组织化筛查项目对乳腺摄影实践、知识和态度的社会经济不平等的影响。
Effect of an organised screening program on socioeconomic inequalities in mammography practice, knowledge and attitudes.
机构信息
Division of Clinical Epidemiology, Geneva University Hospitals, rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland.
Faculty of Medicine, University of Geneva, Geneva, Switzerland.
出版信息
Int J Equity Health. 2018 Jul 3;17(1):95. doi: 10.1186/s12939-018-0811-3.
BACKGROUND
Breast cancer stands as the leading cause of cancer related mortality in women worldwide. Mammography screening has the potential to improve prognosis by reducing stage at diagnosis. Socioeconomic inequalities in mammography cancer screening have been widely reported. The influence of organised programs on socioeconomic disparities regarding mammography screening is to date unclear. We aimed to investigate the impact of an organised regional screening program on socioeconomic inequalities in terms of the uptake, knowledge and attitudes towards mammography screening.
METHODS
Data were obtained from two cross-sectional surveys of women 50 to 69 years old conducted in 1998 and 2012, before and after the implementation of an organised breast cancer screening program in Geneva, Switzerland. Socioeconomic status was measured by monthly household income and education level. Logistic and linear regression multivariable models were used to investigate the evolution of socioeconomic gradients between 1998 and 2012 in terms of uptake, knowledge and attitudes towards mammography screening.
RESULTS
In 1998, before the implementation of an organised screening program, 44% of women from the lowest education category reported mammography practice conforming to recommendations versus 63% of the more educated participants. This socioeconomic gradient was no longer present in 2012 where reported mammography practice at guideline-recommended frequency were 83 and 82% in the lowest and highest education level categories respectively (change in education gradient over time, p = 0.018). The difference in mammography practice in agreement with recommendations between the lowest and the highest income category went from 27 percentage points in 1998 to 14 percentage points in 2012 (change in income gradient over time, p = 0.10). The socioeconomic gradient in negative attitudes towards mammography screening persisted in 2012 but was reduced compared to 1998. We did not observe a reduction in the socioeconomic disparities in knowledge regarding mammography screening over this period.
CONCLUSIONS
This study suggests that mammography screening programs may lessen socioeconomic inequities in mammography practice. Such programs should feature adapted communication tools to reach women of lower socioeconomic status to attempt to further reduce socioeconomic gradients in mammography screening.
背景
乳腺癌是全球女性癌症相关死亡的主要原因。乳房 X 光筛查有可能通过降低诊断时的分期来改善预后。社会经济不平等在乳房 X 光筛查方面已得到广泛报道。关于乳房 X 光筛查，有组织的项目对社会经济差异的影响目前尚不清楚。我们旨在研究有组织的区域筛查计划对乳房 X 光筛查的社会经济不平等的影响，包括参与率、对乳房 X 光筛查的知识和态度。
方法
数据来自于瑞士日内瓦实施有组织的乳腺癌筛查计划之前和之后，于 1998 年和 2012 年对 50 至 69 岁的女性进行的两次横断面调查。社会经济地位通过月家庭收入和教育水平衡量。使用逻辑和线性回归多变量模型来研究 1998 年至 2012 年期间，在参与率、对乳房 X 光筛查的知识和态度方面，社会经济梯度的演变。
结果
1998 年，在实施有组织的筛查计划之前，文化程度最低的女性中，有 44%的人进行了符合建议的乳房 X 光检查，而受教育程度较高的参与者中，有 63%的人进行了乳房 X 光检查。这种社会经济梯度在 2012 年不再存在，在该年度，文化程度最低和最高的女性中，分别有 83%和 82%的人按照指南推荐的频率进行了乳房 X 光检查（随着时间的推移，教育梯度的变化，p=0.018）。1998 年，收入最低和最高的两个群体之间在符合建议的乳房 X 光检查方面的差异为 27 个百分点，到 2012 年，这一差异缩小到 14 个百分点（随着时间的推移，收入梯度的变化，p=0.10）。2012 年，对乳房 X 光筛查的负面态度的社会经济梯度仍然存在，但与 1998 年相比有所减少。在此期间，我们没有观察到对乳房 X 光筛查知识的社会经济差距的减少。
结论
本研究表明，乳房 X 光筛查计划可能会减少乳房 X 光检查实践中的社会经济不平等。此类计划应配备适应的沟通工具，以覆盖社会经济地位较低的女性，试图进一步减少乳房 X 光筛查的社会经济梯度。
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