Tsegaye Adino Tesfahun, Lin John, Cole Allison M, Szpiro Adam, Rao Darcy W, Walson Judd, Winer Rachel L
Department of Epidemiology, University of Washington School of Public Health, 3980 15Th Ave NE UW Box # 351619, Seattle, WA, 98195, USA.
Department of Family Medicine, University of Washington School of Medicine, Seattle, USA.
J Racial Ethn Health Disparities. 2024 Jun 7. doi: 10.1007/s40615-024-02038-5.
Cervical cancer screening (CCS) among East African immigrants (EAI) in the USA is under explored. This study aimed to investigate adherence to CCS and its correlates among EAI.
We identified 1664 EAI women (25-65 years) with ≥ 1 primary care clinic visit(s) between 2017 and 2018, using University of Washington (UW) Medicine electronic health record data. CCS adherence was defined as Pap testing within 3 years or human papillomavirus/Pap co-testing within 5 years. We used Poisson regression with robust standard errors to cross-sectionally estimate associations with correlates of adherence. Twelve-month screening uptake was also evaluated among overdue women.
CCS adherence was 63%. Factors associated with higher adherence included older age (adjusted prevalence ratios [APRs]:1.47:95%CI:1.14-1.90, 1.38:95%CI:1.05-1.80, respectively, for ages 30-39 and 40-49 vs 25-29 years), longer duration of care at UW Medicine (APR:1.22:95%CI:1.03-1.45, comparing > 10 vs < 5 years), higher visit frequency (APR:1.23:95%CI:1.04-1.44, 1.46:95%CI:1.24-1.72, respectively, for 3-5 and ≥ 6 vs 1-2 visits), index visit in an obstetrics-gynecology clinic (APR:1.26:95%CI:1.03-1.55, vs family practice), having an assigned primary care provider (APR:1.35: 95%CI:1.02-1.79), breast cancer screening adherence (APR:1.66: 95%CI:1.27-2.17), and colorectal cancer screening adherence (APR:1.59:95%CI:1.24-2.03). Low BMI was associated with lower adherence (APR:0.50:95%CI:0.26-0.96, comparing < 18.5 kg/m vs 18.5-24.9 kg/m). Among 608 (37%) overdue women, 9% were screened in the subsequent 12 months. Having commercial health insurance vs Medicare/Medicaid was associated with higher uptake (adjusted risk ratio:2.44:95%CI:1.15-5.18).
CCS adherence among EAI was lower than the national average of 80%. Interventions focused on increasing healthcare access/utilization or leveraging healthcare encounters to address barriers could increase CCS in EAIs.
美国东非移民（EAI）的宫颈癌筛查（CCS）情况尚未得到充分研究。本研究旨在调查EAI人群对CCS的依从性及其相关因素。
我们利用华盛顿大学（UW）医学电子健康记录数据，识别出2017年至2018年间有≥1次初级保健门诊就诊记录的1664名年龄在25至65岁之间的EAI女性。CCS依从性定义为3年内进行巴氏试验或5年内进行人乳头瘤病毒/巴氏联合检测。我们使用具有稳健标准误的泊松回归进行横断面分析，以估计与依从性相关因素的关联。我们还对逾期未筛查的女性进行了为期12个月的筛查接受情况评估。
CCS依从率为63%。与较高依从性相关的因素包括年龄较大（30 - 39岁和40 - 49岁相对于25 - 29岁的调整患病率比[APR]分别为1.47:95%CI:1.14 - 1.90和1.38:95%CI:1.05 - 1.80）、在UW医学中心接受治疗的时间较长（APR:1.22:95%CI:1.03 - 1.45，比较>10年与<5年）、就诊频率较高（3 - 5次和≥6次相对于1 - 2次就诊的APR分别为1.23:95%CI:1.04 - 1.44和1.46:95%CI:1.24 - 1.72）、在妇产科门诊进行首次就诊（APR:1.26:95%CI:1.03 - 1.55，相对于家庭医学科）、有指定的初级保健提供者（APR:1.35: 95%CI:1.02 - 1.79）、乳腺癌筛查依从性（APR:1.66: 95%CI:1.27 - 2.17）以及结直肠癌筛查依从性（APR:1.59:95%CI:1.24 - 2.03）。低体重指数与较低的依从性相关（APR:0.50:95%CI:0.26 - 0.96，比较<18.5kg/m²与18.5 - 24.9kg/m²）。在608名（37%）逾期未筛查的女性中，9%在随后的12个月内接受了筛查。拥有商业健康保险相对于医疗保险/医疗补助与更高的接受率相关（调整风险比：:2.44:95%CI:1.15 - 5.18）。
EAI人群的CCS依从性低于全国平均水平80%。针对增加医疗服务可及性/利用率或利用医疗接触来克服障碍的干预措施可能会提高EAI人群的CCS依从性。
