Sarmiento Daiana Denis, Tumas Natalia, Pereyra Sofia Aynelen, Scruzzi Graciela Fabiana, Pou Sonia Alejandra
Centro de Investigaciones en Nutrición Humana (CenINH), Escuela de Nutrición, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba (UNC), Córdoba, Argentina.
Centro de Investigaciones y Estudios sobre Cultura y Sociedad (CIECS), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) y Universidad Nacional de Córdoba (UNC), Córdoba, Argentina.
Cancer Epidemiol Biomarkers Prev. 2024 Dec 2;33(12):1651-1658. doi: 10.1158/1055-9965.EPI-24-1001.
Mammography is crucial for early breast cancer detection. In Latin America, Argentina faces a significant breast cancer burden, with varying mammography rates. The social factors influencing mammography practices remain unclear. This study aimed to identify the proximal and distal social determinants of this practice among Argentinean women using a multilevel approach.
This nationwide cross-sectional study included 4,924 women, ages 50 to 70, participating in the 2018 National Risk Factor Survey of Argentina. Two-level logistic models were used to estimate measures of association (ORs) between timely mammography practice (within the last 2 years) and selected covariates (sociodemographics, proximal environment, and distal-level variables). The intraclass correlation coefficient and proportional change in variance were calculated.
Of the total participants, 62.8% of women underwent timely mammography. Age [OR = 0.96; 95% confidence interval (CI), 0.94-0.97], health insurance (OR = 2.22; 95% CI, 1.87-2.63), education (OR = 2.1; 95% CI, 1.74-2.64), and income (OR = 1.56; 95% CI, 1.23-1.97) were associated with mammography practice. Women in nonmarital (OR = 0.61; 95% CI, 0.52-0.72) or larger households (OR = 0.61; 95% CI, 0.51-0.63) were less likely to have timely mammography; living in a larger city was positively associated with timely mammography (OR = 1.28; 95% CI, 1.12-1.46). Women in provinces with higher physician density (OR = 1.06; 95% CI, 1.01-1.11) and lower maternal mortality ratio (OR = 0.9; 95% CI, 0.87-0.96) had higher chances of timely mammography. The intraclass correlation coefficient and proportional change in variance suggested that the explored healthcare indicators largely explained the macro-contextual effect.
Multilevel factors influenced mammography practices in Argentina. The results highlight disparities linked to sociodemographic characteristics and healthcare resources.
Efforts to address social inequalities in breast cancer screening must consider multilevel determinants, including in healthcare settings.
乳腺钼靶检查对于早期乳腺癌检测至关重要。在拉丁美洲，阿根廷面临着巨大的乳腺癌负担，乳腺钼靶检查率各不相同。影响乳腺钼靶检查行为的社会因素仍不明确。本研究旨在采用多层次方法确定阿根廷女性中这种行为的近端和远端社会决定因素。
这项全国性横断面研究纳入了4924名年龄在50至70岁之间、参与2018年阿根廷全国风险因素调查的女性。使用二级逻辑模型来估计及时进行乳腺钼靶检查（在过去2年内）与选定协变量（社会人口统计学、近端环境和远端层面变量）之间的关联度量（比值比）。计算组内相关系数和方差的比例变化。
在所有参与者中，62.8%的女性及时进行了乳腺钼靶检查。年龄[比值比 = 0.96；95%置信区间（CI），0.94 - 0.97]、医疗保险（比值比 = 2.22；95% CI，1.87 - 2.63）、教育程度（比值比 = 2.1；95% CI，1.74 - 2.64）和收入（比值比 = 1.56；95% CI，1.23 - 1.97）与乳腺钼靶检查行为相关。非婚女性（比值比 = 0.61；95% CI，0.52 - 0.72）或家庭规模较大的女性（比值比 = 0.61；95% CI，0.51 - 0.63）及时进行乳腺钼靶检查的可能性较小；生活在大城市与及时进行乳腺钼靶检查呈正相关（比值比 = 1.28；95% CI，1.12 - 1.46）。医生密度较高省份的女性（比值比 = 1.06；95% CI，1.01 - 1.11）和孕产妇死亡率较低省份的女性（比值比 = 0.9；95% CI，0.87 - 0.96）及时进行乳腺钼靶检查的机会更高。组内相关系数和方差的比例变化表明，所探索的医疗保健指标在很大程度上解释了宏观背景效应。
多层次因素影响了阿根廷的乳腺钼靶检查行为。结果突出了与社会人口统计学特征和医疗资源相关的差异。
解决乳腺癌筛查中社会不平等问题的努力必须考虑多层次决定因素，包括在医疗保健环境中。
