Department of General Medicine, School of Medicine, Lille University, Lille, France.
Department of Public Health, University Hospital of Lille, Lille University, Lille, France.
PLoS One. 2020 May 15;15(5):e0232814. doi: 10.1371/journal.pone.0232814. eCollection 2020.
Cervical cancer screening rates are known to be strongly associated with socioeconomic status. Our objective was to assess whether the rate is also associated with an aggregated deprivation marker, defined by the location of family doctors' offices.
To access this association, we 1) collected data from the claim database of the French Health Insurance Fund about the registered family doctors and their enlisted female patients eligible for cervical screening; 2) carried out a telephone survey with all registered doctors to establish if they were carrying out Pap-smears in their practices; 3) geotracked all the doctors' offices in the smallest existing blocks of socioeconomic homogenous populations (IRIS census units) that were assigned a census derived marker of deprivation, the European Deprivation Index (EDI), and a binary variable of urbanization; and 4) we used a multivariable linear mixed model with IRIS as a random effect.
Of 348 eligible doctors, 343 responded to the telephone survey (98.6%) and were included in the analysis, encompassing 88,152 female enlisted patients aged 25-65 years old. In the multivariable analysis (adjusted by the gender of the family doctor, the practice of Pap-smears by the doctor and the urbanization of the office location), the EDI of the doctor's office was strongly associated with the cervical cancer screening participation rate of eligible patients (p<0.001).
The EDI linked to the location of the family doctor's office seems to be a robust marker to predict female patients' participation in cervical cancer screening.
宫颈癌筛查率与社会经济地位密切相关。我们的目的是评估该比率是否与家庭医生办公室所在地定义的综合贫困指标有关。
为了评估这种关联，我们 1）从法国健康保险基金的索赔数据库中收集了有关注册家庭医生及其在册的符合宫颈癌筛查条件的女性患者的数据；2）对所有注册医生进行了电话调查，以确定他们是否在诊所进行巴氏涂片检查；3）以社会经济同质人群（IRIS 普查单位）的最小现有街区为单位，对所有医生的办公室进行地理追踪，并为每个街区分配一个源自普查的贫困指标，即欧洲贫困指标（EDI）和一个城市化的二进制变量；4）我们使用多变量线性混合模型，将 IRIS 作为随机效应。
在 348 名符合条件的医生中，有 343 名（98.6%）回应了电话调查，并被纳入分析，共纳入 88152 名年龄在 25-65 岁之间的在册女性患者。在多变量分析中（按家庭医生的性别、医生进行巴氏涂片检查的情况以及办公室所在地的城市化程度进行调整），医生办公室的 EDI 与符合条件的患者参与宫颈癌筛查的比率密切相关（p<0.001）。
与家庭医生办公室所在地相关的 EDI 似乎是预测女性患者参与宫颈癌筛查的一个可靠指标。
