Kodama Shimpei, Hinokuma Rika
Department of Comprehensive Community-based Nursing Science, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan.
Public Health Nurs. 2025 Jan-Feb;42(1):70-79. doi: 10.1111/phn.13451. Epub 2024 Oct 16.
This study examined the indirect effects of the number of Japanese municipal public health nurses (PHNs) on cancer standardized mortality ratios (SMRs), using cancer screening and diagnostic follow-up rates as mediators.
Ecological study using municipalities as the unit of analysis MEASUREMENTS: Aggregate, municipal-level government data were analyzed using a linear model with empirical Bayes estimates of SMRs (EBSMRs) for gastric, colorectal, and lung cancers as the dependent variables, and the number of PHNs, cancer screening rate, diagnostic follow-up rate, and adjustment variables as independent variables. Structural equation modeling (SEM) was used to examine the indirect effects of PHNs.
Cancer screening rates were significantly negatively associated with EBSMR, except for gastric cancer in women. No significant association was observed between the EBSMR and diagnostic follow-up rates. SEM revealed a significant indirect effect of the number of PHNs, most of which was due to the cancer screening rate.
From a population-based public health perspective, increasing the number of PHNs and focusing on improving cancer screening rates may effectively reduce cancer SMRs.
本研究以癌症筛查率和诊断随访率作为中介变量，探讨日本各市政公共卫生护士（PHN）数量对癌症标准化死亡率（SMR）的间接影响。
以市为分析单位的生态学研究
使用线性模型分析市级层面的汇总政府数据，以胃癌、结直肠癌和肺癌的标准化死亡率经验贝叶斯估计值（EBSMR）作为因变量，以公共卫生护士数量、癌症筛查率、诊断随访率和调整变量作为自变量。采用结构方程模型（SEM）来检验公共卫生护士的间接影响。
除女性胃癌外，癌症筛查率与EBSMR显著负相关。未观察到EBSMR与诊断随访率之间存在显著关联。结构方程模型显示公共卫生护士数量存在显著的间接影响，其中大部分是由于癌症筛查率。
从基于人群的公共卫生角度来看，增加公共卫生护士数量并注重提高癌症筛查率可能有效降低癌症SMR。
