Department of Social Epidemiology, Institut Pierre Louis D'Epidémiologie Et de Santé Publique IPLESP, Sorbonne Université, INSERM, 75012, Paris, France.
INSERM IPLESP - ERES, 27 rue Chaligny, 75012, Paris, France.
Cancer Causes Control. 2020 Jan;31(1):51-62. doi: 10.1007/s10552-019-01251-6. Epub 2019 Dec 3.
Despite their higher risk for and mortality from cervical cancer, evidence indicates low rates of cervical cancer screening (CCS) among women with obesity. The literature on the specific factors related to CCS nonadherence in this population is limited.
We examined the data on 2,934 women with obesity included in the CONSTANCES survey from 2012 to 2015. Using the Andersen's behavioral model, we studied the relationships between the socioeconomic, sociodemographic, health, health personal behaviors, and healthcare use-related factors with CCS nonadherence. The analysis was performed using structural equation models.
Regular follow-up by a gynecologist, good quality of primary care follow-up, and comorbidities were negatively associated with CCS nonadherence. Limited literacy, older age, being single, living without children, and financial strain were positively associated with CCS nonadherence. Our results do not point to competitive care, since women with comorbidities had better CCS behaviors, which were explained by a good quality of primary care follow-up.
Our study identified the factors that explain CCS nonadherence among women with obesity and clarified the effects of health status and healthcare use on screening. Further efforts should be undertaken to reduce the obstacles to CCS by improving care among women with obesity.
尽管肥胖女性罹患宫颈癌的风险更高，且死亡率更高，但有证据表明，肥胖女性的宫颈癌筛查（CCS）率较低。关于该人群中与 CCS 不依从相关的具体因素的文献有限。
我们研究了 2012 年至 2015 年 CON-STANCES 调查中纳入的 2934 名肥胖女性的数据。我们采用安德森行为模型研究了社会经济、社会人口统计学、健康、个人健康行为以及医疗保健使用相关因素与 CCS 不依从之间的关系。使用结构方程模型进行分析。
定期由妇科医生随访、初级保健随访质量良好以及合并症与 CCS 不依从呈负相关。文化程度低、年龄较大、单身、无子女且经济拮据与 CCS 不依从呈正相关。我们的结果并未表明存在竞争医疗保健，因为合并症患者有更好的 CCS 行为，这可通过初级保健随访质量良好来解释。
本研究确定了肥胖女性 CCS 不依从的解释因素，并阐明了健康状况和医疗保健使用对筛查的影响。应进一步努力通过改善肥胖女性的护理来减少 CCS 的障碍。
