Nattinger A B, Hoffmann R G, Howell-Pelz A, Goodwin J S
Department of Medicine, Medical College of Wisconsin, Milwaukee, USA.
JAMA. 1998 Mar 11;279(10):762-6. doi: 10.1001/jama.279.10.762.
While the actions of popular figures are believed to influence the behavior of the general public, including health care decisions, little research has examined such an effect.
To determine whether a temporal association exists between use of breast-conserving surgery (BCS) for treatment of breast cancer and Nancy Reagan's mastectomy in October 1987.
DESIGN/SETTING: Population-based observational cohort study.
Two sources of data: (1) 82 230 women aged 30 years and older who were included in the Surveillance, Epidemiology, and End Results tumor registry because of a diagnosis of local or regional breast cancer from 1983 to 1990; and (2) 80057 female Medicare beneficiaries aged 65 to 79 years who received inpatient surgery for local or regional breast cancer in 1987 or 1988.
Percentage of use of BCS vs mastectomy over time.
Compared with women undergoing surgery for breast cancer in the third quarter of 1987 (just prior to Mrs Reagan's mastectomy), women were 25% less likely to undergo BCS in the fourth quarter of 1987 (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.66-0.85) and in the first quarter of 1988 (OR, 0.76; 95% CI, 0.67-0.86). In subsequent quarters, the rate returned to the baseline. In multivariate analyses, the decline was significant among white but not nonwhite women. It was most prominent among women aged 50 to 79 years in the central and southern regions of the country, and most sustained among women living in areas with lower levels of income and education.
Celebrity role models can influence decisions about medical care. The influence appears strongest among persons who demographically resemble the celebrity, and those of lower income and educational status.
尽管公众人物的行为被认为会影响普通大众的行为，包括医疗保健决策，但很少有研究考察过这种影响。
确定1987年10月南希·里根接受乳房切除术与乳腺癌保乳手术（BCS）使用之间是否存在时间关联。
设计/背景：基于人群的观察性队列研究。
两个数据来源：（1）1983年至1990年因诊断为局部或区域性乳腺癌而被纳入监测、流行病学和最终结果肿瘤登记处的82230名30岁及以上女性；（2）1987年或1988年因局部或区域性乳腺癌接受住院手术的80057名65至79岁女性医疗保险受益人。
随时间推移BCS与乳房切除术的使用百分比。
与1987年第三季度（恰好在里根夫人乳房切除术前）接受乳腺癌手术的女性相比，1987年第四季度（优势比[OR]，0.75；95%置信区间[CI]，0.66 - 0.85）和1988年第一季度（OR，0.76；95% CI，0.67 - 0.86）接受BCS的女性可能性降低了25%。在随后的季度中，该比率恢复到基线水平。在多变量分析中，下降在白人女性中显著，但在非白人女性中不显著。在该国中部和南部地区50至79岁的女性中最为明显，在收入和教育水平较低地区的女性中持续时间最长。
名人榜样可以影响医疗保健决策。这种影响在人口统计学特征与名人相似以及收入和教育地位较低的人群中似乎最为强烈。
