University of Wisconsin Carbone Cancer Center, Madison; Department of Population Health Sciences, University of Wisconsin, Madison.
University of Wisconsin Carbone Cancer Center, Madison; Department of Population Health Sciences, University of Wisconsin, Madison; Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison.
Ann Epidemiol. 2018 Feb;28(2):65-71.e2. doi: 10.1016/j.annepidem.2017.11.012. Epub 2017 Dec 7.
To assess the association between geographic access to mammography facilities and women's mammography utilization frequency.
Using data from the population-based 1995-2007 Wisconsin Women's Health study, we used proportional odds and logistic regression to test whether driving times to mammography facilities and the number of mammography facilities within 10 km of women's homes were associated with mammography frequency among women aged 50-74 years and whether associations differed between Rural-Urban Commuting Areas and income and education groups.
We found evidence for nonlinear relationships between geographic access and mammography utilization (nonlinear effects of driving times and facility density, P-values .01 and .005, respectively). Having at least one nearby mammography facility was associated with greater mammography frequency among urban women (1 vs. 0 facilities, odds ratio 1.26, 95% confidence interval, 1.09-1.47), with similar effects among rural women. Adding more facilities had decreasing marginal effects. Long driving times tended to be associated with lower mammography frequency. We found no effect modification by income, education, or urbanicity. In rural settings, mammography nonuse was higher, facility density smaller, and driving times to facilities were longer.
Having at least one mammography facility near one's home may increase mammography utilization, with decreasing effects per each additional facility.
评估获得乳房 X 光检查设施的地理位置与女性乳房 X 光检查利用频率之间的关联。
利用基于人群的 1995-2007 年威斯康星州妇女健康研究的数据，我们使用比例优势和逻辑回归检验了前往乳房 X 光检查设施的驾驶时间和女性家附近的乳房 X 光检查设施数量与 50-74 岁女性的乳房 X 光检查频率之间的关系，以及这些关联在城乡通勤区和收入及教育群体之间是否存在差异。
我们发现地理可达性与乳房 X 光检查利用之间存在非线性关系（驾驶时间和设施密度的非线性效应，P 值分别为<.01 和<.005）。至少有一个附近的乳房 X 光检查设施与城市女性更高的乳房 X 光检查频率相关（1 个 vs. 0 个设施，优势比 1.26，95%置信区间 1.09-1.47），农村女性也有类似的效果。增加更多的设施会产生递减的边际效应。较长的驾驶时间往往与较低的乳房 X 光检查频率相关。我们没有发现收入、教育或城市性的效应修饰作用。在农村地区，乳房 X 光检查未利用率较高，设施密度较小，前往设施的驾驶时间较长。
至少有一个乳房 X 光检查设施靠近住所可能会增加乳房 X 光检查的利用率，每增加一个设施的效果会逐渐降低。
