Association of contextual factors and breast cancer screening: Finding new targets to promote early detection
Association of contextual factors and breast cancer screening: Finding new targets to promote early detection
复制标题
DOI：
10.1089/jwh.2006.0090
复制
发表时间：
2007-01-01
影响因子：
3.5
通讯作者：
Tomolo, Anne
中科院分区：
文献类型：
--
作者：
Litaker, David;Tomolo, Anne
背景：在美国，乳腺癌筛查（BCS）存在差异。虽然这样的因素，作为一个女人的收入和保险状况解释了一些差异，额外的贡献有关当地的医疗保健系统的特点或社会和经济背景中，妇女lived.Methods：使用数据从一个横断面调查的俄亥俄州居民，我们评估BCS在一个国家的代表性样本2231名妇女之间的年龄为50岁和69岁。城市化，女性户主家庭（FHH）的比例，管理式护理活动，人均初级保健医生（PCP）的数量，以及县指定为医疗服务不足代表了我们研究的一些背景特征。使用嵌套分层Logistic回归模型，我们评估了这些特征与BCS的关联之前和之后调整受访者的characteristic.Results：符合年龄的妇女筛查乳腺癌的比例为61.9%（n = 1383），县筛查率从12.9%到100%（平均60.3%）。未能完成高中学业、家庭收入较低、缺乏持续保险、通常的护理来源或当前就业与较低的BCS相关。考虑到这些特征，（调整的比值比[AOR] 1.05（1.01，1.10），p = 0.02）和FHH的比例（AOR 0.66（0.44，0.99），p = 0.045）仍然与BCS独立相关。与BCS独立相关的背景特征确定了女性延迟乳腺癌诊断风险增加的领域。这里描述的方法可以告知地区，州或联邦倡议的规划阶段，以加强BCS和减少随后的治疗结果的差异。
Background: Disparities in breast cancer screening (BCS) exist within the United States. Although such factors as a woman's income and insurance status explain some differences, additional contributions related to local healthcare system characteristics or the social and economic context in which women live have not been fully explored.Methods: Using data from a cross-sectional survey of Ohio residents, we assessed BCS in a state-representative sample of 2231 women between the ages of 50 and 69 years. Urbanization, the proportion of female-headed households (FHH), managed care activity, the number of primary care physicians (PCPs) per capita, and county designation as being medically underserved represented some of the contextual characteristics we examined. Using nested hierarchical logistic regression models, we evaluated the association of these characteristics with BCS before and after adjusting for respondents' characteristics.Results: The proportion of age-eligible women screened for breast cancer was 61.9% (n = 1383); county screening rates varied from 12.9% to 100% (mean 60.3%). Failure to complete high school, lower family income, and absence of continuous insurance, a usual source of care, or current employment were associated with lower BCS. After accounting for these characteristics, per capita PCPs (adjusted odds ratio [AOR] 1.05 (1.01, 1.10), p = 0.02) and the proportion of FHH (AOR 0.66 (0.44, 0.99), p = 0.045) remained independently associated with BCS.Conclusions: Contextual characteristics independently associated with BCS identify areas in which women are at increased risk for delayed breast cancer diagnosis. The approach described here can inform the planning phase of regional, state, or federal initiatives to enhance BCS and reduce subsequent disparities in treatment outcomes.