军队医疗系统中与乳腺癌和宫颈癌筛查相关的个人因素和集水区因素。

IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL
Joel E Segel, Alison Chetlen, Mark Ramos, Nicholas G Zaorsky, Guangqing Chi, Patrick Luan
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引用次数: 0

摘要

导言:乳腺癌和宫颈癌筛查对于在早期阶段发现病例以尽早开始治疗并提高存活率至关重要。在军事卫生系统(MHS)中,筛查率存在差异。我们的目标是估算 MHS 内部筛查率变化的驱动因素:我们使用 2007-2019 年军事卫生系统数据存储库数据来研究与 1 年和 2 年乳腺癌和宫颈癌筛查率相关的个人层面和集水区层面因素。具体而言,我们估算了 1 年和 2 年乳腺癌和宫颈癌筛查率概率与年龄组、婚姻状况、军衔、服役部门、受益人类型(服役人员与家属)、服役人员的种族/民族、通过购买护理提供的总体护理的覆盖区比例以及人均支出之间的单变量和多变量关联。该项目获得了宾夕法尼亚州立大学机构审查委员会(IRB)和国防卫生局电子 IRB 的批准:总体而言,我们观察到 1 年乳腺 X 光筛查率为 45.6%,2 年乳腺 X 光筛查率为 65.7%;1 年子宫颈抹片检查率为 30.5%,2 年子宫颈抹片检查率为 51.9%。在乳腺癌筛查方面,我们发现在未调整分析和多变量分析中,年龄较大(50-64 岁)、已婚、现役军人、级别较高或与级别较高的军人结婚的妇女以及非西班牙裔黑人妇女的筛查率较高。相反,我们发现年轻、未婚、级别较低的女性以及非西班牙裔黑人女性的宫颈癌筛查率较高。我们还发现,在私立医疗机构提供医疗服务比例较高的集水区,乳腺癌和宫颈癌筛查率都较高:我们发现,在购买医疗服务比例较高的集水区,筛查率较高,这值得进一步研究,以了解是哪些因素导致了这一结果。个人特征与乳腺癌和宫颈癌筛查之间关系的不同研究结果表明,这两种类型的筛查存在重要差异,可能需要不同的政策来鼓励和加强乳腺癌和宫颈癌筛查。最后,我们的研究结果显示,非西班牙裔黑人妇女的筛查率较高,这表明医疗保险制度的重要特点,如全民低成本分担保险,可能有助于减少乳腺癌和宫颈癌筛查中的种族和民族差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Individual and Catchment Area Factors Associated With Breast and Cervical Cancer Screening Within the Military Health System.

Introduction: Breast and cervical cancer screening is critical to identifying cases at earlier stages in order to begin treatment earlier and improve survival. Screening rates have been shown to vary within the Military Health System (MHS). The goal is to estimate drivers of variation in screening rates within the MHS.

Materials and methods: We used 2007-2019 MHS Data Repository Data to examine individual-level and catchment area-level factors associated with 1- and 2-year breast and cervical cancer screening rates. Specifically, we estimated univariate and multivariate association between 1- and 2-year probability of breast and cervical cancer screening rates and age group, marital status, rank, service branch, beneficiary type (service member vs. dependent), race/ethnicity of service members, catchment area fraction of overall care through purchased care and average per capita spending. The project was approved by both the Penn State Institutional Review Board (IRB) and the Defense Health Agency's electronic IRB.

Results: Overall, we observed a 45.6% 1 year and a 65.7% 2-year mammography screening rate and a 30.5% 1 year and a 51.9% 2-year Pap testing rate. For breast cancer screening, we found higher screening rates for older (ages 50-64 years), married, service members, more senior ranked women or those married to more senior ranked members, and non-Hispanic Black women in both unadjusted and multivariate analyses. Conversely, we found higher rates of cervical cancer screening for younger, unmarried, more junior ranked women as well as for non-Hispanic Black women. We also found higher rates for both breast and cervical cancer screening in catchment areas with a greater fraction of care delivered through the private sector.

Conclusion: Our finding of higher screening in catchment areas with higher rates of purchased care warrants additional study to understand what factors may drive this result. The differential findings of the association between individual characteristics and breast and cervical cancer screening suggest important differences in these 2 types of screening with potentially different policies required to encourage and enhance breast vs. cervical cancer screening. Finally, our results showing higher screening among non-Hispanic Black women suggests important features of the MHS, such as universal, low-cost sharing coverage may help to reduce racial and ethnic disparities in breast and cervical cancer screening.

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来源期刊
Military Medicine
Military Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
2.20
自引率
8.30%
发文量
393
审稿时长
4-8 weeks
期刊介绍: Military Medicine is the official international journal of AMSUS. Articles published in the journal are peer-reviewed scientific papers, case reports, and editorials. The journal also publishes letters to the editor. The objective of the journal is to promote awareness of federal medicine by providing a forum for responsible discussion of common ideas and problems relevant to federal healthcare. Its mission is: To increase healthcare education by providing scientific and other information to its readers; to facilitate communication; and to offer a prestige publication for members’ writings.
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