Division of Primary Care Medicine, Department of Primary Care Medicine, Geneva University Hospitals, Switzerland.
Institute of Sociological Research, University of Geneva, Switzerland; Department of Readaptation and Geriatrics, University of Geneva, Switzerland; Division of Quality of Care, Geneva University Hospitals, Switzerland.
Prev Med. 2019 Dec;129:105829. doi: 10.1016/j.ypmed.2019.105829. Epub 2019 Aug 30.
Skin cancer is one of the most common malignancies. Despite controversy over its efficacy, skin cancer screening has become widespread although socioeconomic screening inequalities have been documented. Switzerland has the highest rate of melanoma in Europe but Swiss trends in skin cancer screening and social disparities have not been investigated. This study aims to evaluate trends in skin cancer screening and its association with socioeconomic indicators in Switzerland between 1997 and 2012.
We used data from four waves (from 1997 to 2012) of the population-based Swiss Health Interview Survey. Multivariable Poisson regressions with robust variance were used to estimate weighted prevalence ratio (PR) and 95% Confidence Intervals (CI) adjusting for demographics, health status and use of healthcare.
This study included 60,764 participants with a mean age of 49.1 years (standard deviation (SD) 17.2) and 53.6% of women. Between 1997 and 2012, the weighted prevalence of ever life-time skin examination and skin examination in the current year increased by 38.2% and 35.3% respectively (p-value <0.001). Participants with a lower education level, lower income and living in non-metropolitan areas were less often screened than their counterparts. Educational differences in ever life-time skin examination increased over time (p-value for trend = 0.036).
While skin cancer screening prevalence in Switzerland increased from 1997 to 2012, most social inequalities persisted over time and educational inequalities increased. Dermatologists should be alerted that populations with lower education should be given special attention.
皮肤癌是最常见的恶性肿瘤之一。尽管对其疗效存在争议，但皮肤癌筛查已经广泛开展，尽管已经记录了社会经济筛查方面的不平等现象。瑞士是欧洲黑色素瘤发病率最高的国家，但瑞士的皮肤癌筛查趋势和社会差异尚未得到调查。本研究旨在评估 1997 年至 2012 年间瑞士皮肤癌筛查的趋势及其与社会经济指标的关系。
我们使用了来自基于人群的瑞士健康访谈调查的四个波次（1997 年至 2012 年）的数据。使用多变量泊松回归和稳健方差来估计加权患病率比（PR）和 95%置信区间（CI），调整了人口统计学、健康状况和医疗保健的使用。
本研究共纳入了 60764 名参与者，平均年龄为 49.1 岁（标准差 17.2），其中 53.6%为女性。1997 年至 2012 年间，一生中曾接受过皮肤检查和当年接受过皮肤检查的加权患病率分别增加了 38.2%和 35.3%（p 值<0.001）。受教育程度较低、收入较低和居住在非大都市地区的参与者接受筛查的比例较低。一生中曾接受过皮肤检查的教育差异随着时间的推移而增加（趋势检验 p 值=0.036）。
尽管瑞士的皮肤癌筛查率从 1997 年到 2012 年有所增加，但大多数社会不平等现象随着时间的推移持续存在，教育不平等现象有所增加。皮肤科医生应该注意到，教育程度较低的人群应该得到特别关注。
