follow-up after a positive screening mammogram by insurance status and age group. Uninsured women younger than 65 years at a positive screening event had delayed follow-up.
Replication of these findings and examination of their clinical significance warrant additional investigation. Cancer Epidemiol Biomarkers Prev; 25(11); 1474-82. ©2016 AACR.
保险可能会延长或阻碍乳腺钼靶筛查呈阳性后的随访时间。我们评估了保险状况与乳腺钼靶筛查呈阳性后首次诊断性随访时间之间的关联。
利用北卡罗来纳州基于人群的乳腺成像与癌症结局登记处1995 - 2010年的数据，我们确定了乳腺钼靶筛查呈阳性的女性。我们使用逻辑回归比较了筛查后60天内接受随访的情况，并使用Cox比例风险回归评估了随访开始的时间。
在纳入研究的43,026名女性中，73%年龄小于65岁，27%年龄在65岁及以上。按年龄组和保险状况划分，直至首次诊断性随访的中位时间相似。在针对年龄小于65岁女性的调整模型中，与有私人保险的女性相比，未参保女性开始诊断性随访的时间更长[风险比（HR），0.47；95%置信区间（CI），0.25 - 0.89]。这些未参保女性未达到疾病控制与预防中心60天内随访指南的几率增加（比值比，1.59；95% CI，1.31 - 1.94）。在65岁及以上的女性中，有私人保险的女性比有医疗保险和私人保险的女性随访时间更快（调整后HR，2.09；95% CI，1.27 - 3.44）。约10%的女性在365天时尚未进行随访。
我们发现乳腺钼靶筛查呈阳性后首次诊断性随访时间因保险状况和年龄组而异。乳腺钼靶筛查呈阳性时年龄小于65岁的未参保女性随访延迟。
重复这些发现并检查其临床意义值得进一步研究。《癌症流行病学、生物标志物与预防》；25(11)；1474 - 82。©2016美国癌症研究协会。
