Riggs Sally L, Thomson Cynthia A, Jacobs Elizabeth, Cutshaw Chistina A, Ehiri John E
Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
Int J Womens Health. 2021 Oct 19;13:929-937. doi: 10.2147/IJWH.S327812. eCollection 2021.
In the United States, Hispanics are more likely to be diagnosed with cervical cancer compared to Non-Hispanic Whites. Annually, 250,000 to 1 million women are diagnosed with a precursor to CC. The aim of this study was to assess whether Hispanics have a higher prevalence of cervical dysplasia compared to Non-Hispanics Whites among a population of low-income women.
We analyzed the results of 10,911 cervical cytology tests administered between 2003 and 2016 that were funded through the Center for Disease Control and Prevention's (CDC) program for low-income, uninsured women entitled the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). In the state of Arizona, the program is called the Well Women HealthCheck Program (WWHP). Logistic regression was used to identify increased risk of dysplasia, including low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesions (HSIL/ICC), and multinomial logistic regression was used to assess increased likelihood for LSIL and HSIL/ICC as separate categories.
In the crude analysis, Hispanic ethnicity was modestly associated with higher prevalence of LSIL (odds ratio (OR)=1.39, 95% CI=1.01-1.91), but this association was not statistically significant after adjusting for confounders. However, in the final models, lower income was independently associated with LSIL (adjusted odds ratio [aOR]=1.55, 95% CI=1.30-1.44), while smoking (aOR=2.88, 95% CI=1.21-6.84) and no history of Pap test within five years (aOR=3.54, 95% CI=1.61-6.99) were independently associated with HSIL.
After adjusting for confounding in a sample of low-income women with comparable Pap screening rates, ethnicity was not associated with greater prevalence of abnormal pap smears. However, other variables were independently associated with LSIL and HSIL. The higher proportion of LSIL cases among lower income individuals compared to those with higher incomes, and the higher proportion of HSIL cases observed among those screened least regularly stresses the importance of programs like WWHP: programs that target low-income, uninsured women. These programs help save lives.
在美国，与非西班牙裔白人相比，西班牙裔女性被诊断出宫颈癌的可能性更高。每年有25万至100万女性被诊断患有宫颈癌前病变。本研究的目的是评估在低收入女性人群中，西班牙裔女性的宫颈发育异常患病率是否高于非西班牙裔白人女性。
我们分析了2003年至2016年间进行的10911例宫颈细胞学检查结果，这些检查由疾病控制与预防中心（CDC）为低收入、未参保女性设立的项目资助，该项目名为国家乳腺癌和宫颈癌早期检测项目（NBCCEDP）。在亚利桑那州，该项目被称为健康女性健康检查项目（WWHP）。采用逻辑回归分析来确定发育异常风险的增加，包括低度鳞状上皮内病变（LSIL）和高度鳞状上皮内病变（HSIL/ICC），并采用多项逻辑回归分析来评估LSIL和HSIL/ICC作为单独类别出现的可能性增加情况。
在粗分析中，西班牙裔种族与LSIL患病率较高有适度关联（优势比（OR）=1.39，95%置信区间=1.01 - 1.91），但在调整混杂因素后，这种关联无统计学意义。然而，在最终模型中，低收入与LSIL独立相关（调整后优势比[aOR]=1.55，95%置信区间=1.30 - 1.44），而吸烟（aOR=2.88，95%置信区间=1.21 - 6.84）和五年内无巴氏试验史（aOR=3.54，95%置信区间=1.61 - 6.99）与HSIL独立相关。
在对巴氏筛查率相当的低收入女性样本进行混杂因素调整后，种族与异常巴氏涂片的较高患病率无关。然而，其他变量与LSIL和HSIL独立相关。与高收入者相比，低收入个体中LSIL病例比例较高，而筛查最不规律者中HSIL病例比例较高，这凸显了WWHP等项目的重要性：这些项目针对低收入、未参保女性。这些项目有助于挽救生命。
