Geographic access and the use of screening mammography.
Geographic access and the use of screening mammography.
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DOI：
10.1097/mlr.0b013e3181ca3ecb
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发表时间：
2010-04
期刊：
影响因子：
3
通讯作者：
Schrag D
中科院分区：
文献类型：
--
作者：
Elkin EB;Ishill NM;Snow JG;Panageas KS;Bach PB;Liberman L;Wang F;Schrag D
乳房X光检查筛查率因地域而异，最近有所下降。在某些地区，乳房X线照相术资源不足可能会妨碍获得这项技术。我们评估了乳腺X射线摄影机的可用性和筛查的使用之间的关系。美国所有乳腺X射线摄影机的位置和数量均来自美国食品和药物管理局的认证机构记录。能力不足的定义是每10 000名40岁或以上妇女不到1.2台乳房X线摄影机，这是达到2010年健康人目标筛查率所需的门槛。在两个队列中评估了能力对利用率的影响：2006年行为风险因素监测系统调查的40岁或40岁以上的女性受访者和2004-2005年全国范围内65岁或65岁以上的女性医疗保险受益人的5%样本。BRFSS队列中约有9%的妇女和医疗保险队列中约有13%的妇女生活在每10,000名40岁或以上妇女中有<1.2台乳房X光检查机的县。在两个队列中，居住在乳房X线摄影能力不足的县与最近乳房X线摄影的较低几率相关（BRFSS中的调整后比值比[AOR]：0.89，95% CI 0.80 - 0.98，p<0.05; Medicare中的AOR：0.86，95% CI 0.85 - 0.87，p<0.05），控制人口统计学和医疗保健特征。在很少或没有乳房X线摄影机的县，成像资源的有限性可能是筛查的障碍。在低容量地区增加机器数量的努力可能会提高乳房X线检查率，并减少乳腺癌筛查的地理差异。
Screening mammography rates vary geographically and have recently declined. Inadequate mammography resources in some areas may impair access to this technology. We assessed the relationship between availability of mammography machines and the use of screening. The location and number of all mammography machines in the US were identified from US Food and Drug Administration records of certified facilities. Inadequate capacity was defined as <1.2 mammography machines per 10,000 women aged 40 or older, the threshold required to meet the Healthy People 2010 target screening rate. The impact of capacity on utilization was evaluated in two cohorts: female respondents age 40 or older to the 2006 Behavioral Risk Factor Surveillance System survey (BRFSS) and a 5% nationwide sample of female Medicare beneficiaries age 65 or older in 2004–2005. About 9% of women in the BRFSS cohort and 13% of women in the Medicare cohort lived in counties with <1.2 mammography machines per 10,000 women age 40 or older. In both cohorts, residence in a county with inadequate mammography capacity was associated with lower odds of a recent mammogram (adjusted odds ratio [AOR] in BRFSS: 0.89, 95% CI 0.80 – 0.98, p<0.05; AOR in Medicare: 0.86, 95% CI 0.85 – 0.87, p<0.05), controlling for demographic and health care characteristics. In counties with few or no mammography machines, limited availability of imaging resources may be a barrier to screening. Efforts to increase the number of machines in low-capacity areas may improve mammography rates and reduce geographic disparities in breast cancer screening.