Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
Department of Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey.
Cancer Epidemiol Biomarkers Prev. 2017 Dec;26(12):1804-1811. doi: 10.1158/1055-9965.EPI-17-0660. Epub 2017 Oct 11.
Racial and ethnic minorities experience lower rates of cancer screening compared with non-Hispanic whites (NHWs). Previous studies evaluating the role of patient-provider race, ethnicity, or gender concordance in cancer screening have been inconclusive. In a cross-sectional analysis using the Medical Expenditure Panel Survey (MEPS), data from 2003 to 2010 were assessed for associations between patient-provider race, ethnicity, and/or gender concordance and, screening (American Cancer Society guidelines) for breast, cervical, and colorectal cancer. Multivariable logistic analyses were conducted to examine associations of interest. Of the 32,041 patient-provider pairs in our analysis, more than 60% of the patients were NHW, 15% were non-Hispanic black (NHB), and 15% were Hispanic. Overall, patients adherent to cancer screening were more likely to be non-Hispanic, better educated, married, wealthier, and privately insured. Patient-provider gender discordance was associated with lower rates of breast [OR, 0.83; 95% confidence interval (CI), 0.76-0.90], cervical (OR, 0.83; 95% CI, 0.76-0.91), and colorectal cancer (OR, 0.84; 95% CI, 0.79-0.90) screening in all patients. This association was also significant after adjusting for racial and/or ethnic concordance. Conversely, among NHWs and NHBs, patient-provider racial and/or ethnic concordance was not associated with screening. Among Hispanics, patient-provider ethnic discordant pairs had higher breast (58% vs. 52%) and colorectal cancer (45% vs. 39%) screening rates compared with concordant pairs. Patient-provider gender concordance positively affected cancer screening. Patient-provider ethnic concordance was inversely associated with receipt of cancer screening among Hispanics. This counter-intuitive finding requires further study. Our findings highlight the importance of gender concordance in improving cancer screening rates. .
少数民族和种族群体的癌症筛查率低于非西班牙裔白人（NHW）。以前评估患者-提供者种族、民族或性别一致性在癌症筛查中的作用的研究结果尚无定论。在使用医疗支出面板调查（MEPS）的横断面分析中，评估了 2003 年至 2010 年的数据，以评估患者-提供者种族、民族和/或性别一致性与乳腺癌、宫颈癌和结直肠癌筛查（美国癌症协会指南）之间的关联。进行多变量逻辑分析以检查相关关联。在我们的分析中，32041 对患者-提供者中，超过 60%的患者是非西班牙裔白人，15%是非西班牙裔黑人（NHB），15%是西班牙裔。总体而言，遵守癌症筛查的患者更有可能是非西班牙裔、受教育程度更高、已婚、更富有、并拥有私人保险。患者-提供者性别不一致与所有患者的乳腺癌[比值比（OR），0.83；95%置信区间（CI），0.76-0.90]、宫颈癌（OR，0.83；95% CI，0.76-0.91）和结直肠癌（OR，0.84；95% CI，0.79-0.90）筛查率较低相关。在调整了种族和/或民族一致性后，这种关联仍然显著。相反，在 NHW 和 NHB 中，患者-提供者的种族和/或民族一致性与筛查无关。在西班牙裔中，与匹配对相比，患者-提供者种族不一致的对乳腺癌（58%比 52%）和结直肠癌（45%比 39%）的筛查率更高。患者-提供者性别一致性对癌症筛查产生积极影响。患者-提供者民族一致性与西班牙裔接受癌症筛查呈负相关。这种与直觉相悖的发现需要进一步研究。我们的研究结果强调了性别一致性在提高癌症筛查率方面的重要性。
