Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL, USA.
Simons Cancer Institute, Southern Illinois University School of Medicine, Springfield, IL, USA.
Cancer Causes Control. 2020 Oct;31(10):951-964. doi: 10.1007/s10552-020-01339-4. Epub 2020 Aug 24.
Although few studies have examined screening uptake among sexual minorities (lesbian, gay, bisexual, queer), almost none have examined it in the specific context of rural populations. Therefore, our objective was to assess how cancer screening utilization varies by residence and sexual orientation.
Publicly available population-level data from the 2014 and 2016 Behavioral Risk Factor Surveillance System were utilized. Study outcomes included recommended recent receipt of breast, cervical, and colorectal cancer screening. Independent variables of interest were residence (rural/urban) and sexual orientation (heterosexual/gay or lesbian/bisexual). Weighted proportions and multivariable logistic regressions were used to assess the association between the independent variables and the outcomes, adjusting for demographic, socioeconomic, and healthcare utilization factors.
Rates for all three cancer screenings were lowest in rural areas and among sexual minority populations (cervical: rural lesbians at 64.8% vs. urban heterosexual at 84.6%; breast: rural lesbians at 66.8% vs. urban heterosexual at 80.0%; colorectal for males: rural bisexuals at 52.4% vs. urban bisexuals at 81.3%; and colorectal for females: rural heterosexuals at 67.2% vs. rural lesbians at 74.4%). In the multivariate analyses for colorectal screening, compared to urban heterosexual males, both rural gay and rural heterosexual males were less likely to receive screening (aOR = 0.45; 95% = 0.24-0.73 and aOR = 0.79; 95% = 0.72-0.87, respectively) as were rural heterosexual females (aOR = 0.87; 95% = 0.80-0.94) compared to urban heterosexual females. For cervical screening, lesbians were less likely to receive screening (aOR = 0.62; 95% = 0.41-0.94) than heterosexuals, and there were no differences for breast screening.
We found that rural sexual minorities may experience disparities in cancer screening utilization associated with the compounding barriers of rural residence and sexual minority status, after adjusting for demographic, socioeconomic, and healthcare utilization factors. Further work is needed to identify factors influencing these disparities and how they might be addressed.
尽管很少有研究调查性少数群体（女同性恋、男同性恋、双性恋、酷儿）的筛查参与情况，但几乎没有研究在农村人群的具体背景下进行调查。因此，我们的目的是评估癌症筛查的利用情况如何因居住地点和性取向而异。
利用 2014 年和 2016 年行为风险因素监测系统的公开人群水平数据。研究结果包括最近接受乳腺癌、宫颈癌和结直肠癌筛查的情况。感兴趣的自变量为居住地（农村/城市）和性取向（异性恋/男同性恋或女同性恋/双性恋）。使用加权比例和多变量逻辑回归来评估独立变量与结果之间的关联，调整了人口统计学、社会经济和医疗保健利用因素。
三种癌症筛查的比例在农村地区和性少数群体中最低（宫颈癌：农村女同性恋者为 64.8%，城市异性恋者为 84.6%；乳腺癌：农村女同性恋者为 66.8%，城市异性恋者为 80.0%；男性结直肠癌：农村双性恋者为 52.4%，城市双性恋者为 81.3%；女性结直肠癌：农村异性恋者为 67.2%，农村女同性恋者为 74.4%）。在结直肠癌筛查的多变量分析中，与城市异性恋男性相比，农村男同性恋者和农村异性恋男性接受筛查的可能性较小（调整后比值比[aOR]分别为 0.45；95%置信区间[CI]为 0.24-0.73 和 0.79；95%CI 为 0.72-0.87），农村异性恋女性（aOR 为 0.87；95%CI 为 0.80-0.94）也低于城市异性恋女性。对于宫颈癌筛查，女同性恋者接受筛查的可能性较小（aOR 为 0.62；95%CI 为 0.41-0.94），而异性恋者则没有差异，乳腺癌筛查则没有差异。
在调整了人口统计学、社会经济和医疗保健利用因素后，我们发现，农村性少数群体在癌症筛查利用方面可能存在差异，这与农村居住和性少数群体地位的综合障碍有关。需要进一步研究确定影响这些差异的因素以及如何解决这些差异。
