Ahmed Ahmed T, Welch Brian T, Brinjikji Waleed, Farah Wigdan H, Henrichsen Tara L, Murad M Hassan, Knudsen John M
Evidence-based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota.
Department of Radiology, Mayo Clinic, Rochester, Minnesota.
J Am Coll Radiol. 2017 Feb;14(2):157-165.e9. doi: 10.1016/j.jacr.2016.07.034. Epub 2016 Dec 16.
Many studies have suggested that disparities exist in the use of medical screening tests. The purpose of this study was to assess racial disparities in screening mammography in the United States via a systematic review and meta-analysis.
We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus for comparative studies published between 1946 and 2015 comparing utilization of mammography among various racial groups. Two independent reviewers extracted data and appraised study. Meta-analysis was conducted when appropriate using the random-effects model.
A total of 5,818,380 patients were included across 39 relevant studies; 43.1% of patients were white, 33.3% were black, 17.4% were Hispanic, and 6.2% were Asian/Pacific Islander. Black and Hispanic populations had lower odds of utilizing screening mammography when compared with the white population (odds ratio [OR] = 0.81; 95% confidence interval [CI], 0.72-0.91; I = 89.4% and OR = 0.83; 95% CI, 0.74-0.93, respectively). For African Americans, these disparities were present in both the 40 to 65 age group and the >65 age group; for Hispanics, these differences were present only in the 40 to 65 age group. There was no difference in mammography utilization between Asians/Pacific Islanders and whites (OR = 1.82; 95% CI, 0.09-38.41).
Racial disparities in utilization of screening mammography are evident in black and Hispanic populations in the United States. Further studies are needed to understand reasons for disparities, trends over time, and the effectiveness of interventions targeting these disparities.
许多研究表明，医学筛查检查的使用存在差异。本研究的目的是通过系统评价和荟萃分析评估美国乳腺钼靶筛查中的种族差异。
我们检索了MEDLINE、EMBASE、Cochrane对照试验中心注册库、Cochrane系统评价数据库和Scopus，以查找1946年至2015年间发表的比较不同种族群体乳腺钼靶使用情况的比较研究。两名独立的评审员提取数据并评估研究。在适当情况下使用随机效应模型进行荟萃分析。
39项相关研究共纳入5818380名患者；43.1%为白人，33.3%为黑人，17.4%为西班牙裔，6.2%为亚裔/太平洋岛民。与白人相比，黑人和西班牙裔人群进行乳腺钼靶筛查的几率较低（优势比[OR]=0.81；95%置信区间[CI]，0.72-0.91；I=89.4%；OR=0.83；95%CI，0.74-0.93）。对于非裔美国人，这些差异在40至65岁年龄组和65岁以上年龄组中均存在；对于西班牙裔，这些差异仅存在于40至65岁年龄组中。亚裔/太平洋岛民和白人在乳腺钼靶使用方面没有差异（OR=1.82；95%CI，0.09-38.41）。
美国黑人和西班牙裔人群在乳腺钼靶筛查使用方面存在明显的种族差异。需要进一步研究以了解差异的原因、随时间的趋势以及针对这些差异的干预措施的有效性。
