Assessment of US Preventive Services Task Force Guideline-Concordant Cervical Cancer Screening Rates and Reasons for Underscreening by Age, Race and Ethnicity, Sexual Orientation, Rurality, and Insurance, 2005 to 2019.
Assessment of US Preventive Services Task Force Guideline-Concordant Cervical Cancer Screening Rates and Reasons for Underscreening by Age, Race and Ethnicity, Sexual Orientation, Rurality, and Insurance, 2005 to 2019.
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DOI：
10.1001/jamanetworkopen.2021.43582
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发表时间：
2022-01-04
影响因子：
13.8
通讯作者：
Spencer JC
中科院分区：
文献类型：
--
作者：
Suk R;Hong YR;Rajan SS;Xie Z;Zhu Y;Spencer JC
有多少比例的筛查合格的妇女没有最新的美国预防服务工作组指南一致的宫颈癌筛查状态，以及他们没有及时接受筛查的主要原因是什么？在这项对20557名女性的横断面研究中，（加权，1.13亿妇女）有资格在美国进行宫颈癌筛查，在所有社会人口群体中，没有进行最新筛查的妇女比例从2005年的14.4%显著增加到2019年的23.0%，不同社会人口群体之间的差异和缺乏知识是接受筛查的最大障碍。这项研究发现，2005年至2019年期间，指南一致的宫颈癌筛查率下降;解决患者知识和医生沟通的活动可能有助于提高宫颈癌筛查率，需要对干预措施进行文化适应以减少现有的差异。宫颈癌筛查率在美国是次优的。需要对不接受筛查的原因进行基于人口的评估，特别是在历史上服务不足的人口群体中的妇女。估计美国预防服务工作组指南一致的宫颈癌筛查随时间的变化，并评估妇女不接受社会人口学因素的最新筛查的原因。这项基于人群的横断面研究使用了2005年至2019年美国国家健康访谈调查的数据。共有20557名妇女（加权，1.131亿妇女），年龄21至65岁，以前没有子宫切除术。分析于2021年3月30日至8月19日进行。社会人口因素，包括年龄、种族和民族、性取向、居住地农村和健康保险类型。主要结局是美国预防服务工作组指南一致的宫颈癌筛查率和自我报告的未接受最新筛查的主要原因。2005年，最新的筛查定义为每3年对21至65岁的妇女进行一次筛查。2019年，最新的筛查定义为每3年筛查一次，仅对21至29岁的女性进行巴氏试验，每3年筛查一次，仅对30至65岁的女性进行巴氏试验或每5年进行一次高危人乳头瘤病毒检测或联合检测。群体估计包括抽样权重。在纳入研究的20 557名妇女（加权，1.131亿妇女）中，大多数年龄在30至65岁之间（16 219名妇女;加权，8630万妇女[76.3%]），并有私人保险（13 571名妇女;加权，7580万妇女[67.0%]）。在种族和族裔方面，997名妇女（加权，690万女性[6.1%]）为亚裔，3821名女性（加权，1950万女性[17.2%]）是西班牙裔，2862名女性（加权，1480万妇女[13.1%]）是非西班牙裔黑人，12423名妇女（加权，6900万女性[61.0%]）为非西班牙裔白色，453名女性（加权，300万妇女[2.7%]）是其他种族和/或民族（包括阿拉斯加土著和美洲印第安人[加权，955 000名妇女（0.8%）]和其他单一和多种族或族裔[加权，200万名妇女（1.8%）]）。2019年，21至29岁的女性的逾期筛查率（29.1%）显著高于30至65岁的女性（21.1%; P < .001）。在这两个年龄组中，没有进行最新筛查的女性比例从2005年到2019年显著增加（从14.4%增加到23.0%; P < .001）。在亚裔和非西班牙裔白色人种和种族中，发现逾期筛查的发生率显著较高（31.4%对20.1%; P = .01），那些被确定为LGBQ+的人（由于样本量小，没有评估性别认同）vs异性恋（32.0%对22.2%; P <0.001），生活在农村与城市地区（26.2%对22.6%; P = 0.04），没有保险与有私人保险的人（41.7%对18.1%; P <0.001）。在所有群体中，没有及时接受筛查的最常见原因是缺乏知识，从47.2%的LGBQ+女性到64.4%的西班牙裔女性。以前接受过人乳头瘤病毒疫苗不是没有进行最新筛查的主要原因（<1%的应答）。从2005年到2019年，在30至65岁的女性中，缺乏机会作为不接受筛查的主要原因显着下降（从21.8%降至9.7%），而缺乏知识（从45.2%降至54.8%）和不接受医疗保健专业人员的建议（从5.9%降至12.0%）显着增加。这项横断面研究发现，2005年至2019年期间，与美国预防服务工作组指南一致的宫颈癌筛查在美国有所减少，据报道，缺乏知识是接受及时筛查的最大障碍。运动解决病人的知识和供应商的沟通可能有助于提高筛查率，文化适应的干预措施，以减少现有的差距。这项横断面研究评估了2005年至2019年美国预防服务工作组指南一致的宫颈癌筛查率，并检查了与女性自我报告的未接受最新筛查原因相关的社会人口因素。
What proportion of screening-eligible women do not have up-to-date US Preventive Services Task Force guideline–concordant cervical cancer screening status, and what are their primary reasons for not receiving timely screening? In this cross-sectional study of 20 557 women (weighted, 113 million women) eligible for cervical cancer screening in the US, the proportion of women without up-to-date screening significantly increased from 14.4% in 2005 to 23.0% in 2019 among all sociodemographic groups, with disparities found across different sociodemographic groups and lack of knowledge reported as the biggest barrier to receiving screening. This study found that guideline-concordant cervical cancer screening rates decreased between 2005 and 2019; campaigns addressing patient knowledge and practitioner communication may help to improve cervical cancer screening rates, and cultural adaptation of interventions is needed to reduce existing disparities. Cervical cancer screening rates are suboptimal in the US. Population-based assessment of reasons for not receiving screening is needed, particularly among women from historically underserved demographic groups. To estimate changes in US Preventive Service Task Force guideline–concordant cervical cancer screening over time and assess the reasons women do not receive up-to-date screening by sociodemographic factors. This pooled population-based cross-sectional study used data from the US National Health Interview Survey from 2005 and 2019. A total of 20 557 women (weighted, 113.1 million women) aged 21 to 65 years without previous hysterectomy were included. Analyses were conducted from March 30 to August 19, 2021. Sociodemographic factors, including age, race and ethnicity, sexual orientation, rurality of residence, and health insurance type. Primary outcomes were US Preventive Services Task Force guideline–concordant cervical cancer screening rates and self-reported primary reasons for not receiving up-to-date screening. For 2005, up-to-date screening was defined as screening every 3 years for women aged 21 to 65 years. For 2019, up-to-date screening was defined as screening every 3 years with a Papanicolaou test alone for women aged 21 to 29 years and screening every 3 years with a Papanicolaou test alone or every 5 years with high-risk human papillomavirus testing or cotesting for women aged 30 to 65 years. Population estimation included sampling weights. Among 20 557 women (weighted, 113.1 million women) included in the study, most were aged 30 to 65 years (16 219 women; weighted, 86.3 million women [76.3%]) and had private insurance (13 571 women; weighted, 75.8 million women [67.0%]). With regard to race and ethnicity, 997 women (weighted, 6.9 million women [6.1%]) were Asian, 3821 women (weighted, 19.5 million women [17.2%]) were Hispanic, 2862 women (weighted, 14.8 million women [13.1%]) were non-Hispanic Black, 12 423 women (weighted, 69.0 million women [61.0%]) were non-Hispanic White, and 453 women (weighted, 3.0 million women [2.7%]) were of other races and/or ethnicities (including Alaska Native and American Indian [weighted, 955 000 women (0.8%)] and other single and multiple races or ethnicities [weighted, 2.0 million women (1.8%)]). In 2019, women aged 21 to 29 years had a significantly higher rate of overdue screening (29.1%) vs women aged 30 to 65 years (21.1%; P < .001). In both age groups, the proportion of women without up-to-date screening increased significantly from 2005 to 2019 (from 14.4% to 23.0%; P < .001). Significantly higher rates of overdue screening were found among those of Asian vs non-Hispanic White race and ethnicity (31.4% vs 20.1%; P = .01), those identifying as LGBQ+ (gender identity was not assessed because of a small sample) vs heterosexual (32.0% vs 22.2%; P < .001), those living in rural vs urban areas (26.2% vs 22.6%; P = .04), and those without insurance vs those with private insurance (41.7% vs 18.1%; P < .001). The most common reason for not receiving timely screening across all groups was lack of knowledge, ranging from 47.2% of women identifying as LGBQ+ to 64.4% of women with Hispanic ethnicity. Previous receipt of a human papillomavirus vaccine was not a primary reason for not having up-to-date screening (<1% of responses). From 2005 to 2019, among women aged 30 to 65 years, lack of access decreased significantly as a primary reason for not receiving screening (from 21.8% to 9.7%), whereas lack of knowledge (from 45.2% to 54.8%) and not receiving recommendations from health care professionals (from 5.9% to 12.0%) increased significantly. This cross-sectional study found that cervical cancer screening that was concordant with US Preventive Services Task Force guidelines decreased in the US between 2005 and 2019, with lack of knowledge reported as the biggest barrier to receiving timely screening. Campaigns addressing patient knowledge and provider communication may help to improve screening rates, and cultural adaptation of interventions is needed to reduce existing disparities. This cross-sectional study assesses the rates of US Preventive Services Task Force guideline–concordant cervical cancer screening in the US from 2005 to 2019 and examines the sociodemographic factors associated with women’s self-reported reasons for not receiving up-to-date screening.
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影响因子：
4.7
作者：
Ford, Sabrina;Tarraf, Wassim;Leach, Richard
通讯作者：
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5.1
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