Steve Hicks School of Social Work, The University of Texas, Austin, Austin, TX, USA.
Ethn Health. 2023 Aug;28(6):895-911. doi: 10.1080/13557858.2023.2174254. Epub 2023 Feb 11.
Previous studies of disparities in breast and cervical cancer screenings have focused on broad racial/ethnic groups or nativity status without accounting for immigration histories. Recent theoretical work argues for using intersectional approaches and examining within-group inequalities. Utilizing multiple years of National Health Interview Survey (NHIS) data, we examined between- and within-group Papanicolaou (Pap) test and mammogram screening based on nativity and length of U.S. residence for Asian and Hispanic women, along with non-Hispanic Black and White women.
The study samples consist of 54,900 women ages 21-64 without a hysterectomy who responded to questions about Pap test screening and 36,300 women ages 40-64 who responded to questions about mammogram screening. Asian and Hispanic women were further stratified by nativity and, for immigrants, length of time in the United States. Logistic regression analysis was used to identify significant associations with Pap test and mammogram screenings.
Recent Asian and Hispanic immigrants had the lowest Pap test and mammogram rates among all other groups, while Black (and White women for mammograms) women had the highest rates. After accounting for age, marital status, health insurance, education, employment status, and income, both Asian groups had lower odds, and Black and all Hispanic groups had higher odds of Pap test screening compared with White women. Similar results were observed for mammogram screening, except that long-term immigrant/U.S.-born Asian and U.S.-born Hispanic women did not have significantly different odds compared with White women. In general, the strength and direction of most sociodemographic variables were similar across groups for Pap test screening but differed for mammogram screening.
The between-group differences identified emphasize the disparities in screening between racial/ethnic groups while the within-group differences suggest the need to examine whether more targeted outreach efforts and prevention messages can increase screening for specific groups.
先前关于乳腺癌和宫颈癌筛查差异的研究集中在广泛的种族/族裔群体或出生地身份上，而没有考虑到移民历史。最近的理论工作认为，需要采用交叉方法，并检查群体内的不平等现象。本研究利用多年的国家健康访谈调查（NHIS）数据，根据出生地和在美国居住的时间，检查了亚洲和西班牙裔女性以及非西班牙裔黑人和白人女性的巴氏试验和乳房 X 光检查筛查的组间和组内差异。
研究样本包括 54900 名年龄在 21-64 岁之间、未接受过子宫切除术的女性，她们回答了巴氏试验筛查问题，36300 名年龄在 40-64 岁之间的女性回答了乳房 X 光检查筛查问题。亚洲和西班牙裔女性进一步根据出生地和移民的在美国居住时间进行分层。Logistic 回归分析用于确定与巴氏试验和乳房 X 光检查筛查相关的显著关联。
最近的亚洲和西班牙裔移民在所有其他群体中的巴氏试验和乳房 X 光检查率最低，而黑人（和白人女性的乳房 X 光检查率）最高。在考虑了年龄、婚姻状况、健康保险、教育、就业状况和收入等因素后，两个亚洲群体的巴氏试验筛查率较低，而黑人以及所有西班牙裔群体的巴氏试验筛查率较高。对于乳房 X 光检查筛查，也观察到了类似的结果，除了长期移民/美国出生的亚洲和美国出生的西班牙裔女性与白人女性相比，没有显著不同的几率。一般来说，大多数社会人口统计学变量在巴氏试验筛查方面在群体间的强度和方向相似，但在乳房 X 光检查筛查方面有所不同。
确定的组间差异强调了不同种族/族裔群体之间在筛查方面的差异，而组内差异则表明需要检查是否可以通过更有针对性的外展工作和预防信息来增加特定群体的筛查。
