The Influence of Social Determinants on Cancer Screening in a Medicaid Sample.
The Influence of Social Determinants on Cancer Screening in a Medicaid Sample.
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社会决定因素对医疗补助样本中癌症筛查的影响。
DOI：
10.1016/j.amepre.2023.02.005
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发表时间：
2023
影响因子：
5.5
通讯作者：
McCarthy,MelissaL
中科院分区：
文献类型：
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作者：
Markus,AnneR;Li,Yixuan;Wilder,MarceéE;Catalanotti,Jillian;McCarthy,MelissaL
简介很少有人关注单独测量的健康社会决定因素对医疗补助人群癌症筛查测试的影响。方法对来自哥伦比亚特区医疗补助队列研究的医疗补助参与者亚组 (N=8,943) 的 2015-2020 年索赔数据进行了分析，这些参与者有资格患结直肠癌 (n=2,131)、乳腺癌 (n=1,156) 和宫颈癌 (n=第5,068章）筛选。根据参与者对健康问题社会决定因素问卷的回答，将其分为四个不同的健康社会决定因素组。本研究使用对数二项式回归，根据人口统计、疾病严重程度和社区水平的剥夺程度进行调整，估计了健康群体的四个社会决定因素对接受每项筛查测试的影响。结果结直肠癌、宫颈癌和乳腺癌的癌症筛查测试接受率分别为 42%、58% 和 66%。与健康状况最不利的社会决定因素组相比，健康状况最不利的社会决定因素组的患者接受结肠镜检查/乙状结肠镜检查的可能性较小（调整后的 RR=0.70，95% CI=0.54，0.92）。乳房X光检查和子宫颈抹片检查的模式相似（调整后的RR = 0.94，95％CI = 0.80，1.11和调整后的RR = 0.90，95％CI = 0.81，1.00）。相比之下，健康状况最不利的社会决定因素组的参与者比处境最不利的组的参与者更有可能接受粪便潜血检测（调整后的RR = 1.52，95％CI = 1.09，2.12）。结论在个体水平上测量的严重的健康社会决定因素与较低的癌症预防筛查相关。解决影响癌症筛查的社会和经济逆境的有针对性的方法可能会导致该医疗补助人群的预防性筛查率更高。
IntroductionLittle attention has been paid to the influence of individually measured social determinants of health on cancer screening tests in the Medicaid population.MethodsAnalysis was conducted on 2015–2020 claims data from a subgroup of Medicaid enrollees from the District of Columbia Medicaid Cohort Study (N=8,943) who were eligible for colorectal (n=2,131), breast (n=1,156), and cervical cancer (n= 5,068) screening. Participants were grouped into four distinct social determinants of health groups on the basis of their responses to social determinants of health questionnaire. This study estimated the influence of the four social determinants of health groups on the receipt of each screening test using log-binomial regression adjusted for demographics, illness severity, and neighborhood-level deprivation.ResultsThe receipt of cancer screening tests was 42%, 58%, and 66% for colorectal, cervical, and breast cancer, respectively. Those in the most disadvantaged social determinants of health group were less likely to receive a colonoscopy/sigmoidoscopy than those in the least disadvantaged one (adjusted RR=0.70, 95% CI=0.54, 0.92). The pattern for mammograms and Pap smears was similar (adjusted RR=0.94, 95% CI=0.80, 1.11 and adjusted RR=0.90, 95% CI=0.81, 1.00, respectively). In contrast, participants in the most disadvantaged social determinants of health group were more likely to receive fecal occult blood test than those in the least disadvantaged one (adjusted RR=1.52, 95% CI=1.09, 2.12).ConclusionsSevere social determinants of health measured at the individual level are associated with lower cancer preventive screening. A targeted approach that addresses the social and economic adversities that affect cancer screening could result in higher preventive screening rates in this Medicaid population.