Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, FL, United States of America; University of Florida Health Cancer Center, Gainesville, FL, United States of America.
Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America.
Prev Med. 2022 Jan;154:106869. doi: 10.1016/j.ypmed.2021.106869. Epub 2021 Nov 9.
Prior studies of screening mammography patterns by functional status in older women show inconsistent results. We used Breast Cancer Surveillance Consortium-Medicare linked data (1999-2014) to investigate the association of functional limitations with adherence to screening mammography in 145,478 women aged 66-74 years. Functional limitation was represented by a claims-based function-related indicator (FRI) score which incorporated 16 items reflecting functional status. Baseline adherence was defined as mammography utilization 9-30 months after the index screening mammography. Longitudinal adherence was examined among women adherent at baseline and defined as time from the index mammography to end of the first 30-month gap in mammography. Multivariable logistic regression and Cox proportional hazards models were used to investigate baseline and longitudinal adherence, respectively. Subgroup analyses were conducted by age (66-70 vs. 71-74 years). Overall, 69.6% of participants had no substantial functional limitation (FRI score 0), 23.5% had some substantial limitations (FRI score 1), and 6.8% had serious limitations (FRI score ≥ 2). Mean age at baseline was 68.5 years (SD = 2.6), 85.3% of participants were white, and 77.1% were adherent to screening mammography at baseline. Women with a higher FRI score were more likely to be non-adherent at baseline (FRI ≥ 2 vs. 0: aOR = 1.13, 95% CI = 1.06, 1.20, p-trend < 0.01). Similarly, a higher FRI score was associated with longitudinal non-adherence (FRI ≥ 2 vs. 0: aHR = 1.16, 95% CI = 1.11, 1.22, p-trend < 0.01). Effect measures of FRI did not differ substantially by age categories. Older women with a higher burden of functional limitations are less likely to be adherent to screening mammography recommendations.
先前关于老年女性功能状态筛查乳房 X 光模式的研究结果不一致。我们使用乳腺癌监测联合会-医疗保险链接数据（1999-2014 年），调查了 145478 名 66-74 岁女性中功能限制与接受筛查乳房 X 光检查之间的关联。功能限制由一个基于索赔的与功能相关的指标（FRI）评分来表示，该评分纳入了 16 个反映功能状态的项目。基线依从性定义为在索引筛查乳房 X 光检查后 9-30 个月进行乳房 X 光检查。对基线依从的女性进行纵向依从性检查，并定义为从索引乳房 X 光检查到首次 30 个月乳房 X 光检查间隔结束的时间。使用多变量逻辑回归和 Cox 比例风险模型分别研究了基线和纵向依从性。根据年龄（66-70 岁与 71-74 岁）进行亚组分析。总体而言，69.6%的参与者没有实质性的功能限制（FRI 评分为 0），23.5%有一些实质性的限制（FRI 评分为 1），6.8%有严重的限制（FRI 评分≥2）。基线时的平均年龄为 68.5 岁（SD=2.6），85.3%的参与者为白人，77.1%的参与者在基线时接受了筛查性乳房 X 光检查。FRI 评分较高的女性在基线时更不可能依从（FRI≥2 与 0：aOR=1.13，95%CI=1.06，1.20，p 趋势<0.01）。同样，较高的 FRI 评分与纵向不依从相关（FRI≥2 与 0：aHR=1.16，95%CI=1.11，1.22，p 趋势<0.01）。FRI 的效应度量在年龄类别之间没有显著差异。功能限制负担较重的老年女性更不可能遵守筛查性乳房 X 光检查建议。
