Bather Jemar R, Goodman Melody S, Kaphingst Kimberly A
New York University School of Global Public Health, USA.
Huntsman Cancer Institute, Salt Lake City, UT, USA.
J Prim Care Community Health. 2025 Jan-Dec;16:21501319251342102. doi: 10.1177/21501319251342102. Epub 2025 May 25.
Genetic testing helps individuals with disease management, family planning, and medical decision-making. Identifying individual-level factors related to the use of genetic services is essential but may only partially explain differential genetic service usage. To address this knowledge gap, we analyzed data on a national sample of US adults to evaluate whether higher neighborhood vulnerability is significantly associated with lower genetic testing utilization, controlling for sociodemographic and health characteristics.
A 2024 nationally representative cross-sectional survey of 631 US adults recruited using NORC's probability-based AmeriSpeak panel. Genetic testing uptake was measured as self-reported ever use of ancestry, personal trait, specific disease, or prenatal genetic carrier testing. Secondary outcomes were indicator variables for each genetic testing type. Neighborhood vulnerability (low versus high) was measured by the Social Vulnerability Index, capturing socioeconomic factors affecting community resilience to natural hazards and disasters.
Forty-eight percent of the weighted sample used genetic testing services. Compared to those in low vulnerability areas, individuals in high vulnerability areas had 42% lower odds (adjusted OR: 0.58, 95% CI: 0.37-0.90) of using genetic testing services, controlling for individual-level characteristics. Secondary analyses showed no evidence of statistically significant relationships between neighborhood vulnerability and specific types of genetic testing services.
Findings suggest that neighborhood vulnerability may contribute to differences in genetic testing uptake, which is crucial to increasing early detection of cancer susceptibility and reducing US cancer incidence. This study demonstrates the importance of going beyond examining individual characteristics to investigating structural factors negatively impacting genetic testing usage.
基因检测有助于个人进行疾病管理、计划生育和医疗决策。识别与基因服务使用相关的个体层面因素至关重要，但可能只能部分解释基因服务使用的差异。为了填补这一知识空白，我们分析了美国成年人全国样本的数据，以评估在控制社会人口统计学和健康特征的情况下，较高的社区脆弱性是否与较低的基因检测利用率显著相关。
对使用美国国家民意研究中心基于概率的美国民意调查小组招募的631名美国成年人进行了2024年全国代表性横断面调查。基因检测的采用情况通过自我报告的是否曾使用过血统、个人特质、特定疾病或产前基因携带者检测来衡量。次要结果是每种基因检测类型的指标变量。社区脆弱性（低与高）通过社会脆弱性指数来衡量，该指数反映了影响社区对自然灾害和灾难恢复能力的社会经济因素。
加权样本中有48%的人使用了基因检测服务。在控制个体层面特征的情况下，与低脆弱性地区的人相比，高脆弱性地区的人使用基因检测服务的几率低42%（调整后的OR：0.58，95%CI：0.37-0.90）。次要分析表明，没有证据表明社区脆弱性与特定类型的基因检测服务之间存在统计学上的显著关系。
研究结果表明，社区脆弱性可能导致基因检测采用情况的差异，这对于提高癌症易感性的早期检测和降低美国癌症发病率至关重要。这项研究表明，除了研究个体特征之外，调查对基因检测使用产生负面影响的结构因素也很重要。
