Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada.
ICES, Toronto, Ontario, Canada.
Am J Prev Med. 2019 Apr;56(4):487-493. doi: 10.1016/j.amepre.2018.11.011. Epub 2019 Feb 21.
Primary care represents an opportunity to improve health for people who experience imprisonment, and screening for colorectal and breast cancer indicate primary care quality. The study objectives were to examine the proportion of people released from provincial correctional facilities who were overdue for colorectal or breast cancer screening on admission to the correctional facility and who were still overdue after 3 years, and to compare findings with data for the general population.
Administrative data were used to identify people eligible for colorectal and breast cancer screening who were released from provincial correctional facilities in 2010 (N=3,803 and N=249, respectively) and in the general population (N=2,757,584 and N=1,099,942, respectively) in Ontario, Canada. Chi-square tests and log binomial regression models were used to compare the proportion of individuals overdue for screening on admission or on July 1, 2010 for the general population, and still overdue after 3 years. Analyses were conducted in 2017 and 2018.
Compared with the general population, people in the corrections group were 1.53 times (95% CI=1.50, 1.55) more likely to be overdue for colorectal cancer screening: 77.1% (95% CI=74.3, 79.9) vs 50.5% (95% CI=50.5, 50.6), and 2.25 times (95% CI=2.06, 2.46) more likely to be overdue for breast cancer screening: 65.9% (95% CI=56.2, 76.8) vs 29.3% (95% CI=29.2, 29.4, both p<0.001). They were also more likely to still be overdue 3 years later: 62.6% (95% CI=60.1, 65.2) vs 33.6% (95% CI=33.5, 33.6) for colorectal cancer and 52.2% (95% CI=43.6, 62.0) vs 20.2% (95% CI=20.1, 20.3) for breast cancer (both p<0.001).
People who experience imprisonment are less likely than the general population to access colorectal and breast cancer screening. This suggests the need to strengthen primary care for this population. Specifically, efforts should be made to improve access to colorectal and breast cancer screening, through health promotion, program delivery, and linkage to community services while in correctional facilities.
初级保健为经历监禁的人群改善健康提供了机会，而结直肠癌和乳腺癌筛查则表明了初级保健的质量。本研究的目的是调查从省级惩教机构获释的人群中，在进入惩教机构时和 3 年后仍未进行结直肠癌或乳腺癌筛查的人数比例，并将结果与普通人群的数据进行比较。
使用行政数据确定有资格进行结直肠癌和乳腺癌筛查的人，这些人于 2010 年从安大略省省级惩教机构获释（分别为 3803 人和 249 人）和普通人群（分别为 2757584 人和 1099942 人）。使用卡方检验和对数二项式回归模型比较筛查人群在入院时或 2010 年 7 月 1 日的筛查比例，以及 3 年后仍未进行筛查的比例。分析于 2017 年和 2018 年进行。
与普通人群相比，惩教机构中的人群更有可能延迟接受结直肠癌筛查：77.1%（95%CI=74.3，79.9）比 50.5%（95%CI=50.5，50.6），更有可能延迟接受乳腺癌筛查：65.9%（95%CI=56.2，76.8）比 29.3%（95%CI=29.2，29.4），差异均有统计学意义（均<0.001）。3 年后，他们仍然更有可能未进行筛查：62.6%（95%CI=60.1，65.2）比 33.6%（95%CI=33.5，33.6）用于结直肠癌，52.2%（95%CI=43.6，62.0）比 20.2%（95%CI=20.1，20.3）用于乳腺癌，差异均有统计学意义（均<0.001）。
经历监禁的人群比普通人群更不可能接受结直肠癌和乳腺癌筛查。这表明需要加强对这一人群的初级保健。具体而言，应通过健康促进、项目实施和在惩教机构时与社区服务的联系，努力改善结直肠癌和乳腺癌筛查的获取途径。
