Katz S J, Hofer T P
Division of General Medicine, University of Michigan, Ann Arbor 48109-0376.
JAMA. 1994 Aug 17;272(7):530-4.
To compare the association of income and education with breast and cervical cancer screening in Ontario, Canada, and the United States.
Survey using data from the Ontario Health Survey and the US National Health Interview Survey.
A multistage random sample of women aged 18 years and older living in households in Ontario (N = 23,521) and the United States (N = 23,932) in 1990.
Persons were considered screened if they reported a Papanicolaou test within the previous 2 years, a clinical breast examination within the previous year, or a mammogram within the previous year.
Papanicolaou test and clinical breast examination rates were similar between countries, but mammography rates were two to three times higher in the United States across all age groups. Compared with women with less than a high school degree, college graduates were more likely to receive screening (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.2 to 1.7) and there was no difference between countries. Across all procedures, women with higher incomes were more likely to receive screening. For Papanicolaou test and clinical breast examination, there was no difference between countries. Compared with the lowest income, the OR was 1.7 (95% CI, 1.3 to 2.1) in Ontario and 1.9 (95% CI, 1.6 to 2.2) in the United States for Papanicolaou test and 2.1 (95% CI, 1.6 to 2.8) in Ontario and 2.1 (95% CI, 1.8 to 2.6) in the United States for the clinical breast examination for women with income greater than $45,600 (US dollars). For mammography screening, the association of income with use was greater in the United States: the OR was 1.8 (95% CI, 1.3 to 2.6) in Ontario and 2.7 (95% CI, 2.3 to 3.2) in the United States for women with income greater than $45,600 (US dollars).
Despite the long-time presence of universal insurance coverage in Ontario the disparities in the use of cancer screening procedures by the poor were similar to the United States. Universal coverage is not sufficient to overcome the large disparities in screenings across socioeconomic status demonstrated in both countries.
比较加拿大安大略省和美国收入与教育水平同乳腺癌和宫颈癌筛查之间的关联。
利用安大略省健康调查和美国国家健康访谈调查的数据进行调查。
1990年居住在安大略省（N = 23,521）和美国（N = 23,932）家庭中的18岁及以上女性的多阶段随机样本。
如果受访者报告在过去2年内进行过巴氏试验、过去1年内进行过临床乳房检查或过去1年内进行过乳房X光检查，则被视为接受过筛查。
两国之间的巴氏试验和临床乳房检查率相似，但美国各年龄组的乳房X光检查率高出两到三倍。与高中以下学历的女性相比，大学毕业生接受筛查的可能性更大（优势比[OR]，1.5；95%置信区间[CI]，1.2至1.7），且两国之间无差异。在所有检查项目中，收入较高的女性接受筛查的可能性更大。对于巴氏试验和临床乳房检查，两国之间无差异。与最低收入相比，安大略省巴氏试验的OR为1.7（95%CI，1.3至2.1），美国为1.9（95%CI，1.6至2.2）；安大略省临床乳房检查的OR为2.1（95%CI，1.6至2.8），美国为2.1（95%CI，1.8至2.6），针对收入超过45,600美元（美元）的女性。对于乳房X光检查筛查，美国收入与检查使用率之间的关联更大：安大略省收入超过45,600美元（美元）的女性的OR为1.8（95%CI，1.3至2.6），美国为2.7（95%CI，2.3至3.2）。
尽管安大略省长期实行全民保险覆盖，但贫困人群在癌症筛查程序使用方面的差异与美国相似。全民覆盖不足以克服两国在社会经济地位方面筛查存在的巨大差异。
