Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States; College of Nursing, University of South Carolina, 1601 Greene Street Columbia, SC, 29208, United States; Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street Columbia, SC, 29208, United States.
Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States; Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street Columbia, SC, 29208, United States.
Cancer Epidemiol. 2020 Apr;65:101681. doi: 10.1016/j.canep.2020.101681. Epub 2020 Feb 5.
Lack of participation in cervical cancer screening in underserved populations has been attributed to access to care, particularly among women in rural areas. Federally Qualified Health Centers (FQHCs) were created to address this need in medically underserved populations. This study observed proximity to three health centers in relation to cervical cancer screening rates in South Carolina.
Data were obtained from FQHC patient visits (from 3 centers) between 2007-2010 and were limited to women eligible for cervical cancer screening (n = 24,393). ArcGIS was used to geocode patients addresses and FQHC locations, and distance was calculated. Modified Poisson regression was used to estimate relative risk of obtaining cervical cancer screening within one yearor ever, stratified by residential area.
Findings differed markedly by center and urban/rural status. At two health clinics, rural residents living the furthest away from the clinic (∼9 miles difference between quartile 4 and quartile 1) were more likely to be ever screened (RRs = 1.05 and 1.03, p-values < 0.05), while urban residents living the furthest away were less likely to be ever screened (RR = 0.85, p-value < 0.05). At the third center, only urban residents living the furthest away were more likely to be ever screened (RR = 1.02, p-value < 0.05).
Increased travel distance significantly increased the likelihood of cervical cancer screening at two FQHC sites while significantly decreasing the likelihood of screening at the 3rd site. These findings underscore the importance of contextual and environmental factors that impact use of cervical cancer screening services.
在服务不足的人群中，参与宫颈癌筛查的人数较少，这归因于获得医疗服务的机会，尤其是在农村地区的妇女。联邦合格的健康中心 (FQHC) 的建立是为了满足医疗服务不足人群的这一需求。本研究观察了与南卡罗来纳州宫颈癌筛查率相关的三个健康中心的接近程度。
数据来自于 2007-2010 年期间三个 FQHC 患者就诊（n=24393），并限定为符合宫颈癌筛查条件的女性。ArcGIS 用于对患者地址和 FQHC 位置进行地理编码，并计算距离。采用修正泊松回归，按居住区域分层，估计一年内或以往获得宫颈癌筛查的相对风险。
发现结果因中心和城乡状况而有明显差异。在两个健康诊所中，居住在离诊所最远的农村居民（第 4 四分位与第 1 四分位之间差异约 9 英里）更有可能进行过宫颈癌筛查（RRs=1.05 和 1.03，p 值均<0.05），而居住在最远的城市居民则不太可能进行过宫颈癌筛查（RR=0.85，p 值<0.05）。在第三个中心，只有居住在最远的城市居民更有可能进行过宫颈癌筛查（RR=1.02，p 值<0.05）。
在两个 FQHC 地点，旅行距离的增加显著增加了宫颈癌筛查的可能性，而在第三个地点，旅行距离的增加显著降低了筛查的可能性。这些发现强调了影响宫颈癌筛查服务使用的背景和环境因素的重要性。
