Individual-, neighborhood-, and state-level socioeconomic predictors of cervical carcinoma screening among US black women - A multilevel analysis
Individual-, neighborhood-, and state-level socioeconomic predictors of cervical carcinoma screening among US black women - A multilevel analysis
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DOI：
10.1002/cncr.21660
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发表时间：
2006-02-01
期刊：
影响因子：
6.2
通讯作者：
Rosenberg, L
中科院分区：
文献类型：
--
作者：
Datta, GD;Colditz, GA;Rosenberg, L
背景宫颈癌是美国非裔美国妇女中第五常见的癌症。尽管巴氏涂片是早期发现该疾病的有效筛查工具，但已知在社会经济群体中使用该程序的差异持续存在。关于宫颈癌筛查和协变量的数据是通过1995年邮寄的问卷从美国59，090名黑人妇女健康研究参与者中获得的。Logistic回归和多水平技术用于评估协变量对非近期宫颈癌筛查的独立影响。总的来说，在本分析的40，009名妇女中，有8.3%在过去2年内没有接受过巴氏涂片检查（非近期筛查）。低教育程度，年龄较大，肥胖，吸烟和邻里贫困被发现是独立相关的非最近的筛查风险增加。与贫困率低于5%的社区相比，居住在贫困率为20%或以上的社区的妇女，非近期筛查的调整优势比为1.2（95%置信区间[95%CI]，1.1-1.4）。居住地也与非近期宫颈癌筛查相关。这些结果表明，在黑人妇女中，居住在高贫困（20%）社区与非近期宫颈癌筛查的风险增加相关，独立于个人水平的风险因素。
BACKGROUND. Cervical carcinoma is the fifth most common cancer among African American women in the U.S. Although the Papanicolaou (Pap) smear is an efficacious screening tool in the early detection of the disease, disparities are known to persist in the utilization of this procedure across socioeconomic groups.METHODS. Data regarding cervical carcinoma screening and covariates were obtained from the 59,090 Black Women's Health Study participants across the U.S. via a mailed questionnaire in 1995. Logistic regression and multilevel techniques were used to assess the independent effects of the covariates on nonrecent cervical carcinoma screening.RESULTS. in all, 8.3% of the 40,009 women in the present analysis had not undergone a Pap smear examination within the previous 2 years (nonrecent screening). Lower educational attainment, older age, obesity, smoking, and neighborhood poverty were found to be independently related to increased risk of nonrecent screening. The adjusted odds ratio for nonrecent screening was 1.2 (95% confidence interval [95% CI], 1.1-1.4) for women residing in neighborhoods with 20% or more poverty compared with those in neighborhoods with less than 5% poverty. State of residence was also associated with nonrecent cervical carcinoma screening.CONCLUSION. These results suggest that among black women, residence in high-poverty (20%) neighborhoods is associated with an increased risk of nonrecent cervical carcinoma screening, independent of individual level risk factors.