Bao H L, Zhao Z P, Zhang M, Wang L M, Cong S, Fang L W, Wang L H
National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
Zhonghua Yu Fang Yi Xue Za Zhi. 2018 Mar 6;52(3):260-264. doi: 10.3760/cma.j.issn.0253-9624.2018.03.008.
To assess the impact of Chinese Cervical Cancer Screening Program for Rural Area (NACCSPRA) on population-based screening rates. The subjects were selected from 2013-2014 Chinese Chronic Diseases and Risk Factors Surveillance (CDRFS2013), which adopting multi-stage stratified cluster sampling from 31 provinces. A total of 169 632 participants aged 18 years and older in 297 surveillance points were interviewed, of whom 65 476 women aged 35-64 years were included in the analysis. The surveillance points in CDRFS 2013 were divided into the screening areas and the control areas by matching points in CDRFS2014 with counties in NACCSPRA. The difference in socioeconomic status between areas was compared. The screening rates and 95% confidence interval (95) were estimated by Tylar series variance method. The Propensity Score was evaluated for individuals by multivariate logistic regression and the greedy matching method based on propensity score value was used to conduct 1∶1 matching sample for the screening areas and the control areas. After matching, multivariate conditional logistic regression model was fitted to assess the impact of national cervical cancer screening intervention on the likelihood of undergoing cervical cancer screening at population level. Among 65 476 subjects, 48.6% (31 794) was in the screening areas. Before matching, in the rural area the screening rate in the screening areas (24.0% (4 763/19 838), 95 21.8%-26.3%) was higher than that in the control areas (15.6% (2 331/14 942), 95 13.4%-17.8%); whereas in the urban area the screening rate in the screening areas (28.5% (3 413/11 956), 95 26.1%-31.0%) was similar to that in the control areas (26.3% (4 923/18 740), 95 24.1%-28.4%). After matching, in rural area the screening rate in the screening areas (23.2% (3 454/14 875), 95 20.9%-25.5%) was higher than that in the control areas (15.6% (2 315/14 875), 95 13.3%-17.8%); in urban area the screening rate in the screening areas (28.7% (3 202/11 146), 95 26.2%-31.2%) was higher than that in the control areas (23.1% (2 571/11 146), 95 20.9%-25.3%). Multivariate conditional logistic regression model showed that the cervical cancer screening rates in intervention areas significantly increased among women aged 35-64 years both in urban areas (1.44, 95 1.34-1.54) and rural areas (1.78, 95 1.67-1.90) as compared with those in control areas. The implementation of Chinese cervical cancer screening program during the five years substantially increased the population-based screening rates both in urban and rural areas.
评估中国农村地区宫颈癌筛查项目（NACCSPRA）对基于人群的筛查率的影响。研究对象选自2013 - 2014年中国慢性病与危险因素监测（CDRFS2013），该监测采用多阶段分层整群抽样方法，覆盖31个省份。在297个监测点，共访谈了169632名18岁及以上的参与者，其中65476名35 - 64岁的女性被纳入分析。通过将CDRFS2014中的监测点与NACCSPRA中的县进行匹配，将CDRFS 2013中的监测点分为筛查区和对照区。比较了不同区域之间社会经济地位的差异。采用泰勒级数方差法估计筛查率及95%置信区间（95%CI）。通过多因素logistic回归对个体评估倾向得分，并基于倾向得分值采用贪婪匹配法对筛查区和对照区进行1∶1匹配抽样。匹配后，拟合多因素条件logistic回归模型，评估国家宫颈癌筛查干预对人群层面接受宫颈癌筛查可能性的影响。在65476名研究对象中，48.6%（31794名）来自筛查区。匹配前，农村地区筛查区的筛查率（24.0%（4763/19838），95%CI 21.8% - 26.3%）高于对照区（15.6%（2331/14942），95%CI 13.4% - 17.8%）；而在城市地区，筛查区的筛查率（28.5%（3413/11956），95%CI 26.1% - 31.0%）与对照区（26.3%（4923/18740），95%CI 24.1% - 28.4%）相似。匹配后，农村地区筛查区的筛查率（23.2%（3454/14875），95%CI 20.9% - 25.5%）高于对照区（15.6%（2315/14875），95%CI 13.3% - 17.8%）；城市地区筛查区的筛查率（28.7%（3202/11146），95%CI 26.2% - 31.2%）高于对照区（23.1%（2571/11146），95%CI 20.9% - 25.3%）。多因素条件logistic回归模型显示，与对照区相比，干预区35 - 64岁女性的宫颈癌筛查率在城市地区（1.44，95%CI 1.34 - 1.54）和农村地区（1.78，95%CI 1.67 - 1.90）均显著提高。中国宫颈癌筛查项目在五年期间的实施显著提高了城乡地区基于人群的筛查率。
