Segura Noguera J M, Porta Serra M, Macià Guilà F, Casamitjana Abellà M, Castells Oliveres X
Institut Català de la Salut, Barcelona.
Med Clin (Barc). 1998 Sep 12;111(7):251-6.
The objective was to analyze sociodemographic, organizational and health care-related factors associated to level of enrollment in a breast cancer screening program developed in one area of Barcelona (Spain).
Three types of indicators were used: coverage, response and participation. The influence of age, educational level, previous clinical contacts, the person who received the citation and the reason for not attending after the first citation were studied. The odds ratio (OR) was used to estimate the magnitude of the association between variables. The OR were adjusted by age and education through unconditional logistic regression.
The rates were: coverage 79.2%, response 74.6%, and participation 61%. The response after the first citation was influenced by the recipient of the letter (p < 0.001); when it was the target-woman, the response was 75%. The response after the successive citations was 50.5% if the reason for not attending previously was circumstantial, and 11.5% when it was lack of interest. Having had previous clinical contacts in the primary care centre or in the reference hospital multiplied by 4 to 7 times the response. Coverage decreased with age, and it presented a curvilinear pattern with respect to educational level. Multivariate analyses emphasized the importance of previous clinical contacts (ORs between 3.5 and 8.1; p < 0.001).
Previous contacts with the health system, the method of citation and the reason for not attending after the initial phase were factors clearly associated with participation in a breast cancer screening program. Research on factors influencing participation would contribute to improve the results of screening programs currently underway in Spain.
目的是分析与在巴塞罗那（西班牙）一个地区开展的乳腺癌筛查项目参与水平相关的社会人口统计学、组织和医疗保健相关因素。
使用了三种类型的指标：覆盖率、响应率和参与率。研究了年龄、教育水平、既往临床接触情况、收到通知的人以及首次通知后未参加的原因的影响。比值比（OR）用于估计变量之间关联的强度。通过无条件逻辑回归对OR进行年龄和教育调整。
各项比率分别为：覆盖率79.2%，响应率74.6%，参与率61%。首次通知后的响应受信件接收者影响（p<0.001）；当接收者为目标女性时，响应率为75%。如果之前未参加的原因是偶然情况，后续通知后的响应率为50.5%，如果是缺乏兴趣则为11.5%。在初级保健中心或参考医院有过既往临床接触会使响应率提高4至7倍。覆盖率随年龄降低，并且在教育水平方面呈现曲线模式。多变量分析强调了既往临床接触的重要性（OR在3.5至8.1之间；p<0.001）。
与卫生系统的既往接触、通知方式以及初始阶段后未参加的原因是与参与乳腺癌筛查项目明显相关的因素。对影响参与的因素进行研究将有助于改善西班牙目前正在进行的筛查项目的结果。
