对医疗保健的不信任和文化因素与西班牙裔和亚裔美国人接受结直肠癌筛查有关。

Distrust in health care and cultural factors are associated with uptake of colorectal cancer screening in Hispanic and Asian Americans.

机构信息

Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida.

Counseling and Counselor Education, College of Education, University of Florida, Gainesville, Florida.

出版信息

Cancer. 2018 Jan 15;124(2):335-345. doi: 10.1002/cncr.31052. Epub 2017 Oct 4.

DOI:10.1002/cncr.31052

PMID:28976535

Abstract

BACKGROUND

There are racial/ethnic disparities in colorectal cancer (CRC) screening, including lower uptake rates among Hispanic Americans (HAs) and Asian Americans (AAs) relative to non-Hispanic white Americans. The objective of this study was to explore pathways associated with the use of health services and to characterize multifaceted associations with the uptake of CRC screening among HAs and AAs.

METHODS

Data were obtained from the Medical Expenditure Panel Survey (2012-2013). Participants included HA (n = 3731) and AA (n = 1345) respondents ages 50 to 75 years who met CRC screening recommendations. A modified Andersen behavioral model was used to examine pathways that lead to CRC screening uptake, including predisposing characteristics (education, economic, and cultural factors), health insurance, health needs (perceived health status and several comorbidities), and health provider contextual factors (access to care, perceived quality of health services, and distrust in health care). Structural equation modeling was used to examine the models for HAs and AAs.

RESULTS

In the HA model, cultural factors (standardized regression coefficient [β] = -0.04; P = .013) and distrust in health care (β = -0.05; P = .007) directly and negatively affected CRC screening. Similarly, cultural factors (β = -0.11; P = .002) negatively affected CRC screening in the AA model, but distrust in health care was not significant (P = .103). In both models, perceived quality of health services was positively associated with CRC screening uptake and mediated the negative association between cultural factors and CRC screening. Access to care was not associated with CRC screening.

CONCLUSIONS

Correlations between CRC screening and associated factors differ among HAs and AAs, suggesting a need for multilevel interventions tailored to race/ethnicity. The current findings suggest that facilitating access to care without improving perceived quality of health services may be ineffective for increasing the uptake of CRC screening among HAs and AAs. Cancer 2018;124:335-45. © 2017 American Cancer Society.

摘要

背景

结直肠癌（CRC）筛查存在种族/民族差异，包括西班牙裔美国人和亚裔美国人（AA）的参与率相对较低，而非西班牙裔白人美国人。本研究的目的是探讨与卫生服务利用相关的途径，并描述西班牙裔和亚裔接受 CRC 筛查的多方面关联。

方法

数据来自医疗支出面板调查（2012-2013 年）。参与者包括年龄在 50 至 75 岁之间符合 CRC 筛查建议的西班牙裔（n = 3731）和亚裔（n = 1345）受访者。采用改良的安德森行为模型来研究导致 CRC 筛查参与的途径，包括易感性特征（教育、经济和文化因素）、健康保险、健康需求（自我感知的健康状况和几种合并症）以及卫生服务提供者的环境因素（获得医疗服务的机会、感知的医疗服务质量和对医疗保健的不信任）。结构方程模型用于研究西班牙裔和亚裔的模型。

结果

在西班牙裔模型中，文化因素（标准化回归系数[β] = -0.04；P =.013）和对医疗保健的不信任（β = -0.05；P =.007）直接且负性地影响 CRC 筛查。同样，在 AA 模型中，文化因素（β = -0.11；P =.002）也对 CRC 筛查产生负面影响，但对医疗保健的不信任不具有统计学意义（P =.103）。在两个模型中，感知医疗服务质量与 CRC 筛查的采用呈正相关，并且中介了文化因素与 CRC 筛查之间的负相关。获得医疗服务与 CRC 筛查无关。