Department of Biomedical Engineering, Tel-Aviv University, Tel-Aviv, Israel.
Department of Biomedical Engineering, Tel-Aviv University, Tel-Aviv, Israel; Edmond J. Safra Center for Bioinformatics, Tel-Aviv University, Tel-Aviv, Israel.
Prev Med. 2024 Aug;185:108045. doi: 10.1016/j.ypmed.2024.108045. Epub 2024 Jun 18.
To investigate the relationship between Body Mass Index (BMI) and adherence to recommended screening tests, addressing gaps in previous literature by utilizing a large cohort, while considering longitudinal changes in weight and the type of screening.
Data from Clalit Health Services in Israel were retrospectively analyzed, including participants aged 50 and above from 2002 to 2021. BMI measurements and various screening test records were examined. Generalized Estimating Equations were employed for analysis, adjusting for potential confounding variables, including age, gender, geographic location, and socioeconomic status.
The study included 634,879 participants with 4,630,030 BMI measurements and 56,453,659 test records. Participants were categorized into BMI cohorts at the time of the test, with overweight and obese individuals showing lower odds of undergoing intimate examination-based screening tests (mammography, PAPS, and skin examination), as opposed to higher odds of several non-intimate tests (e.g., diabetes and eye disorder screenings).
Our findings suggest that individuals with overweight and obesity are less likely to undergo screenings involving intimate physical examinations, potentially due to weight stigma and discomfort. This avoidance behavior may contribute to increased morbidity rates in these populations. Interventions addressing weight stigma, improving access to care, and enhancing patient engagement are warranted.
通过利用大型队列研究，同时考虑体重的纵向变化和筛查类型，探究体重指数（BMI）与推荐筛查测试依从性之间的关系，以弥补先前文献中的空白。
回顾性分析了以色列克利夫兰医疗服务机构的数据，纳入了 2002 年至 2021 年间年龄在 50 岁及以上的参与者。对 BMI 测量值和各种筛查测试记录进行了检查。采用广义估计方程进行分析，调整了潜在的混杂变量，包括年龄、性别、地理位置和社会经济地位。
该研究纳入了 634879 名参与者，共进行了 4630030 次 BMI 测量和 56453659 次测试记录。参与者在接受测试时被分为 BMI 队列，超重和肥胖个体进行基于亲密检查的筛查测试（乳房 X 光检查、前列腺特异抗原检查和皮肤检查）的可能性较低，而接受多项非亲密测试（如糖尿病和眼部疾病筛查）的可能性较高。
我们的研究结果表明，超重和肥胖个体进行涉及亲密体检的筛查的可能性较低，这可能是由于体重歧视和不适所致。这种回避行为可能导致这些人群的发病率增加。需要采取干预措施来解决体重歧视问题，改善医疗服务的可及性，并增强患者的参与度。
