Abstract：
BACKGROUND: Cervical cancer screening (CCS) among East African immigrants (EAI) in the USA is under explored. This study aimed to investigate adherence to CCS and its correlates among EAI.
METHODS: We identified 1664 EAI women (25-65 years) with ≥ 1 primary care clinic visit(s) between 2017 and 2018, using University of Washington (UW) Medicine electronic health record data. CCS adherence was defined as Pap testing within 3 years or human papillomavirus/Pap co-testing within 5 years. We used Poisson regression with robust standard errors to cross-sectionally estimate associations with correlates of adherence. Twelve-month screening uptake was also evaluated among overdue women.
RESULTS: CCS adherence was 63%. Factors associated with higher adherence included older age (adjusted prevalence ratios [APRs]:1.47:95%CI:1.14-1.90, 1.38:95%CI:1.05-1.80, respectively, for ages 30-39 and 40-49 vs 25-29 years), longer duration of care at UW Medicine (APR:1.22:95%CI:1.03-1.45, comparing > 10 vs < 5 years), higher visit frequency (APR:1.23:95%CI:1.04-1.44, 1.46:95%CI:1.24-1.72, respectively, for 3-5 and ≥ 6 vs 1-2 visits), index visit in an obstetrics-gynecology clinic (APR:1.26:95%CI:1.03-1.55, vs family practice), having an assigned primary care provider (APR:1.35: 95%CI:1.02-1.79), breast cancer screening adherence (APR:1.66: 95%CI:1.27-2.17), and colorectal cancer screening adherence (APR:1.59:95%CI:1.24-2.03). Low BMI was associated with lower adherence (APR:0.50:95%CI:0.26-0.96, comparing < 18.5 kg/m2 vs 18.5-24.9 kg/m2). Among 608 (37%) overdue women, 9% were screened in the subsequent 12 months. Having commercial health insurance vs Medicare/Medicaid was associated with higher uptake (adjusted risk ratio:2.44:95%CI:1.15-5.18).
CONCLUSIONS: CCS adherence among EAI was lower than the national average of 80%. Interventions focused on increasing healthcare access/utilization or leveraging healthcare encounters to address barriers could increase CCS in EAIs.
METHODS: We identified 1664 EAI women (25-65 years) with ≥ 1 primary care clinic visit(s) between 2017 and 2018, using University of Washington (UW) Medicine electronic health record data. CCS adherence was defined as Pap testing within 3 years or human papillomavirus/Pap co-testing within 5 years. We used Poisson regression with robust standard errors to cross-sectionally estimate associations with correlates of adherence. Twelve-month screening uptake was also evaluated among overdue women.
RESULTS: CCS adherence was 63%. Factors associated with higher adherence included older age (adjusted prevalence ratios [APRs]:1.47:95%CI:1.14-1.90, 1.38:95%CI:1.05-1.80, respectively, for ages 30-39 and 40-49 vs 25-29 years), longer duration of care at UW Medicine (APR:1.22:95%CI:1.03-1.45, comparing > 10 vs < 5 years), higher visit frequency (APR:1.23:95%CI:1.04-1.44, 1.46:95%CI:1.24-1.72, respectively, for 3-5 and ≥ 6 vs 1-2 visits), index visit in an obstetrics-gynecology clinic (APR:1.26:95%CI:1.03-1.55, vs family practice), having an assigned primary care provider (APR:1.35: 95%CI:1.02-1.79), breast cancer screening adherence (APR:1.66: 95%CI:1.27-2.17), and colorectal cancer screening adherence (APR:1.59:95%CI:1.24-2.03). Low BMI was associated with lower adherence (APR:0.50:95%CI:0.26-0.96, comparing < 18.5 kg/m2 vs 18.5-24.9 kg/m2). Among 608 (37%) overdue women, 9% were screened in the subsequent 12 months. Having commercial health insurance vs Medicare/Medicaid was associated with higher uptake (adjusted risk ratio:2.44:95%CI:1.15-5.18).
CONCLUSIONS: CCS adherence among EAI was lower than the national average of 80%. Interventions focused on increasing healthcare access/utilization or leveraging healthcare encounters to address barriers could increase CCS in EAIs.
摘要：
背景：正在探索美国东非移民（EAI）中的宫颈癌筛查（CCS）。本研究旨在调查EAI对CCS的依从性及其相关性。
方法：我们使用华盛顿大学（UW）医学电子健康记录数据，在2017年至2018年之间确定了1664名EAI女性（25-65岁），其初级保健门诊就诊时间≥1次。CCS依从性被定义为3年内的Pap测试或5年内的人乳头瘤病毒/Pap共同测试。我们使用具有稳健标准误差的泊松回归来跨截面估计与依从性相关的关联。还评估了逾期妇女的12个月筛查率。
结果：CCS依从性为63%。与较高依从性相关的因素包括年龄较大（调整后的患病率比[APRs]：1.47：95CI：1.14-1.90，1.38：95CI：1.05-1.80，30-39岁和40-49岁vs25-29岁)，UWMedicine的护理时间更长（APR：1.22：95CI：1.03-1.45，比较>10年和<5年），更高的访问频率(分别为:1.23:95CI:1.04-1.44，1.46:95CI:1.24-1.72，3-5次和≥6次与1-2次就诊)，妇产科诊所的索引访问（APR：1.26：95CI：1.03-1.55，vs家庭实践），拥有指定的初级保健提供者（APR：1.35：95CI：1.02-1.79），乳腺癌筛查依从性（APR：1.66：95CI：1.27-2.17），和结直肠癌筛查依从性（APR：1.59：95CI：1.24-2.03）。低BMI与较低的依从性相关（APR：0.50：95CI：0.26-0.96，<18.5kg/m2vs18.5-24.9kg/m2）。在608名(37%)逾期女性中，9％的人在随后的12个月中进行了筛查。拥有商业健康保险与Medicare/Medicaid的比例更高（调整后的风险比：2.44：95CI：1.15-5.18）。
结论：EAI中的CCS依从性低于全国平均水平的80%。专注于增加医疗保健访问/利用率或利用医疗保健遇到来解决障碍的干预措施可能会增加EAI中的CCS。
方法：我们使用华盛顿大学（UW）医学电子健康记录数据，在2017年至2018年之间确定了1664名EAI女性（25-65岁），其初级保健门诊就诊时间≥1次。CCS依从性被定义为3年内的Pap测试或5年内的人乳头瘤病毒/Pap共同测试。我们使用具有稳健标准误差的泊松回归来跨截面估计与依从性相关的关联。还评估了逾期妇女的12个月筛查率。
结果：CCS依从性为63%。与较高依从性相关的因素包括年龄较大（调整后的患病率比[APRs]：1.47：95CI：1.14-1.90，1.38：95CI：1.05-1.80，30-39岁和40-49岁vs25-29岁)，UWMedicine的护理时间更长（APR：1.22：95CI：1.03-1.45，比较>10年和<5年），更高的访问频率(分别为:1.23:95CI:1.04-1.44，1.46:95CI:1.24-1.72，3-5次和≥6次与1-2次就诊)，妇产科诊所的索引访问（APR：1.26：95CI：1.03-1.55，vs家庭实践），拥有指定的初级保健提供者（APR：1.35：95CI：1.02-1.79），乳腺癌筛查依从性（APR：1.66：95CI：1.27-2.17），和结直肠癌筛查依从性（APR：1.59：95CI：1.24-2.03）。低BMI与较低的依从性相关（APR：0.50：95CI：0.26-0.96，<18.5kg/m2vs18.5-24.9kg/m2）。在608名(37%)逾期女性中，9％的人在随后的12个月中进行了筛查。拥有商业健康保险与Medicare/Medicaid的比例更高（调整后的风险比：2.44：95CI：1.15-5.18）。
结论：EAI中的CCS依从性低于全国平均水平的80%。专注于增加医疗保健访问/利用率或利用医疗保健遇到来解决障碍的干预措施可能会增加EAI中的CCS。
