The Role of Social Determinants of Health in Self-Reported Access to Health Care Among Women Undergoing Screening Mammography
The Role of Social Determinants of Health in Self-Reported Access to Health Care Among Women Undergoing Screening Mammography
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DOI：
10.1089/jwh.2019.8267
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发表时间：
2020-05-05
影响因子：
3.5
通讯作者：
Onega, Tracy
中科院分区：
文献类型：
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作者：
Henderson, Louise M.;O'Meara, Ellen S.;Onega, Tracy
背景：健康的社会决定因素（SDOH）助长了保健差距，社会和经济障碍往往导致难以获得必要的保健。我们评估了接受医疗服务的障碍，重点是看护人的责任、医疗保险和费用以及交通。材料和方法：我们纳入了2012年至2017年在三个乳腺癌监测联盟登记处接受乳房x光筛查的年龄为bb0 = 40岁的女性。妇女自我报告在乳房x光检查前12个月内接受医疗保健的社会和经济障碍。我们使用多元逻辑回归评估了与报告障碍相关的妇女和基于人口普查的社区水平因素。我们使用Wald检验评估了城市居民与非城市居民的相互作用。结果：在393,430名女性中，3.6%的人报告存在障碍，城市环境比非城市环境的比例更高（分别为3.9% [n = 11,977]对2.2% [n = 1,655], p < 0.001）。在报告遇到障碍的妇女中，医疗费用和/或没有保险是最常见的（49.3%），没有交通工具是最不常见的（7.8%）。与白人妇女相比，黑人妇女（调整优势比[aOR] = 1.30, 95%可信区间[CI]: 1.16-1.44）、西班牙裔妇女（aOR = 1.66, 95% CI: 1.53-1.80）和其他种族妇女（aOR = 1.84, 95% CI: 1.65-2.04）报告障碍的几率更高。家庭收入中位数较高的妇女（aOR = 0.69, 95% CI: 0.61-0.79）或平均医疗保险费用较高的妇女（aOR = 0.85, 95% CI: 0.74-0.98）不太可能出现障碍，但在多样性指数高的地区更可能出现障碍（aOR = 1.28, 95% CI: 1.11-1.48）。结论：在接受乳房x光筛查的女性中，存在基于种族/民族和与收入、保险费用和居住地相关的SDOH的社会和经济障碍。乳腺成像机构可以利用这些障碍的信息来提高两年一次的筛查依从性，或确保有异常发现的妇女通过有针对性的干预获得适当的随访护理。
Background: Social determinants of health (SDOH) contribute to health care disparities, with social and economic barriers often leading to difficulties in obtaining necessary care. We evaluated barriers to receiving health care, focusing on caretaker responsibilities, health insurance and cost, and transportation.Materials and Methods: We included women ages >= 40 years receiving screening mammography across three Breast Cancer Surveillance Consortium registries from 2012 to 2017. Women self-reported social and financial barriers to receiving health care in the 12 months before their screening mammogram. We evaluated woman- and census-based community-level factors associated with reporting a barrier using multivariate logistic regression. We assessed interaction with urban versus nonurban residence using Wald tests.Results: Among 393,430 women, 3.6% reported a barrier with a higher proportion in urban versus nonurban settings (3.9% [n = 11,977] vs. 2.2% [n = 1,655], respectively; p < 0.001). Among women reporting a barrier, health care cost and/or no insurance was the most common (49.3%), and no transportation was the least common (7.8%). Compared with white women, odds of reporting barriers were higher among black (adjusted odds ratio [aOR] = 1.30, 95% confidence interval [CI]: 1.16-1.44), Hispanic (aOR = 1.66, 95% CI: 1.53-1.80), and other race (aOR = 1.84, 95% CI: 1.65-2.04) women. Barriers were less likely in women with higher median household income (aOR = 0.69, 95% CI: 0.61-0.79) or higher average health insurance costs (aOR = 0.85, 95% CI: 0.74-0.98), but were more likely in high diversity index areas (aOR = 1.28, 95% CI: 1.11-1.48).Conclusions: Social and financial barriers exist based on race/ethnicity and SDOH related to income, insurance costs, and place of residence among women undergoing screening mammography. Breast imaging facilities could utilize information on these barriers to improve biennial screening adherence or ensure that women with abnormal findings obtain appropriate follow-up care through targeted interventions.