Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA.
Department of Chronic Disease Epidemiology, Yale University, New Haven, CT, USA.
Cancer Causes Control. 2019 Oct;30(10):1045-1055. doi: 10.1007/s10552-019-01217-8. Epub 2019 Aug 19.
Previous studies suggesting that rural US women may be less likely to have a recent mammogram than urban women are limited in either scope or granularity. This study explored urban-rural disparities in US breast cancer-screening practices at the national, regional, and state levels.
We used data from the 2012, 2014, and 2016 Behavioral Risk Factor Surveillance Systems surveys. Logistic models were utilized to examine the impact of living in an urban/rural area on mammogram screening at three geographic levels while adjusting for covariates. We then calculated average adjusted predictions (AAPs) and average marginal effects (AMEs) to isolate the association between breast cancer screening and the urban/rural factor.
At all geographic levels, AAPs of breast cancer screening were similar among urban, suburban, and rural residents. Regarding "ever having a mammogram" and "having a recent mammogram," urban women had small but significantly higher adjusted probabilities (AAP: 94.6%, 81.1%) compared to rural women (AAP: 93.5%, 80.2%).
While urban-rural differences in breast cancer screening are small, they can translate into tens of thousands of rural women not receiving mammograms. Hence, there is a need to continue screening initiatives in these areas to reduce the number of breast cancer deaths.
之前的研究表明，与城市女性相比，美国农村女性近期进行乳房 X 光检查的可能性可能较低，但这些研究在范围或粒度上存在局限性。本研究探讨了美国在国家、地区和州级层面上城乡乳腺癌筛查实践的差异。
我们使用了来自 2012 年、2014 年和 2016 年行为风险因素监测系统调查的数据。利用逻辑模型，在调整协变量的情况下，检验了居住在城市/农村地区对三种地理层面的乳房 X 光筛查的影响。然后，我们计算了平均调整预测值（AAP）和平均边际效应（AME），以隔离乳腺癌筛查与城乡因素之间的关联。
在所有地理层面，城市、郊区和农村居民的乳腺癌筛查 AAP 相似。就“曾进行过乳房 X 光检查”和“最近进行过乳房 X 光检查”而言，与农村女性（AAP：93.5%，80.2%）相比，城市女性的调整后概率（AAP：94.6%，81.1%）虽小但具有显著优势。
尽管城乡之间的乳腺癌筛查存在差异较小，但这可能导致成千上万的农村女性无法接受乳房 X 光检查。因此，需要继续在这些地区开展筛查活动，以减少乳腺癌死亡人数。
