Do age-based discontinuation recommendations influence cervical cancer screening rates? Evidence from the United States' Behavioral Risk Factor Surveillance System, 2016 and 2018.
Do age-based discontinuation recommendations influence cervical cancer screening rates? Evidence from the United States' Behavioral Risk Factor Surveillance System, 2016 and 2018.
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基于年龄的停药建议会影响宫颈癌筛查率吗？
DOI：
10.1016/j.ypmed.2023.107543
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发表时间：
2023
影响因子：
5.1
通讯作者：
Jacobson,Mireille
中科院分区：
文献类型：
--
作者：
Estenson,Lilly;Kim,Narae;Jacobson,Mireille
美国预防服务工作组（USPSTF）建议，有足够的预先筛查和平均宫颈癌风险的妇女在65岁后停止常规宫颈癌筛查。这项研究的目的是评估USPSTF的建议如何影响美国66岁女性的巴氏（Pap）检测率。我们使用具有全国代表性的2016年和2018年行为风险因素监测系统数据，年龄在56-76岁之间的女性（n= 226，031）和回归不连续设计，以估计66岁时每年巴氏试验率的变化。在66-76岁的妇女中，22.5%的人报告在过去一年内接受了巴氏试验。在66岁时，每年的巴氏症发病率下降了5.9个百分点（p. p.）。(95%置信区间[CI]：−7.7，−4.1），低于66岁以前的39%。这种变化因种族/民族、教育和婚姻状况而异。非西班牙裔黑人妇女的巴氏检查率没有离散变化（0.8 p. p.; 95% CI：-5.4，7.1），但其他种族/族裔群体的女性则如此。大学毕业的女性下降幅度更大（-9.0 p. p.; 95%CI：-12.0，-5.9），而没有大学学位的女性和从未结婚的女性（-9.4 p. p.，95% CI：-17.3，-1.5），而已婚/同居或离婚/分居的女性。USPSTF建议在65岁后停止宫颈癌筛查，导致66岁时巴氏试验率急剧下降，但基于种族，教育和婚姻状况对女性产生不利影响。需要进一步研究来评估这些变化的后果。
The United States Preventive Services Task Force (USPSTF) recommends that women with adequate prior screening and average cervical cancer risk discontinue routine cervical cancer screening after age 65. This study's objective was to estimate how the USPSTF recommendation affects Papanicolaou (Pap) test rates among women at age 66 in the United States. We used nationally representative 2016 and 2018 Behavioral Risk Factor Surveillance System data for women ages 56–76 (n= 226,031) and a regression discontinuity design to estimate changes in annual Pap test rates at age 66. Among women age 66–76, 22.5% reported receiving a Pap test within the past one year. At age 66, annual Pap rates declined by 5.9 percentage points (p.p.) (95% Confidence Interval [CI]: −7.7, −4.1) off a pre-66 rate of 39%. The change varied by race/ethnicity, education, and marital status. Pap rates did not change discretely for non-Hispanic Black women (0.8 p.p.; 95% CI: −5.4, 7.1) but did for women from other racial/ethnic groups. The decline was larger for women who graduated college (−9.0 p.p.; 95% CI: −12.0, −5.9) than for women without a college degree and for women who were never married (−9.4 p.p., 95% CI: −17.3, −1.5) than for women who were married/partnered or divorced/separated. The USPSTF recommendation to discontinue cervical cancer screening after age 65 leads to a sharp decline in Pap test rates at age 66 but disparately affects women based on race, education and marital status. Further study is needed to assess the consequences of these changes.