Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
Steve Hicks School of Social Work, The University of Texas at Austin, 1 University Station D3500, Austin, TX, 78712, USA.
J Cancer Educ. 2022 Apr;37(2):421-429. doi: 10.1007/s13187-020-01832-z.
The study examined the impact of (1) county-level poverty rates and (2) patient navigation on breast and cervical cancer screening outcomes for women in rural and border counties in Texas reporting barriers to screening.Univariate analyses described the distribution and screening prevalence rates in the sample, while a series of random intercept logistic regression models analyzed mammogram (N = 2326 women aged 40+) and Papanicolaou (Pap; N = 2959 women aged 21-64) screening separately.Mammogram and Pap screening prevalence rates were highest among women who were aged 40-64, Spanish-speaking Latinas, lower educated, attending cancer education events because of the cost of the screenings, patient navigation recipients, living in the south region of Texas, and in counties with high poverty. Although models indicated significant variability in screening rates by county, county-level poverty was only significantly associated with odds of getting Pap screening in adjusted models. Not receiving patient navigation vs. receiving it was associated with lower odds for both mammogram (OR: 0.51, CI: 0.38-0.70) and Pap (OR: 0.69, CI: 0.50-0.94) screenings.County-level variation in screening rates exists for both mammogram and Pap tests and should be considered in the development and implementation of screening interventions in rural and border areas. However, other factors beyond poverty levels may explain the variation.
该研究考察了（1）县级贫困率和（2）患者导航对报告农村和边境县筛查障碍的德克萨斯州妇女的乳腺癌和宫颈癌筛查结果的影响。单变量分析描述了样本中的分布和筛查流行率，而一系列随机截距逻辑回归模型则分别分析了乳房 X 光（N=2326 名 40 岁以上女性）和巴氏涂片（N=2959 名 21-64 岁女性）筛查。40-64 岁、讲西班牙语的拉丁裔、受教育程度较低、因筛查费用而参加癌症教育活动、接受患者导航的女性、居住在德克萨斯州南部地区以及贫困率较高的县的妇女，乳房 X 光和巴氏涂片筛查的流行率最高。尽管模型表明筛查率存在显著的县间差异，但调整模型仅表明县级贫困与接受巴氏涂片筛查的几率显著相关。与接受患者导航相比，未接受患者导航与乳房 X 光（OR：0.51，CI：0.38-0.70）和巴氏涂片（OR：0.69，CI：0.50-0.94）筛查的几率较低有关。乳房 X 光和巴氏涂片检查的筛查率存在县间差异，应在农村和边境地区的筛查干预措施的制定和实施中加以考虑。然而，除贫困水平以外的其他因素可能解释了这种差异。
