Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia.
Cancer Epidemiol. 2022 Oct;80:102231. doi: 10.1016/j.canep.2022.102231. Epub 2022 Jul 25.
Like many Eastern-European countries, Estonia struggles with ineffective cervical cancer (CC) screening. Despite a long-term organised screening programme and high overall Pap-smear coverage, CC incidence and mortality remain very high. The aim of the study was to examine the reasons for high CC incidence in Estonia by analysing the effect of Pap-smears and sociodemographic factors on CC risk.
In this population-based case-control study, women aged ≥ 25 years with an in situ/invasive CC diagnosed in Estonia in 2011-2017 were defined as cases. Using a density sampling scheme, controls were randomly selected from general population. To estimate CC risk associated with having no Pap-smears during seven years before diagnosis (cases) or index date (controls), place of residence, interruption in health insurance, and several sociodemographic factors, multivariate logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI). Individual-level data from three population-based registries were used.
Among 1439 cases and 4317 controls, proportion of women with no Pap-smears was 53% and 35%, respectively. Women with no Pap-smears were at higher risk for CC (OR=2.35; 95% CI: 1.85-2.98). CC risk was increased among women who were younger, living in more remote regions, lower-educated, or divorced/widowed. Interruption in health insurance was associated with a 23% risk increase. Regional differences in CC risk were observed among screened women.
To reduce the risk of CC in Estonia, efforts are necessary to increase screening coverage among high-risk women and ensure the quality of CC screening programme. Screening approaches and communication should be tailored to the needs of different population groups. Further studies are warranted to identify the reasons for regional differences in CC risk.
与许多东欧国家一样，爱沙尼亚在宫颈癌（CC）筛查方面效果不佳。尽管长期以来一直有组织的筛查计划和高总体巴氏涂片覆盖率，但 CC 的发病率和死亡率仍然很高。本研究旨在通过分析巴氏涂片和社会人口因素对 CC 风险的影响，研究爱沙尼亚高 CC 发病率的原因。
在这项基于人群的病例对照研究中，2011 年至 2017 年期间在爱沙尼亚诊断出原位/浸润性 CC 的年龄≥25 岁的女性被定义为病例。使用密度抽样方案，从一般人群中随机选择对照。为了估计在诊断前 7 年（病例）或指数日期（对照）期间没有巴氏涂片检查与 CC 风险之间的关系，利用多变量逻辑回归计算比值比（OR）及其 95%置信区间（CI）。使用来自三个基于人群的登记处的个体水平数据。
在 1439 例病例和 4317 例对照中，没有巴氏涂片检查的女性比例分别为 53%和 35%。没有巴氏涂片检查的女性 CC 风险更高（OR=2.35；95%CI：1.85-2.98）。年龄较小、居住在较偏远地区、受教育程度较低或离婚/丧偶的女性 CC 风险增加。中断医疗保险与风险增加 23%相关。在筛查女性中观察到 CC 风险的区域差异。
为了降低爱沙尼亚的 CC 风险，需要努力提高高危女性的筛查覆盖率，并确保 CC 筛查计划的质量。筛查方法和沟通应根据不同人群的需求进行调整。需要进一步研究以确定 CC 风险区域差异的原因。
