Huang Tracy, Ekenga Christine C
Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Prev Med Rep. 2025 Mar 4;52:103026. doi: 10.1016/j.pmedr.2025.103026. eCollection 2025 Apr.
To investigate the association between county-level social capital and screening mammography rates among older women in the United States.
This cross-sectional ecological study included 2765 U.S. counties, using 2018 county-level screening mammography rates among female Medicare enrollees aged 67-69 as the outcome. Social capital data were obtained from the 2018 Social Capital Project, including indices for Family Unity, Institutional Health, Collective Efficacy, and Community Health. Multivariable log-binomial regression analyses were conducted to estimate adjusted prevalence ratios (aPRs) and confidence intervals for "high" mammography rates (top 10 % nationally), controlling for county-level demographic and healthcare covariates. Stratified analyses examined associations among metropolitan and nonmetropolitan counties.
Mammography screening rates ranged from 17 % to 64 %, with a mean of 41 %. Strong positive associations were observed between social capital and mammography rates (Q4 vs. Q1: aPR = 2.29, 95 % CI: 1.20-4.36), particularly for the dimensions of Community Health (Q4 vs. Q1: aPR = 1.99, 95 % CI = 1.25-3.17) and Institutional Health (Q4 vs. Q1: aPR = 4.31, 95 % CI = 2.40-7.75). These associations were strongest among nonmetropolitan counties. No significant associations were found for Family Unity or Collective Efficacy.
County-level social capital, specifically community and institutional health, is significantly associated with higher mammography screening rates, particularly in non-metropolitan areas. These findings suggest that enhancing public trust and community engagement may improve screening behaviors. Future research should explore the role of social capital at multiple levels and its influence on various cancer screening behaviors.
研究美国县级社会资本与老年女性乳腺钼靶筛查率之间的关联。
这项横断面生态研究纳入了2765个美国县，将2018年67 - 69岁女性医疗保险参保者的县级乳腺钼靶筛查率作为研究结果。社会资本数据来自2018年社会资本项目，包括家庭团结、机构健康、集体效能和社区健康等指数。进行多变量对数二项回归分析，以估计“高”乳腺钼靶筛查率（全国前10%）的调整患病率比（aPRs）和置信区间，并控制县级人口统计学和医疗保健协变量。分层分析检验了大城市县和非大城市县之间的关联。
乳腺钼靶筛查率在17%至64%之间，平均为41%。社会资本与乳腺钼靶筛查率之间存在强正相关（四分位数4 vs. 四分位数1：aPR = 2.29，95% CI：1.20 - 4.36），特别是在社区健康（四分位数4 vs. 四分位数1：aPR = 1.99，95% CI = 1.25 - 3.17）和机构健康（四分位数4 vs. 四分位数1：aPR = 4.31，95% CI = 2.40 - 7.75）方面。这些关联在非大城市县中最为明显。未发现家庭团结或集体效能与筛查率之间存在显著关联。
县级社会资本，特别是社区和机构健康，与较高的乳腺钼靶筛查率显著相关，尤其是在非大都市地区。这些发现表明，增强公众信任和社区参与可能会改善筛查行为。未来的研究应探索社会资本在多个层面的作用及其对各种癌症筛查行为的影响。
