Stoll Kathrin
Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
Health Equity. 2019 Jul 11;3(1):328-335. doi: 10.1089/heq.2018.0051. eCollection 2019.
No studies have examined the frequency of thyroid screening in the Canadian population, and whether thyroid screening and medication use vary by sex, race, income, and preexisting health conditions. Using data from the 2011, 2012 cycles of the Canadian Community Health Survey, we report rates of thyroid screening among Quebec residents ≥35 (=7024) and rates of thyroid medication use among Quebec residents ≥35 (=16,081). We examine variations in medication use and screening by sex, age, race, immigration status, access to a regular doctor, and health conditions that have been linked to thyroid disease. Of the Quebec residents ≥35, 10.3% reported taking thyroid medication and 0.4% reported that the last blood test a physician ordered was to check for a new thyroid condition. Canadian-born residents and those who identified as White reported higher medication use and screening rates, compared to immigrants and those who identified as visible minorities. Racial disparities were especially pronounced, with White Quebec residents reporting three times greater odds of thyroid screening than visible minorities. The strongest predictors of both thyroid medication use and screening were access to a regular doctor. Despite women being eight times more likely to suffer from thyroid disease, women were not significantly more likely to be screened, compared to men (odds ratio=1.38, 95% confidence interval: 0.74-2.60). Strategies are needed to decrease disparities in thyroid screening and medication use. Interventions that target health systems (e.g., increasing physician supply), providers (continuing professional education modules about thyroid disease for family physicians), and recipients of care (multilanguage public awareness campaigns and posters at walk-in clinics that describe common symptoms of different thyroid disorders) should be implemented and tested.
尚无研究调查过加拿大人群中甲状腺筛查的频率，以及甲状腺筛查和药物使用是否因性别、种族、收入和既有健康状况而异。利用2011年、2012年加拿大社区健康调查的数据，我们报告了魁北克省35岁及以上居民（n = 7024）的甲状腺筛查率，以及魁北克省35岁及以上居民（n = 16,081）的甲状腺药物使用率。我们研究了药物使用和筛查在性别、年龄、种族、移民身份、是否能看普通医生以及与甲状腺疾病相关的健康状况方面的差异。在魁北克省35岁及以上的居民中，10.3%报告正在服用甲状腺药物，0.4%报告医生最近一次要求进行的血液检查是为了检查新的甲状腺疾病。与移民和那些被认定为少数族裔的人相比，加拿大出生的居民以及那些认定自己为白人的居民报告的药物使用率和筛查率更高。种族差异尤为明显，魁北克省白人居民报告的甲状腺筛查几率是少数族裔的三倍。甲状腺药物使用和筛查的最强预测因素都是能否看普通医生。尽管女性患甲状腺疾病的可能性是男性的八倍，但与男性相比，女性接受筛查的可能性并没有显著更高（优势比 = 1.38，95%置信区间：0.74 - 2.60）。需要采取策略来减少甲状腺筛查和药物使用方面的差异。应实施并测试针对卫生系统（如增加医生供应）、医疗服务提供者（为家庭医生提供关于甲状腺疾病的继续医学教育模块）以及医疗服务接受者（多语言公众意识宣传活动以及在随诊诊所张贴描述不同甲状腺疾病常见症状的海报）的干预措施。
