Multilevel factors associated with long-term adherence to screening mammography in older women in the US
Multilevel factors associated with long-term adherence to screening mammography in older women in the US
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DOI：
10.1016/j.ypmed.2016.05.034
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发表时间：
2016-08-01
影响因子：
5.1
通讯作者：
Onega, Tracy
中科院分区：
文献类型：
--
作者：
Hubbard, Rebecca A.;O'Meara, Ellen S.;Onega, Tracy
在美国，指南建议妇女至少在74岁之前继续进行乳房X光检查，但最近的证据表明，老年妇女的筛查率下降。我们在一个纵向队列的老年妇女中估计了筛查性乳腺X线摄影的依从性和与依从性相关的多层次因素。在乳腺癌监测联盟内接受筛查性乳房X光检查的66-75岁妇女与医疗保险索赔有关（2005-2010年）。索赔数据确定了基线依从性，定义为在大约2年内接受后续乳房X线摄影，以及依从指南的时间长度。使用logistic和考克斯比例风险回归模型研究与依从性相关的特征。分析按年龄分层，以调查患者因素和依从性之间关系的变化。在49，775名女性中，89%在基线时遵守。在66-70岁的女性中，与具有大学学位的女性相比，高中教育程度以下的女性在基线时不遵守的可能性更大（比值比[OR] 1.96; 95%置信区间[CI] 1.65-2.33），并且保持遵守的时间更短（风险比[HR] 1.41; 95%CI 1.11-1.80）。与无Charlson合并症相比，Charlson合并症>= 1的女性更可能在基线时不依从（OR 1.46; 95% CI 1.31-1.62），并且保持依从的时间更短（HR 1.44; 95% CI 1.24-1.66）。71-75岁的女性总体依从性较低，但与不依从性相关的因素相似。总之，在接受筛查性乳房X光检查的美国参加医疗保险的妇女中，对指南的遵守率很高。需要努力确保弱势群体达到同样高的遵守率。(C)2016 Elsevier Inc. All rights reserved.
In the U.S., guidelines recommend that women continue mammography screening until at least age 74, but recent evidence suggests declining screening rates in older women. We estimated adherence to screening mammography and multilevel factors associated with adherence in a longitudinal cohort of older women. Women aged 66-75 years receiving screening mammography within the Breast Cancer Surveillance Consortium were linked to Medicare claims (2005-2010). Claims data identified baseline adherence, defined as receiving subsequent mammography within approximately 2 years, and length of time adherent to guidelines. Characteristics associated with adherence were investigated using logistic and Cox proportional hazards regression models. Analyses were stratified by age to investigate variation in relationships between patient factors and adherence. Among 49,775 women, 89% were adherent at baseline. Among women 66-70 years, those with less than a high school education were more likely to be non-adherent at baseline (odds ratio [OR] 1.96; 95% confidence interval [CI] 1.65-2.33) and remain adherent for less time (hazard ratio [HR] 1.41; 95% CI 1.11-1.80) compared to women with a college degree. Women with >= 1 versus no Charlson co-morbidities were more likely to be non-adherent at baseline (OR 1.46; 95% CI 1.31-1.62) and remain adherent for less time (HR 1.44; 95% CI 1.24-1.66). Women aged 71-75 had lower adherence overall, but factors associated with non-adherence were similar. In summary, adherence to guidelines is high among Medicare-enrolled women in the U.S. receiving screening mammography. Efforts are needed to ensure that vulnerable populations attain these same high levels of adherence. (C) 2016 Elsevier Inc. All rights reserved.