Larsen Mette Bach, Mikkelsen Ellen M, Jeppesen Ulla, Svanholm Hans, Andersen Berit
Department of Public Health Programs, Randers Regional Hospital, Skovlyvej 1, 8930, Randers, NØ, Denmark.
Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé, 43-45 8200, Aarhus N, Denmark.
BMC Health Serv Res. 2017 Jun 20;17(1):423. doi: 10.1186/s12913-017-2371-4.
High coverage of a screening program is essential to program success. Many European screening programs cover only 10-80% of their target population. A possible explanation for the low coverage may be that some women in the screening population have had a total hysterectomy, thus they are not at risk of cervical cancer. The aim of this study was to identify the prevalence of hysterectomy in the target population of the Danish National Cervical Cancer Screening Program (NCCSP) and to recalculate coverage after excluding women with total hysterectomy. Furthermore, to analyze the association between hysterectomy and sociodemographic factors within the screening population.
A population-based cross-sectional study using register data on all women in the target population of the NCCSP on January 12, 2012 (women born January 12, 1947, to January 12, 1986). The total coverage included women with hysterectomy in the target population whereas the recalculated coverage was calculated excluding women with total hysterectomy. To test the differences between the total coverage and the recalculated coverage, a two-sample z-test between the proportion of covered hysterectomized women and the proportion of covered non-hysterectomised women were used. A logistic regression model adjusted for age and sociodemographic characteristics was used to analyze the association between sociodemographic factors and total hysterectomy.
The coverage among women aged 26-49 years and 55-64 years were 77.4% and 72.7%, respectively. The recalculated coverage was 78.2% (26-49 years) and 79.4% (55-64 years). Recalculating the coverage did not result in coverage higher than 82.7% at any age. The effect of excluding women with total hysterectomy increased with age, reaching its maximum of 8 % points for the oldest women. Women with higher socioeconomic status (higher education and higher disposable income) had lower odds of being hysterectomized compared to other women. Also, immigrants and descendants had lower odds of being hysterectomized compared to ethnic Danes.
Excluding women with total hysterectomy only partly explained the low coverage of the NCCSP. Thus, initiatives must be made to improve acceptability of and accessibility to the NCCSP, especially in the youngest and the oldest women.
筛查项目的高覆盖率是项目成功的关键。许多欧洲的筛查项目仅覆盖其目标人群的10%至80%。覆盖率低的一个可能原因是筛查人群中的一些女性已接受全子宫切除术，因此她们没有患宫颈癌的风险。本研究的目的是确定丹麦国家宫颈癌筛查项目（NCCSP）目标人群中子宫切除术的患病率，并在排除接受全子宫切除术的女性后重新计算覆盖率。此外，分析筛查人群中子宫切除术与社会人口学因素之间的关联。
一项基于人群的横断面研究，使用2012年1月12日NCCSP目标人群中所有女性的登记数据（1947年1月12日至1986年1月12日出生的女性）。总覆盖率包括目标人群中接受子宫切除术的女性，而重新计算的覆盖率是在排除接受全子宫切除术的女性后计算得出的。为了检验总覆盖率和重新计算的覆盖率之间的差异，对接受子宫切除术的覆盖女性比例和未接受子宫切除术的覆盖女性比例进行了双样本z检验。使用调整了年龄和社会人口学特征的逻辑回归模型来分析社会人口学因素与全子宫切除术之间的关联。
26至49岁和55至64岁女性的覆盖率分别为77.4%和72.7%。重新计算的覆盖率分别为78.2%（26至49岁）和79.4%（55至64岁）。重新计算覆盖率后，任何年龄的覆盖率都未超过82.7%。排除接受全子宫切除术女性的影响随年龄增加，在年龄最大的女性中达到最大值8个百分点。社会经济地位较高（高等教育和较高可支配收入）的女性与其他女性相比，接受子宫切除术的几率较低。此外，与丹麦族裔相比，移民及其后代接受子宫切除术的几率较低。
排除接受全子宫切除术的女性仅部分解释了NCCSP覆盖率低的原因。因此，必须采取措施提高NCCSP的可接受性和可及性，特别是在最年轻和最年长的女性中。
