From the Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY 10016 (S.K.K., S.L.H., L.M.); Department of Population Health, NYU Langone Medical Center, New York, NY (S.K.K.); Harvey L. Neiman Health Policy Institute, Reston, Va (M.J., D.R.H.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (R.D.); and School of Economics, Georgia Institute of Technology, Atlanda, Ga (D.R.H.).
Radiology. 2018 Sep;288(3):660-668. doi: 10.1148/radiol.2018172326. Epub 2018 Jun 5.
Purpose To retrospectively assess whether there is an association between screening mammography and the use of a variety of preventive services in women who are enrolled in Medicare. Materials and Methods U.S. Medicare claims from 2010 to 2014 Research Identifiable Files were reviewed to retrospectively identify a group of women who underwent screening mammography and a control group without screening mammography in 2012. The screened group was divided into positive versus negative results at screening, and the positive subgroup was divided into false-positive and true-positive findings. Multivariate logistic regression models and inverse probability of treatment weighting were used to examine the relationship between screening status and the probabilities of undergoing Papanicolaou test, bone mass measurement, or influenza vaccination in the following 2 years. Results The cohort consisted of 555 705 patients, of whom 185 625 (33.4%) underwent mammography. After adjusting for patient demographics, comorbidities, geographic covariates, and baseline preventive care, women who underwent index screening mammography (with either positive or negative results) were more likely than unscreened women to later undergo Papanicolaou test (odds ratio [OR], 1.49; 95% confidence interval: 1.40, 1.58), bone mass measurement (OR, 1.70; 95% confidence interval: 1.63, 1.78), and influenza vaccine (OR, 1.45; 95% confidence interval: 1.37, 1.53). In women who had not undergone these preventive measures in the 2 years before screening mammography, use of these three services after false-positive findings at screening was no different than after true-negative findings at screening. Conclusion In beneficiaries of U.S. Medicare, use of screening mammography was associated with higher likelihood of adherence to other preventive guidelines, without a negative association between false-positive results and cervical cancer screening.
回顾性评估参加医疗保险的女性进行乳房 X 线筛查与使用各种预防性服务之间的关系。
回顾性分析 2010 年至 2014 年美国医疗保险索赔研究可识别文件，以确定一组 2012 年接受乳房 X 线筛查和未接受乳房 X 线筛查的女性。将筛查组分为筛查阳性与阴性结果，并将阳性亚组分为假阳性和真阳性结果。使用多变量逻辑回归模型和治疗反概率加权法来检查筛查状态与在接下来的 2 年内进行巴氏涂片检查、骨量测量或流感疫苗接种的概率之间的关系。
该队列包括 555705 例患者，其中 185625 例（33.4%）接受了乳房 X 线检查。在调整患者人口统计学特征、合并症、地理协变量和基线预防性护理后，与未接受筛查的女性相比，接受指数乳房 X 线筛查（无论结果阳性还是阴性）的女性更有可能随后进行巴氏涂片检查（优势比[OR]，1.49；95%置信区间：1.40，1.58）、骨量测量（OR，1.70；95%置信区间：1.63，1.78）和流感疫苗接种（OR，1.45；95%置信区间：1.37，1.53）。在乳房 X 线筛查前 2 年内未进行这些预防措施的女性中，在筛查结果为假阳性后使用这三种服务与在筛查结果为真阴性后使用并无差异。
在美国医疗保险受益人群中，乳房 X 线筛查的使用与更有可能遵循其他预防指南相关，而假阳性结果与宫颈癌筛查之间没有负相关关系。
