1 Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences , Little Rock, Arkansas.
2 Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences , Little Rock, Arkansas.
J Womens Health (Larchmt). 2018 Jul;27(7):875-884. doi: 10.1089/jwh.2017.6425. Epub 2018 Mar 27.
In November 2009, the United States Preventive Services Task Force (USPSTF) changed their mammography screening guidelines from recommending a screen every 1-2 years for women older than 40 years. The revised guideline recommends against regular screening for women aged 40-49 and recommends biennial screening for women aged 50-74.
We used autoregressive integrated moving-average (ARIMA) time series modeling to estimate the effect of the USPSTF 2009 guidelines on trends in screening rates. Enrollment and encounter files from the PharMetrics LifeLink+ commercial insurance claims database, years 2006-2014, were linked to determine monthly screening rates. The main outcome measure was mammography screening rates per 1,000 commercially insured women aged 40-49 or aged 50-64.
The study sample included 493,347 women aged 40-49 years with at least 1 month of eligibility and 658,052 women aged 50-64 years with at least 1 month of eligibility. There were 1,305,375 total screening mammograms from 2007 to 2014. Average monthly mammography screening rates from 2007 to 2014 were 40.4 per 1,000 women aged 40-49 and 54.8 per 1,000 women aged 50-64. There was a temporary decline in monthly screening rates of 11.8% and 11.2% for the 40-49 and 50-64 age groups, respectively, in the 2-month period after the guideline change (January and February 2010), but the rates quickly returned to pre-USPSTF trend levels afterward.
Implementation of the USPSTF 2009 guidelines was not associated with a persistent long-term change in mammography screening rates over the next 5 years, despite a temporary decline of 2 months immediately following the guidelines.
2009 年 11 月，美国预防服务工作组（USPSTF）改变了其对 40 岁以上女性的乳房 X 光筛查指南，从建议每 1-2 年进行一次筛查改为不建议 40-49 岁的女性进行常规筛查，建议 50-74 岁的女性每两年进行一次筛查。
我们使用自回归综合移动平均（ARIMA）时间序列模型来估计 USPSTF 2009 年指南对筛查率趋势的影响。 PharMetrics LifeLink+商业保险理赔数据库的登记和就诊文件，2006-2014 年，被链接起来以确定每月的筛查率。主要结局指标是每 1000 名商业保险女性 40-49 岁或 50-64 岁的乳房 X 光筛查率。
研究样本包括至少有 1 个月资格的 493347 名 40-49 岁女性和至少有 1 个月资格的 658052 名 50-64 岁女性。2007 年至 2014 年期间共进行了 1305375 次乳房 X 光筛查。2007 年至 2014 年期间，40-49 岁女性的平均每月乳房 X 光筛查率为 40.4/1000 人，50-64 岁女性为 54.8/1000 人。在指南改变后的 2 个月（2010 年 1 月和 2 月），40-49 岁和 50-64 岁年龄组的每月筛查率分别暂时下降了 11.8%和 11.2%，但此后很快恢复到 USPSTF 前的趋势水平。
尽管在指南发布后的 2 个月内，筛查率暂时下降，但在接下来的 5 年内，实施 USPSTF 2009 年指南与乳房 X 光筛查率的持续长期变化无关。
