Area-level Socioeconomic Inequalities in the Use of Mammography Screening: A Multilevel Analysis of the Health of Houston Survey
Area-level Socioeconomic Inequalities in the Use of Mammography Screening: A Multilevel Analysis of the Health of Houston Survey
复制标题
DOI：
10.1016/j.whi.2015.11.002
复制
发表时间：
2016-03-01
影响因子：
3.2
通讯作者：
Linder, Stephen H.
中科院分区：
文献类型：
--
作者：
Calo, William A.;Vernon, Sally W.;Linder, Stephen H.
背景：一项新兴的文献报道，居住在社会经济贫困社区的妇女不太可能坚持乳房X光检查。这项研究在德克萨斯州不同种族和民族的女性样本中探索了地区层面的社会经济措施与乳房X光检查之间的关联。方法：我们进行了一项横断面、多水平的研究，将2010年休斯顿健康调查的个人水平数据与美国人口普查的背景数据联系起来。分析包括了年龄在40岁到74岁之间的女性(n=1,541)。我们考察了地区水平的贫困、失业、教育、西班牙裔和黑人构成、女性户主家庭以及拥挤作为背景指标。使用多水平Logistic回归模型，比较最不利区域(四分位2-4)和最有利区域(四分位1)。结果：总体上，%的样本坚持进行乳房摄影筛查。西班牙裔、在外国出生的人、40至49岁的妇女、低教育程度、失业和没有医疗保险的人的筛查率较低(p<；.05)。生活在贫困程度高的地区(四分位数2对1：优势比[OR]，0.50；95%CI，0.30-0.85)、西班牙裔构成(四分位数3：OR，0.54；95%CI，0.32-0.90)和拥挤(四分位数4对1：OR，0.53；95%CI，0.29-0.96)的妇女不太可能进行最新的乳房X光检查，扣除个人水平的因素。结论：我们的研究结果强调了在乳房X光检查中检查地区层面社会经济不平等的重要性。这项研究代表了先前研究的进步，因为我们检查了多个区域测量，控制了关键的个体水平协变量，使用了在区域水平聚集的数据，并考虑了数据的嵌套结构。版权所有(C)2016年，由雅各布斯妇女健康研究所所有。由爱思唯尔公司出版。
Background: An emerging literature reports that women who reside in socioeconomically deprived communities are less likely to adhere to mammography screening. This study explored associations between area-level socioeconomic measures and mammography screening among a racially and ethnically diverse sample of women in Texas.Methods: We conducted a cross-sectional, multilevel study linking individual-level data from the 2010 Health of Houston Survey and contextual data from the U.S. Census. Women ages 40 to 74 years (n = 1,541) were included in the analyses. We examined tract-level poverty, unemployment, education, Hispanic and Black composition, female-headed householder families, and crowding as contextual measures. Using multilevel logistic regression modeling, we compared most disadvantaged tracts (quartiles 2-4) to the most advantaged tract (quartile 1).Results: Overall, 64% of the sample was adherent to mammography screening. Screening rates were lower (p < .05) among Hispanics, those foreign born, women aged 40 to 49 years, and those with low educational attainment, unemployed, and without health insurance coverage. Women living in areas with high levels of poverty (quartile 2 vs. 1: odds ratio [OR], 0.50; 95% CI, 0.30-0.85), Hispanic composition (quartile 3 vs. 1: OR, 0.54; 95% CI, 0.32-0.90), and crowding (quartile 4 vs. 1: OR, 0.53; 95% CI, 0.29-0.96) were less likely to have up-to-date mammography screening, net of individual-level factors.Conclusion: Our findings highlight the importance of examining area-level socioeconomic inequalities in mammography screening. The study represents an advance on previous research because we examined multiple area measures, controlled for key individual-level covariates, used data aggregated at the tract level, and accounted for the nested structure of the data. Copyright (C) 2016 by the Jacobs Institute of Women's Health. Published by Elsevier Inc.