Effect of area poverty rate on cancer screening across US communities
Effect of area poverty rate on cancer screening across US communities
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DOI：
10.1136/jech.2005.041020
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发表时间：
2006-03-01
影响因子：
6.3
通讯作者：
Walker, MS
中科院分区：
文献类型：
--
作者：
Schootman, M;Jeffe, DB;Walker, MS
研究目的：分析地区贫困率对从未接受过乳腺癌、宫颈癌和结肠直肠癌筛查的背景影响，方法是：（1）描述98个美国大都市地区筛查行为的变化程度;（2）确定缺乏筛查的变化是否可以用居住在这些地区的人的特征差异来解释;（3）确定是否生活在一个贫困率较高的大都市地区会增加从未接受过癌症筛查的可能性，而不是个人特征。多水平逻辑回归包括个人水平因素以及地区贫困率。设置：美国98个地区。参与者：居住在98个地区的118000多人;样本旨在估计48.3%的美国人口年龄在18岁或以上。主要结果：在调整个人水平因素后，地区水平贫困率（每5%）的增加仍然与从未进行过乳房X光检查有关（比值比（OR）= 1.28，95%置信区间（CI）：1.03 - 1.37）;临床乳腺检查（OR = 1.28，95% CI：1.11 - 1.48），结肠镜/乙状结肠镜检查（OR = 1.10，95%CI：1.01至1.19），粪便潜血试验（OR = 1.19，95%CI：1.12至1.27）。贫困率与从未进行过巴氏涂片检查无关（OR = 1.12; 95%CI：0.90 - 1.41）。大都市或小都市统计区（MMSA）之间的方差大小因筛查试验类型而异，组内相关系数范围从4.9%（从未有过巴氏涂片）到1.2%（从未有过结肠镜检查/乙状结肠镜检查）。结论：地区贫困率与从未筛查过乳腺癌和结直肠癌独立相关，但与宫颈癌无关。MMSA之间的方差大小充其量是适度的。
Study objective: To analyse the contextual effect of area poverty rate on never having been screened for breast, cervical, and colorectal cancer by (1) describing the extent of the variation in screening behaviours among 98 US metropolitan areas; (2) determining if the variation in lack of screening can be explained by differences in the characteristics of the persons who resided in these areas; and (3) determining if living in a metropolitan area with a higher poverty rate increased the likelihood of never having been screened for cancer over and above individual characteristics.Design: Cross sectional survey using data from the 2002 Behavioral Risk Factor Surveillance System. Multilevel logistic regression included both individual level factors as well as area poverty rate.Setting: Ninety eight areas across the USA.Participants: Over 118 000 persons residing in 98 areas; a sample aimed at estimating 48.3% of the US population age 18 or older.Main results: After adjustment for individual level factors, increasing area level poverty rate (per 5%) remained associated with never having had a mammogram (odds ratio (OR) = 1.28, 95% confidence interval (CI): 1.03 to 1.37); clinical breast examination (OR = 1.28, 95% CI: 1.11 to 1.48), colonoscopy/sigmoidoscopy (OR = 1.10, 95% CI: 1.01 to 1.19), and a faecal occult blood test (OR = 1.19, 95% CI: 1.12 to 1.27). Poverty rate was not independently associated with never having had a Pap smear (OR = 1.12; 95% CI: 0.90 to 1.41). The size of the variance among metropolitan or micropolitan statistical areas (MMSAs) varied by type of screening test, with intraclass correlation coefficients ranging from 4.9% (never having had a Pap smear) to 1.2% (never having had a colonoscopy/sigmoidoscopy).Conclusions: Area poverty rate was independently associated with never having been screened for breast and colorectal cancer, but not cervical cancer. The size of the variance among MMSAs was modest at best.