Impact of socio-economic status on breast cancer screening in women with diabetes: a population-based study
Impact of socio-economic status on breast cancer screening in women with diabetes: a population-based study
复制标题
DOI：
10.1111/dme.12422
复制
发表时间：
2014-07-01
影响因子：
3.5
通讯作者：
Lipscombe, L. L.
中科院分区：
文献类型：
--
作者：
Chan, W.;Yun, L.;Lipscombe, L. L.
目的有证据表明，乳腺X线摄影率下降的妇女糖尿病患者和妇女的社会经济地位较低。鉴于低社会经济地位与糖尿病之间的密切联系，我们探讨了社会经济地位的差异在多大程度上解释了糖尿病女性乳腺X线摄影率较低的原因。方法在加拿大安大略进行一项基于人群的回顾性队列研究，研究对象为1999年至2010年年龄在50至69岁之间的糖尿病女性，年龄与非糖尿病女性的比例为1：2。主要结果测量是糖尿病妇女在36个月内至少接受一次筛查性乳房X线检查的可能性，从1999年1月1日开始，即她们50岁生日，或糖尿病诊断后20年-以最后发生者为准。结果与同期无糖尿病的女性进行比较，根据社区收入和其他人口统计学和临床变量调整社会经济地位。结果在研究的504288名女性中（188759名患有糖尿病，315529名无糖尿病），63.8%接受了筛查性乳房X光检查。在调整社会经济地位和其他因素后，糖尿病女性患者进行乳房X线检查的可能性显著降低（优势比0.79，95%CI 0.78-0.80）。即使在社会经济地位最高的五分位数的女性中，糖尿病与乳腺X线检查使用率较低相关（优势比0.79，95%CI 0.75-0.83）。结论糖尿病的存在是乳腺癌筛查的一个独立障碍，这不能用社会经济地位的差异来解释。需要针对患者，提供者和卫生系统因素的干预措施来改善这一人群的癌症筛查。
Aims There is evidence to suggest that mammography rates are decreased in women with diabetes and in women of lower socio-economic status. Given the strong association between low socio-economic status and diabetes, we explored the extent to which differences in socio-economic status explain lower mammography rates in women with diabetes. Methods A population-based retrospective cohort study in Ontario, Canada, of women aged 50 to 69years with diabetes between 1999 and 2010 age matched 1:2 to women without diabetes. Main outcome measure is the likelihood of at least one screening mammogram in women with diabetes within a 36-month period, starting as of either 1 January 1999, their 50th birthday, or 2years after diabetes diagnosis - whichever came last. Outcomes were compared with those in women without diabetes during the same period as their matched counterparts, adjusting for socio-economic status based on neighbourhood income and other demographic and clinical variables. Results Of 504288 women studied (188759 with diabetes, 315529 with no diabetes), 63.8% had a screening mammogram. Women with diabetes were significantly less likely to have a mammogram after adjustment for socio-economic status and other factors (odds ratio0.79, 95%CI 0.78-0.80). Diabetes was associated with lower mammogram use even in women from the highest socio-economic status quintile (odds ratio0.79, 95%CI 0.75-0.83). Conclusions The presence of diabetes was an independent barrier to breast cancer screening, which was not explained by differences in socio-economic status. Interventions that target patient, provider, and health system factors are needed to improve cancer screening in this population.