Rakowski W, Pearlman D, Rimer B K, Ehrich B
Department of Community Health, Brown University, Providence, Rhode Island 02912, USA.
Prev Med. 1995 Mar;24(2):149-58. doi: 10.1006/pmed.1995.1028.
Although screening mammography rates have increased, even women with higher incomes and more formal education do not all obtain the exam. This study examined why a modest proportion of higher income/higher education women do not get screened and, conversely, why a small percentage of lower income/lower education women do receive screening.
Data were from the 1990 National Health Interview Survey of Health Promotion and Disease Prevention. A total of 3,014 women, ages 40-75, were in the sample. Low-resource women had incomes of less than $20,000 and less than a high school diploma. High-resource women had incomes of $30,000 or more and at least some college education.
Correlates of screening status were similar for both resource groups. Recency of Papanicolaou test, recency of clinical breast exam, and regular breast self-examination were associated with higher rates of screening. Four or more persons in a household were associated with lower rates. Among low-resource women, incomes of $10,000-$19,999 were associated with higher likelihood of screening. An income of $50,000 or more was associated with screening among high-resource women.
The fact that several variables were important for both resource groups suggests that targeted interventions could have benefits across a wide population. Nonetheless, in the high-resource group, 2-year rates never exceeded 80% and repeated screening never exceeded 60%. Rates for low-resource women were over 30% lower. Medical care utilization data did not differ between the two resource groups sufficiently to account for the discrepant rates. Improving screening rates in both resource groups remains a major challenge.
尽管乳腺钼靶筛查率有所提高，但即使是收入较高、受教育程度较高的女性也并非都进行了该项检查。本研究探讨了为什么收入较高/受教育程度较高的女性中有一小部分没有接受筛查，以及相反地，为什么收入较低/受教育程度较低的女性中有一小部分接受了筛查。
数据来自1990年全国健康促进与疾病预防访谈调查。样本共有3014名年龄在40 - 75岁之间的女性。资源匮乏的女性收入低于2万美元且未获得高中文凭。资源丰富的女性收入为3万美元或以上且至少接受过一些大学教育。
两个资源组的筛查状况相关因素相似。巴氏试验的近期性、临床乳腺检查的近期性以及定期乳房自我检查与较高的筛查率相关。家庭中有四人或更多人则与较低的筛查率相关。在资源匮乏的女性中，收入在1万至1.9999万美元之间与较高的筛查可能性相关。收入在5万美元或以上与资源丰富的女性进行筛查相关。
几个变量对两个资源组都很重要这一事实表明，有针对性的干预措施可能会使广大人群受益。尽管如此，在资源丰富的组中，两年筛查率从未超过80%，重复筛查率从未超过60%。资源匮乏女性的筛查率低30%以上。两个资源组的医疗保健利用数据差异不足以解释筛查率的差异。提高两个资源组的筛查率仍然是一项重大挑战。
