Sassenou Jeanne, Ringa Virginie, Zins Marie, Ozguler Anna, Paquet Sylvain, Panjo Henri, Franck Jeanna-Eve, Menvielle Gwenn, Rigal Laurent
Centre for Research in Epidemiology and Population Health (CESP), Inserm U1018, Université Paris-Saclay, Villejuif, France.
National Institute for Health and Medical Research (Inserm), Population-based Epidemiologic Cohorts Units, UMS 011, Villejuif, France.
Prev Med Rep. 2023 Sep 9;36:102363. doi: 10.1016/j.pmedr.2023.102363. eCollection 2023 Dec.
The regular performance of Pap tests for cervical cancer screening reduces this disease's incidence and mortality. Income inequalities have been reported for this screening, partly because in some countries women must advance or even pay out-of-pocket costs. Because immigrant status is also associated with low Pap test uptake, we aimed to analyze the combined impact of immigrant status and low income on cervical cancer underscreening. This study, based on the French CONSTANCES cohort, uses data from the cohort questionnaires and linked health insurance fund data about Pap test reimbursement. To measure income inequalities in screening, we calculated a Slope Index of Inequality (SII) by linear regression, taking into account the migration status of participants. The majority of the 70,614 women included in the analysis were not immigrants (80.2%), while 12.9% were second-generation immigrants, and 6.9% first-generation immigrants. The proportion of underscreening increased with immigrant status, from 19.5% among nonimmigrants to 23.6% among the second generation, and 26.5% among the first ( < 0.01). The proportion of underscreening also increased as income level decreased. The income gradient rose significantly from 14% among nonimmigrants to 21% in second-generation immigrants and 19% in the first generation ( < 0.01). Among first-generation migrants, the shorter the duration of residence, the higher the SII. Women who are first- or second-generation immigrants are simultaneously underscreened and subject to a more unfavorable economic gradient than native French women born to native French parents. The accumulation of several negative factors could be particularly unfavorable to screening uptake.
定期进行巴氏试验以筛查宫颈癌可降低该疾病的发病率和死亡率。据报道，这种筛查存在收入不平等现象，部分原因是在一些国家，女性必须自行承担费用，甚至要自掏腰包。由于移民身份也与巴氏试验接受率低有关，我们旨在分析移民身份和低收入对宫颈癌筛查不足的综合影响。这项基于法国CONSTANCES队列的研究，使用了队列问卷数据以及与之相关的医疗保险基金关于巴氏试验报销的数据。为了衡量筛查中的收入不平等，我们通过线性回归计算了不平等斜率指数（SII），同时考虑了参与者的移民身份。分析纳入的70614名女性中，大多数不是移民（80.2%），而第二代移民占12.9%，第一代移民占6.9%。筛查不足的比例随着移民身份的增加而上升，从非移民中的19.5%升至第二代移民中的23.6%，第一代移民中则为26.5%（P<0.01）。筛查不足的比例也随着收入水平的降低而增加。收入梯度从非移民中的14%显著升至第二代移民中的21%和第一代移民中的19%（P<0.01）。在第一代移民中，居住时间越短，SII越高。第一代或第二代移民女性不仅筛查不足，而且与法国本土父母所生的法国本土女性相比，面临更不利的经济梯度。多种负面因素的累积可能对筛查接受率特别不利。
