Department of Surgery, University of California, Davis, Sacramento.
Division of Nephrology, Department of Medicine, Medical College of Wisconsin, Milwaukee.
JAMA Netw Open. 2024 Oct 1;7(10):e2437492. doi: 10.1001/jamanetworkopen.2024.37492.
Growing evidence suggests that social determinants of health are associated with low uptake of preventive care services.
To examine the independent associations of social risk factor domains with preventive care services among US adults.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used National Health Interview Survey data on 82 432 unweighted individuals (239 055 950 weighted) from 2016 to 2018. Subpopulations were created for each of the primary outcomes: routine mammography (women aged 40-74 years), Papanicolaou test (women aged 21-65 years), colonoscopy (adults aged 45-75 years), influenza vaccine (adults aged ≥18 years), and pneumococcal vaccine (adults aged ≥65 years). Statistical analysis was performed from July to December 2023.
Six social risk domains (economic instability, lack of community, education deficit, food insecurity, social isolation, and lack of access to care) and a count of domains.
Logistic regression models were used to examine the independent association between each primary outcome (mammography, Papanicolaou test, colonoscopy, influenza vaccine, and pneumococcal vaccine) and social risk factor domains, while controlling for covariates (age, sex, race and ethnicity, health insurance, and comorbidities).
A total of 82 432 unweighted US individuals (239 055 950 weighted individuals) were analyzed. A total of 54.3% were younger than 50 years, and 51.7% were female. All 5 screening outcomes were associated with educational deficit (mammography: odds ratio [OR], 0.73 [95% CI, 0.67-0.80]; Papanicolaou test: OR, 0.78 [95% CI, 0.72-0.85]; influenza vaccine: OR, 0.71 [95% CI, 0.67-0.74]; pneumococcal vaccine: OR, 0.68 [95% CI, 0.63-0.75]; colonoscopy: OR, 0.82 [95% CI, 0.77-0.87]) and a lack of access to care (mammography: OR, 0.32 [95% CI, 0.27-0.38]; Papanicolaou test: OR, 0.49 [95% CI, 0.44-0.54]; influenza vaccine: OR, 0.44 [95% CI, 0.41-0.47]; pneumococcal vaccine: OR, 0.30 [95% CI, 0.25-0.38]; colonoscopy: OR, 0.35 [95% CI, 0.30-0.41]). Fully adjusted models showed that every unit increase in social risk count was significantly associated with decreased odds of receiving a mammography (OR, 0.74 [95% CI, 0.71-0.77]), Papanicolaou test (OR, 0.84 [95% CI, 0.81-0.87]), influenza vaccine (OR, 0.81 [95% CI, 0.80-0.83]), pneumococcal vaccine (OR, 0.80 [95% CI, 0.77-0.83]), and colonoscopy (OR, 0.88 [95% CI, 0.86-0.90]).
This cross-sectional study of US adults suggests that social risk factor domains were associated with decreased odds of receiving preventive services; this association was cumulative. There is a need to address social risk factors to optimize receipt of recommended preventive services.
越来越多的证据表明，健康的社会决定因素与预防保健服务的低利用率有关。
研究美国成年人中社会风险因素领域与预防保健服务之间的独立关联。
设计、地点和参与者：这项横断面研究使用了 2016 年至 2018 年期间来自全国健康访谈调查的数据，涉及 82432 名未经加权的个体（239055950 名经加权的个体）。为每个主要结果创建了子群体：常规乳房 X 光检查（40-74 岁女性）、巴氏试验（21-65 岁女性）、结肠镜检查（45-75 岁成年人）、流感疫苗（18 岁以上成年人）和肺炎球菌疫苗（65 岁以上成年人）。统计分析于 2023 年 7 月至 12 月进行。
六个社会风险领域（经济不稳定、缺乏社区、教育不足、食品安全、社会孤立和缺乏医疗服务）和一个领域计数。
使用逻辑回归模型检查每个主要结果（乳房 X 光检查、巴氏试验、结肠镜检查、流感疫苗和肺炎球菌疫苗）与社会风险因素领域之间的独立关联，同时控制协变量（年龄、性别、种族和民族、医疗保险和合并症）。
分析了 82432 名未经加权的美国个体（239055950 名经加权的个体）。共有 54.3%的人年龄小于 50 岁，51.7%的人为女性。所有 5 项筛查结果均与教育不足相关（乳房 X 光检查：优势比[OR]，0.73[95%置信区间，0.67-0.80]；巴氏试验：OR，0.78[95%置信区间，0.72-0.85]；流感疫苗：OR，0.71[95%置信区间，0.67-0.74]；肺炎球菌疫苗：OR，0.68[95%置信区间，0.63-0.75]；结肠镜检查：OR，0.82[95%置信区间，0.77-0.87]）和缺乏医疗服务（乳房 X 光检查：OR，0.32[95%置信区间，0.27-0.38]；巴氏试验：OR，0.49[95%置信区间，0.44-0.54]；流感疫苗：OR，0.44[95%置信区间，0.41-0.47]；肺炎球菌疫苗：OR，0.30[95%置信区间，0.25-0.38]；结肠镜检查：OR，0.35[95%置信区间，0.30-0.41]）。完全调整后的模型表明，社会风险计数每增加一个单位，接受乳房 X 光检查的几率显著降低（OR，0.74[95%置信区间，0.71-0.77]）、巴氏试验（OR，0.84[95%置信区间，0.81-0.87]）、流感疫苗（OR，0.81[95%置信区间，0.80-0.83]）、肺炎球菌疫苗（OR，0.80[95%置信区间，0.77-0.83]）和结肠镜检查（OR，0.88[95%置信区间，0.86-0.90]）。
这项对美国成年人的横断面研究表明，社会风险因素与预防保健服务的接受率降低有关；这种关联是累积的。需要解决社会风险因素，以优化推荐的预防服务的接受率。
