Springer Rachel, Erroba Jeremy, O'Malley Jean P, Huguet Nathalie
Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA.
OCHIN, Inc., Portland, OR, USA.
SSM Popul Health. 2024 Jan 26;25:101612. doi: 10.1016/j.ssmph.2024.101612. eCollection 2024 Mar.
There is interest in using clinic- and area-level data to inform cancer control, but it is unclear what value these sources may add in combination with patient-level data sources. This study aimed to investigate associations of up-to-date colorectal and cervical cancer screenings at community health centers (CHCs) with ethnicity and language variables at patient-, clinic-, and area-levels, while exploring whether patient-level associations differed based on clinic-level patient language and ethnicity distributions.
This was a cross-sectional study using data from multiple sources, including electronic health records, clinic patient panel data, and area-level demographic data. The study sample included English-preferring Hispanic, Spanish-preferring Hispanic, English-preferring non-Hispanic, and non-English-preferring non-Hispanic patients eligible for either colorectal cancer (N = 98,985) or cervical cancer (N = 129,611) screenings in 2019 from 130 CHCs in the OCHIN network in CA, OR, and WA.
The study population consisted of adults aged 45+ eligible for colorectal cancer screening and adults with a cervix aged 25-65 eligible for cervical cancer screening.
Spanish-preferring Hispanic patients were significantly more likely to be up-to-date with colorectal and cervical cancer screenings than other groups. Patients seen at clinics with higher concentrations of Spanish-preferring Hispanics were significantly more likely to be up-to-date, as were individuals residing in areas with higher percentages of Spanish-speaking residents. Differential associations between patient ethnicity and language and up-to-date colorectal cancer screenings were greater among patients seen at clinics with higher concentrations of Spanish-preferring Hispanics.
The findings highlight that Spanish-speaking Hispanics seen in CHCs have higher rates of up-to-date cervical and colorectal cancer screenings than other groups and that this relationship is stronger at clinics with higher percentages of Spanish-preferring Hispanic patients. Our findings suggest area-level variables are not good substitutions for patient-level data, but variables at the clinic patient panel-level are more informative.
人们对利用诊所和地区层面的数据来为癌症控制提供信息很感兴趣，但尚不清楚这些数据来源与患者层面的数据来源相结合可能会增加什么价值。本研究旨在调查社区卫生中心（CHC）最新的结直肠癌和宫颈癌筛查与患者、诊所和地区层面的种族和语言变量之间的关联，同时探讨患者层面的关联是否因诊所层面患者的语言和种族分布而有所不同。
这是一项横断面研究，使用了来自多个来源的数据，包括电子健康记录、诊所患者面板数据和地区层面的人口统计数据。研究样本包括2019年在加利福尼亚州、俄勒冈州和华盛顿州的OCHIN网络中的130家社区卫生中心符合结直肠癌（N = 98,985）或宫颈癌（N = 129,611）筛查条件的偏好英语的西班牙裔、偏好西班牙语的西班牙裔、偏好英语的非西班牙裔以及不偏好英语的非西班牙裔患者。
研究人群包括年龄在45岁及以上符合结直肠癌筛查条件的成年人以及年龄在25 - 65岁有子宫颈且符合宫颈癌筛查条件的成年人。
偏好西班牙语的西班牙裔患者比其他群体更有可能进行最新的结直肠癌和宫颈癌筛查。在偏好西班牙语的西班牙裔患者集中度较高的诊所就诊的患者进行最新筛查的可能性显著更高，居住在说西班牙语居民比例较高地区的个体也是如此。在偏好西班牙语的西班牙裔患者集中度较高的诊所就诊的患者中，患者种族和语言与最新结直肠癌筛查之间的差异关联更大。
研究结果表明，在社区卫生中心就诊的讲西班牙语的西班牙裔人群进行最新宫颈癌和结直肠癌筛查的比例高于其他群体，并且在偏好西班牙语的西班牙裔患者比例较高的诊所中这种关系更强。我们的研究结果表明，地区层面的变量不能很好地替代患者层面的数据，但诊所患者面板层面的变量信息更丰富。
