Banegas Matthew P, O'Malley Jean, Kaufmann Jorge, Marino Miguel, Gottlieb Laura M, Huguet Nathalie, Anyane-Yeboa Adjoa, Gold Rachel
Center for Health Equity Education and Research, Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA 92037, United States.
OCHIN, Inc, Portland, OR 97228, United States.
JNCI Cancer Spectr. 2024 Nov 1;8(6). doi: 10.1093/jncics/pkae115.
Social risks are negatively associated with receipt of cancer preventive care. As knowledge is lacking on the pathways underlying these associations, we investigated associations between patient-reported social risks and colorectal cancer (CRC), cervical cancer, and breast cancer screening order provision and screening completion.
This study included patients eligible for CRC, cervical cancer, or breast cancer screening at 186 community-based clinics between July 1, 2015, and February 29, 2020. Outcomes included up-to-date status for indicated cancer screenings at baseline; percentage of subsequent study months in which patients were up-to-date on screenings; screening order receipt; and screening completion. Independent variables were patient-reported food insecurity, transportation barriers, and housing instability. Analyses used covariate-adjusted generalized estimating equation models, stratified by social risk.
Patients with documented social risks were less likely to be up-to-date on any cancer screening at baseline and in most cases had a lower rate of total study months up-to-date on screenings. All cancer screenings were ordered less often for food-insecure patients. Cervical cancer screening was ordered less often for transportation-insecure patients. The likelihood of completing a screening test differed statistically significantly by select social risks: Cervical cancer and CRC screening rates were lower among food-insecure patients, and CRC screening rates were lower among transportation-insecure patients. The likelihood of breast cancer screening completion did not differ by social risk status.
Social risks affect both the ordering and the receipt of cancer screening. Research is needed on strategies to mitigate the impact of different social risks on cancer early-detection services.
社会风险与癌症预防保健的接受情况呈负相关。由于缺乏对这些关联背后途径的了解，我们调查了患者报告的社会风险与结直肠癌（CRC）、宫颈癌和乳腺癌筛查医嘱开具及筛查完成情况之间的关联。
本研究纳入了2015年7月1日至2020年2月29日期间在186家社区诊所符合CRC、宫颈癌或乳腺癌筛查条件的患者。结局包括基线时指定癌症筛查的最新状态；患者在后续研究月份中处于筛查最新状态的百分比；筛查医嘱的接收情况；以及筛查完成情况。自变量为患者报告的粮食不安全、交通障碍和住房不稳定情况。分析采用协变量调整的广义估计方程模型，并按社会风险进行分层。
有记录的社会风险患者在基线时进行任何癌症筛查的可能性较小，并且在大多数情况下，处于筛查最新状态的总研究月份率较低。粮食不安全患者接受所有癌症筛查医嘱的频率较低。交通不安全患者接受宫颈癌筛查医嘱的频率较低。根据特定社会风险，完成筛查测试的可能性在统计学上有显著差异：粮食不安全患者的宫颈癌和CRC筛查率较低，交通不安全患者的CRC筛查率较低。乳腺癌筛查完成的可能性在不同社会风险状态下没有差异。
社会风险影响癌症筛查的医嘱开具和接受情况。需要研究减轻不同社会风险对癌症早期检测服务影响的策略。
