What Explains Education Disparities in Screening Mammography in the United States? A Comparison with The Netherlands.
What Explains Education Disparities in Screening Mammography in the United States? A Comparison with The Netherlands.
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DOI：
10.3390/ijerph15091961
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发表时间：
2018-09-08
影响因子：
--
通讯作者：
Van Ourti T
中科院分区：
文献类型：
--
作者：
Koç H;O'Donnell O;Van Ourti T
背景：在美国，受教育程度较低的妇女接受乳房X光检查的可能性要小得多。目前尚不清楚这是否是由于在获得筛查或对乳腺癌的风险和筛查的有效性的看法的差异。我们通过研究在以获取和感知指标为条件后，乳房X光检查对教育的依赖性如何变化来权衡这两种解释的合理性。我们还比较了美国的估计与荷兰的估计，荷兰普遍接受公共资助的筛查计划。方法：来自美国生活小组（n = 646）和荷兰社会科学纵向互联网研究（n = 1398）的横截面和跨国可比个人水平数据被用来估计和解释美国和荷兰40岁以上女性筛查乳房X线照片的教育差异。使用logit模型估计教育梯度。控制顺序增加，以检测差异是否被解释为在访问或风险和有效性的看法的差异。结果如下：在美国，高中毕业生在前两年接受筛查性乳房X光检查的可能性比大学毕业生低11.5个百分点（95% CI：1-22个百分点）。这种教育梯度在很大程度上是由收入、保险范围和接受医疗建议方面的差异造成的。这并不能用在乳腺癌风险和乳房X光检查有效性方面的教育差异来解释。在接受乳房X光检查方面，国家筛查方案所涵盖的50-75岁荷兰妇女之间没有教育差异。结论：在美国缺乏普遍筛查计划的情况下，获得的决定因素-收入、保险范围和接受医疗咨询-似乎是造成筛查性乳房X光检查中教育差距的原因。
Background: In the U.S., less educated women are substantially less likely to receive screening mammography. It is not clear whether this is due to differences in access to screening or in perceptions of breast cancer risks and the effectiveness of screening. We weigh the plausibility of these two explanations by examining how the dependence of mammography on education changes after conditioning on indicators of access and perceptions. We also compare estimates for the U.S. with those for the Netherlands where there is universal access to a publicly financed screening program. Method: Cross-sectional and cross-country comparable individual level data from the American Life Panel (n = 646) and the Netherlands Longitudinal Internet Studies for the Social Sciences (n = 1398) were used to estimate and explain education disparities in screening mammograms given to American and Dutch women aged 40+. The education gradient was estimated using logit models. Controls were sequentially added to detect whether disparities were explained by differences in access or perceptions of risks and effectiveness. Results: In the United States, high school graduates were 11.5 percentage points (95% CI: 1–22 percentage points) less likely than college graduates to receive a screening mammogram in the previous two years. This education gradient was largely explained by differences in income, insurance coverage and receipt of medical advice. It was not explained by educational differences in the perceived risk of breast cancer and the effectiveness of mammography. There were no education disparities in receipt of mammography among Dutch women within the 50–75 age range covered by the national screening program. Conclusion: In the absence of a universal screening program in the U.S., determinants of access—income, insurance coverage and receipt of medical advice—appear to drive the education disparities in screening mammography.
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影响因子：
5
作者：
Heck, KE;Pamuk, ER
通讯作者：
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