Association Between Individual and Geographic Factors and Nonadherence to Mammography Screening Guidelines
Association Between Individual and Geographic Factors and Nonadherence to Mammography Screening Guidelines
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DOI：
10.1089/jwh.2013.4668
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发表时间：
2014-08-01
影响因子：
3.5
通讯作者：
Stroup, Antoinette M.
中科院分区：
文献类型：
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作者：
Henry, Kevin A.;McDonald, Kaila;Stroup, Antoinette M.
背景：这项研究调查了犹他州不遵守乳房X光检查筛查指南的相关因素，该州的乳房X光筛查率一直低于全国平均水平。方法：我们检查了2008年和2010年犹他州行为风险因素监测系统(n=5,197，加权n=417,064)40-74岁女性报告的乳房X光检查数据。结果：在2008年和2010年，年龄在40-49岁之间的女性报告在最近两年内没有接受过乳房X光检查的比例(43.1%，95%可信区间39.9%-46.3%)与50-74岁的女性(26.8%，95%可信区间24.9%-28.7%)不成比例。没有一个地理因素是筛查依从性的显著预测因素。基于协变量调整模型，与最近两年内不接受乳房X光检查的几率增加相关的统计学显著(p<；0.05)因素包括没有正规医生、没有医疗保险、40-49岁、收入低于25,000美元以及家中有三个或更多的孩子。结论：犹他州的乳房X光检查工作应侧重于改善获得保险或定期医疗保健的机会。未来的研究还应考虑如何最好地解决极端的时间要求和相互竞争的优先事项，这些问题对大家庭的妇女构成了潜在的障碍，导致这些妇女的筛查水平较低。
Background: This study investigates factors that are associated with nonadherence to mammography screening guidelines in Utah, a state where mammography screening rates have remained consistently lower than national averages.Methods: We examined data on reported mammography use among women aged 40-74 years from the 2008 and 2010 Utah Behavioral Risk Factor Surveillance System (n = 5,197, weighted n = 417,064). Logistic regression models were used to estimate the effects of individual-level and geographic (travel time to nearest mammography facility, geographic accessibility, and rural/urban residence) factors on the odds of a woman not reporting receiving a mammogram in the last 2 years.Results: In 2008 and 2010, a disproportionate number of women aged 40-49 (43.1%, 95% confidence interval [CI] 39.9%-46.3%) reported not receiving a mammogram within the last 2 years compared to women 50-74 (26.8%, 95% CI 24.9%-28.7%). None of the geographic factors were significant predictors of screening adherence. Based on covariate adjusted models, statistically significant (p < 0.05) factors associated with increased odds of not receiving mammogram within the last 2 years included not having a regular physician, no health insurance, being aged 40-49, income less than $25,000, and the presence of three or more children in the home.Conclusion: Mammography screening efforts in Utah should focus on improving access to insurance or a regular source of health care. Future research should also consider how best to address extreme time demands and competing priorities that present potential barriers for women with large families, resulting in lower screening levels among these women.