Lurie N, Slater J, McGovern P, Ekstrum J, Quam L, Margolis K
Department of Medicine, Hennepin County Medical Center, Minneapolis, MN 55415.
N Engl J Med. 1993 Aug 12;329(7):478-82. doi: 10.1056/NEJM199308123290707.
Emphasis on ensuring women's access to preventive health services has increased over the past decade. Relatively little attention has been paid to whether the sex of the physician affects the rates of cancer screening among women. We examined differences between male and female physicians in the frequency of screening mammograms and Pap smears among women patients enrolled in a large Midwestern health plan.
We identified claims for mammography and Pap tests submitted by primary care physicians for 97,962 women, 18 to 75 years of age, who were enrolled in the health plan in 1990. The sex of the physician was manually coded, and the physician's age was obtained from the state licensing board. After identifying a principal physician for each woman, we calculated the frequency of mammography and Pap smears for each physician, using the number of women in his or her practice during 1990 as the denominator. Using unconditional logistic regression, we also calculated the odds ratio of having a Pap smear or mammogram for women patients with female physicians as compared with those with male physicians, controlling for the physician's and the patient's age.
Crude rates for Pap smears and mammography were higher for the patients of female than male physicians in most age groups of physicians. The largest differences between female and male physicians were in the rates of Pap smears among the youngest physicians. For the subgroup of women enrolled in the health plan for a year who saw only one physician, after adjustment for the patient's age and the physician's age and specialty, the odds ratio for having a Pap smear was 1.99 (95 percent confidence interval, 1.72 to 2.30) for the patients of female physicians as compared with those of male physicians. For women 40 years old and older, the odds ratio for having a mammogram was 1.41 (95 percent confidence interval, 1.22 to 1.63). For both Pap smears and mammography, the differences between female and male physicians in screening rates were much more pronounced in internal medicine and family practice than in obstetrics and gynecology.
Women are more likely to undergo screening with Pap smears and mammograms if they see female rather than male physicians, particularly if the physician is an internist or family practitioner.
在过去十年中，对确保女性能够获得预防性健康服务的重视有所增加。但相对而言，医生的性别是否会影响女性的癌症筛查率却很少受到关注。我们研究了在中西部一个大型健康计划中登记的女性患者中，男医生和女医生在乳腺钼靶筛查和巴氏涂片检查频率上的差异。
我们确定了1990年登记参加该健康计划的97962名年龄在18至75岁之间的女性患者的初级保健医生提交的乳腺钼靶检查和巴氏试验的索赔记录。医生的性别通过人工编码确定，医生的年龄从州执照委员会获取。在为每位女性确定一名主治医生后，我们以1990年其执业的女性人数为分母，计算了每位医生的乳腺钼靶检查和巴氏涂片检查频率。使用无条件逻辑回归，我们还计算了女性医生的女性患者与男性医生的女性患者进行巴氏涂片检查或乳腺钼靶检查的比值比，并对医生和患者的年龄进行了控制。
在大多数年龄组的医生中，女性医生的患者进行巴氏涂片检查和乳腺钼靶检查的粗率高于男性医生。女性和男性医生之间最大的差异在于最年轻医生中的巴氏涂片检查率。对于在健康计划中登记一年且只看一位医生的女性亚组，在调整患者年龄、医生年龄和专业后，女性医生的患者进行巴氏涂片检查的比值比为1.99（95%置信区间为1.72至2.30），而男性医生的患者为1。对于40岁及以上的女性，进行乳腺钼靶检查的比值比为1.41（95%置信区间为1.22至1.63）。对于巴氏涂片检查和乳腺钼靶检查，内科和家庭医疗中女性和男性医生在筛查率上的差异比妇产科更为明显。
女性如果看女医生而不是男医生，尤其是如果医生是内科医生或家庭医生，更有可能接受巴氏涂片检查和乳腺钼靶检查。
