INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, Department of social epidemiology, F75012 Paris, France.
CESP, INSERM U1018, Univ Paris-Saclay, Univ Paris-Sud, UVSQ, Villejuif, France.
Cancer Epidemiol. 2019 Feb;58:98-103. doi: 10.1016/j.canep.2018.11.009. Epub 2018 Dec 6.
Immigrant women often have lower cervical cancer screening (CCS) rates, tend to have a higher body mass index (BMI) and may be more vulnerable to BMI-related stigmatization. Our aim was to assess the role of BMI in differences in CCS rates by migration history.
Analyses were based on the 2012-2015 inclusion data (n = 27,226) for the population-based CONSTANCES cohort, including detailed, self-reported information on demographics and socioeconomic characteristics, migration history, health behaviours, health, and health care use. Measured BMI (underweight (<18.5), normal-weight (18.5-25), overweight (25-30), obese (>30)) was collected. Poisson regression models with robust variance were conducted to assess the contribution of BMI to differences in CCS rates by migration history, and analyses stratified by BMI were done. Multiple imputations were performed.
The CCS rates ranged from 87% among French-born women with two French parents to 86% among French-born women with at least one parent of foreign origin, 82% among naturalized immigrants and 74% among non-naturalized immigrants. After adjusting for covariates, non-naturalized immigrants showed an 11% (95% CI: 8%-14%) lower CCS rate than French-born women with two French parents. Adjusting for BMI did not change the estimates. When stratifying by BMI category, non-naturalized immigrants showed an 11% (7%-14%) lower CCS rate then French-born with two French parents when normal weight, a 9% (2%-16%) lower CCS rate when overweight, and an 18% (5%-30%) lower CCS rate when obese.
Migration history and BMI jointly impact CCS rates. They were lower among all non-naturalized immigrants, particularly those who were obese.
移民女性的宫颈癌筛查（CCS）率往往较低，体质量指数（BMI）较高，并且可能更容易受到 BMI 相关的污名化影响。我们的目的是评估 BMI 在移民史差异导致的 CCS 率差异中的作用。
分析基于 2012-2015 年基于人群的 CONSTANCES 队列的纳入数据（n=27226），包括人口统计学和社会经济特征、移民史、健康行为、健康和卫生保健使用的详细、自我报告信息。测量 BMI（体重不足（<18.5）、正常体重（18.5-25）、超重（25-30）、肥胖（>30））。采用具有稳健方差的泊松回归模型评估 BMI 对移民史差异导致的 CCS 率的贡献，并对 BMI 进行分层分析。进行多次插补。
CCS 率从父母双方均为法国人的法国出生女性的 87%到至少有一方为外国出生的法国出生女性的 86%，从归化移民的 82%到非归化移民的 74%不等。在调整了协变量后，非归化移民的 CCS 率比父母双方均为法国人的法国出生女性低 11%（95%CI：8%-14%）。调整 BMI 后并未改变估计值。按 BMI 类别分层时，当体重正常时，非归化移民的 CCS 率比父母双方均为法国人的法国出生女性低 11%（7%-14%），超重时低 9%（2%-16%），肥胖时低 18%（5%-30%）。
移民史和 BMI 共同影响 CCS 率。所有非归化移民的 CCS 率都较低，尤其是肥胖的非归化移民。
