Abstract：
To explore rates of under- and overscreening for cervical cancer among a national cohort.
The MarketScan database, a national administrative database of employee-sponsored insurance, was queried for elements relevant to cervical cancer screening among women aged 21-65 with 6 years of continuous enrollment (2015-2019). Average-risk women were defined as those without high-risk medical conditions or abnormal screening histories, and without evidence of hysterectomy with removal of the cervix for benign indications. Average-risk women were considered adequately screened if they had Pap tests alone at 2.5-3.5 year intervals, or HPV tests or co-tests at 4.5-5.5 year intervals. Logistic regressions were used to predict the odds of receiving guideline-adherent screening, underscreening, and overscreening.
Among 1,872,809 eligible patients, 1,471,063 (78.5%) qualified for routine screening. Of these, only 18.1% received guideline-adherent screening, and 25.4% were unscreened during the 6-year period. Younger women (aged 21-39) were more likely to be overscreened [OR 1.46]. Older women (aged 50-64) were more likely to be underscreened or unscreened during the study period [OR 2.54]. Guideline-adherent screening was highest with HPV testing alone (80%) followed by co-testing (44%), and lowest with cytology alone (15%). A total of 329,062 women in this general population sample (18%) met high-risk criteria that required increased frequency of screening.
High rates of both underscreening and overscreening indicate a need for additional strategies to improve guideline-adherent care.
N/A.
The MarketScan database, a national administrative database of employee-sponsored insurance, was queried for elements relevant to cervical cancer screening among women aged 21-65 with 6 years of continuous enrollment (2015-2019). Average-risk women were defined as those without high-risk medical conditions or abnormal screening histories, and without evidence of hysterectomy with removal of the cervix for benign indications. Average-risk women were considered adequately screened if they had Pap tests alone at 2.5-3.5 year intervals, or HPV tests or co-tests at 4.5-5.5 year intervals. Logistic regressions were used to predict the odds of receiving guideline-adherent screening, underscreening, and overscreening.
Among 1,872,809 eligible patients, 1,471,063 (78.5%) qualified for routine screening. Of these, only 18.1% received guideline-adherent screening, and 25.4% were unscreened during the 6-year period. Younger women (aged 21-39) were more likely to be overscreened [OR 1.46]. Older women (aged 50-64) were more likely to be underscreened or unscreened during the study period [OR 2.54]. Guideline-adherent screening was highest with HPV testing alone (80%) followed by co-testing (44%), and lowest with cytology alone (15%). A total of 329,062 women in this general population sample (18%) met high-risk criteria that required increased frequency of screening.
High rates of both underscreening and overscreening indicate a need for additional strategies to improve guideline-adherent care.
N/A.
摘要：
目的：在全国队列中探讨宫颈癌筛查不足和过度筛查的比率。
方法：MarketScan数据库，员工发起保险的国家管理数据库，在连续入组6年(2015-2019年)的21-65岁女性中,询问了与宫颈癌筛查相关的因素.平均风险女性被定义为没有高风险医疗条件或异常筛查史的女性。并且没有证据表明子宫切除术和宫颈切除是良性适应症。如果平均风险的女性在2.5-3.5年的时间间隔内单独进行巴氏试验，则被认为是经过充分筛查的。或HPV测试或共同测试，间隔4.5-5.5年。Logistic回归用于预测接受指南性筛查的几率，低估，和过度筛查。
结果：在1,872,809名合格患者中，1,471,063（78.5%）符合常规筛查条件。其中,只有18.1%的人接受了遵循指南的筛查，25.4%在6年期间未筛查。年轻女性（21-39岁）更有可能过度筛查[OR1.46]。在研究期间，老年女性（50-64岁）更有可能是低筛查或未筛查[OR2.54]。遵循指南的筛查最高，单独进行HPV检测（80％），然后进行共同检测（44％）。仅细胞学最低（15％）。在这个普通人群样本中，共有329,062名女性（18％）符合高风险标准，需要增加筛查频率。
结论：筛查不足和筛查过度的高比率表明需要额外的策略来改善指南依附性护理。
背景：不适用。
方法：MarketScan数据库，员工发起保险的国家管理数据库，在连续入组6年(2015-2019年)的21-65岁女性中,询问了与宫颈癌筛查相关的因素.平均风险女性被定义为没有高风险医疗条件或异常筛查史的女性。并且没有证据表明子宫切除术和宫颈切除是良性适应症。如果平均风险的女性在2.5-3.5年的时间间隔内单独进行巴氏试验，则被认为是经过充分筛查的。或HPV测试或共同测试，间隔4.5-5.5年。Logistic回归用于预测接受指南性筛查的几率，低估，和过度筛查。
结果：在1,872,809名合格患者中，1,471,063（78.5%）符合常规筛查条件。其中,只有18.1%的人接受了遵循指南的筛查，25.4%在6年期间未筛查。年轻女性（21-39岁）更有可能过度筛查[OR1.46]。在研究期间，老年女性（50-64岁）更有可能是低筛查或未筛查[OR2.54]。遵循指南的筛查最高，单独进行HPV检测（80％），然后进行共同检测（44％）。仅细胞学最低（15％）。在这个普通人群样本中，共有329,062名女性（18％）符合高风险标准，需要增加筛查频率。
结论：筛查不足和筛查过度的高比率表明需要额外的策略来改善指南依附性护理。
背景：不适用。
