Surveillance & Health Equity Science Department, American Cancer Society, Atlanta, Georgia, USA.
Cancer. 2024 Jul 1;130(13):2315-2324. doi: 10.1002/cncr.35265. Epub 2024 Mar 25.
Community health centers (CHCs) provide historically marginalized populations with primary care, including cancer screening. Previous studies have reported that women living in rural areas are less likely to be up to date with cervical cancer screening than women living in urban areas. However, little is known about rural-urban differences in cervical cancer screening in CHCs and the contributing factors, and whether such differences changed during the COVID-19 pandemic.
Using 8-year pooled Uniform Data System (2014-2021) data and Oaxaca-Blinder decomposition, the extent to which CHC- and catchment area-level characteristics explained rural-urban differences in up-to-date cervical cancer screening was estimated.
Up-to-date cervical cancer screening was lower in rural CHCs than urban CHCs (38.2% vs 43.0% during 2014-2019), and this difference increased during the pandemic (43.5% vs 49.0%). The rural-urban difference in cervical cancer screening in 2014-2019 was mostly explained by differences in CHC-level proportions of patients with limited English proficiency (55.9%) or income below the poverty level (12.3%) and females aged 21 to 64 years (9.8%), and catchment area-level's unemployment (3.4%) and primary care physician density (3.2%). However, Medicaid (-48.5%) or no insurance (-19.6%) counterbalanced the differences between rural-urban CHCs. The contribution of these factors to rural-urban differences in cervical cancer screening generally increased in 2020-2021.
Rural-urban differences in cervical cancer screening were mostly explained by multiple CHC-level and catchment area-level characteristics. The findings call for tailored interventions, such as providing resources and language services, to improve cancer screening utilization among uninsured, Medicaid, and patients with limited English proficiency in rural CHCs.
社区卫生中心（CHC）为包括癌症筛查在内的初级保健提供服务，为历史上处于边缘地位的人群提供服务。先前的研究报告称，居住在农村地区的女性接受宫颈癌筛查的比例低于居住在城市地区的女性。然而，对于 CHC 中农村和城市地区宫颈癌筛查的差异以及促成因素，以及这些差异在 COVID-19 大流行期间是否发生变化，知之甚少。
使用 8 年统一数据系统（2014-2021 年）数据和 Oaxaca-Blinder 分解，估计 CHC 和集水区水平特征在多大程度上解释了农村和城市地区宫颈癌筛查的差异。
农村 CHC 的宫颈癌筛查及时率低于城市 CHC（2014-2019 年期间为 38.2%对 43.0%），而在大流行期间这一差异有所增加（43.5%对 49.0%）。2014-2019 年，农村和城市 CHC 之间宫颈癌筛查的差异主要由 CHC 层面上英语能力有限的患者比例（55.9%）或收入低于贫困线（12.3%）和 21 至 64 岁的女性比例（9.8%）以及集水区层面上的失业率（3.4%）和初级保健医生密度（3.2%）差异造成。然而，医疗补助（-48.5%）或没有保险（-19.6%）抵消了农村和城市 CHC 之间的差异。这些因素对农村和城市 CHC 之间宫颈癌筛查差异的贡献在 2020-2021 年期间普遍增加。
农村和城市 CHC 之间宫颈癌筛查的差异主要由多种 CHC 层面和集水区层面的特征造成。这些发现呼吁采取有针对性的干预措施，例如为农村 CHC 中的 uninsured、 Medicaid 和英语能力有限的患者提供资源和语言服务，以提高癌症筛查的利用率。
