Araujo Mélanie, Franck Jeanna-Eve, Cadot Emmanuelle, Gautier Arnaud, Chauvin Pierre, Rigal Laurent, Ringa Virginie, Menvielle Gwenn
Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012 Paris, France.
IRD, UMR 5569, HydroSciences, F-34394 Montpellier, France.
Cancer Epidemiol. 2017 Jun;48:117-123. doi: 10.1016/j.canep.2017.04.014. Epub 2017 May 5.
Some contextual factors associated with participation in cervical cancer screening are reported in the literature, but few studies have examined their combined effect. Our objective was to assess the role of contextual characteristics, separately and in combination, in participation in cervical cancer screening in France.
Marginal Poisson regression models - taking into account the correlation between women in a given commune - were conducted using data from the Baromètre Santé 2010 survey. The characteristics of the commune of residence of the women studied were the potential spatial accessibility to general practitioners (GP) and gynecologists, the agglomeration category, and the socioeconomic level.
The analyses were performed in 3380 women, 88.2% of whom were up to date with their cervical cancer screening. Once the individual characteristics were taken into account, the screening participation rate was similar in all the communes, with the exception of those with poor access to a gynecologist and good access to a GP, where the rate was 6% lower (95%CI: 0.5-11%) than in the communes with good access to both GP and gynecologist. The same association with accessibility was observed in small agglomerations. Compared to women living in the more advantaged communes, the screening participation rate was 8% (2-12%) lower in those living in the more disadvantaged ones, except when accessibility to both types of physician was high.
We observed an association between potential spatial accessibility to care in women's residential communities and their cervical cancer screening practices, in particular in small agglomerations, rural communes, and more disadvantaged communes.
文献中报道了一些与参与宫颈癌筛查相关的背景因素，但很少有研究考察它们的综合作用。我们的目的是评估背景特征单独以及综合起来在法国参与宫颈癌筛查中的作用。
使用2010年健康晴雨表调查的数据，进行了考虑给定社区内女性之间相关性的边际泊松回归模型分析。所研究女性居住社区的特征包括到全科医生（GP）和妇科医生处就诊的潜在空间可达性、集聚类别以及社会经济水平。
对3380名女性进行了分析，其中88.2%的女性宫颈癌筛查及时。在考虑个体特征后，除了那些难以找到妇科医生但容易找到全科医生的社区外，所有社区的筛查参与率相似，在这些社区中，筛查参与率比那些同时容易找到全科医生和妇科医生的社区低6%（95%置信区间：0.5 - 11%）。在小集聚地区也观察到了与可达性相同的关联。与生活在较富裕社区的女性相比，生活在较贫困社区的女性筛查参与率低8%（2 - 12%），但两种医生的可达性都很高时除外。
我们观察到女性居住社区的潜在空间医疗可达性与其宫颈癌筛查行为之间存在关联，特别是在小集聚地区、农村社区和较贫困社区。
