在美国,宫颈癌筛查率并不理想。需要对未接受筛查的原因进行基于人群的评估,特别是来自历史上服务不足的人口群体的妇女。
评估随着时间的推移,美国预防服务工作组指南一致宫颈癌筛查的变化,并通过社会人口统计学因素评估女性没有接受最新筛查的原因。
这项基于人群的横断面研究使用了2005年和2019年美国国家健康访谈调查的数据。共有20557名妇女(加权,包括1.131亿妇女),年龄在21至65岁之间,以前没有子宫切除术。分析于2021年3月30日至8月19日进行。
社会人口因素,包括年龄,种族和民族,性取向,居住的乡村,和健康保险类型。
主要结果是美国预防服务工作组指南一致的宫颈癌筛查率和自我报告的未接受最新筛查的主要原因。2005年,最新筛查定义为每3年筛查21至65岁的女性。2019年,最新筛查定义为每3年对21至29岁的女性进行一次Papanicolaou测试,每3年单独进行一次Papanicolaou测试或每5年对30至65岁的女性进行高危型人乳头瘤病毒测试或共同测试。人口估计包括抽样权重。
在20557名女性中(加权,1.131亿妇女)纳入研究,大多数人年龄在30至65岁之间(16219名女性;加权,8630万妇女[76.3%]),并有私人保险(13571名妇女;加权,7580万女性[67.0%])。关于种族和族裔,997名妇女(加权,690万女性[6.1%])是亚洲人,3821名妇女(加权,1950万女性[17.2%])是西班牙裔,2862名妇女(加权,1480万女性[13.1%])是非西班牙裔黑人,12423名妇女(加权,6900万女性[61.0%])是非西班牙裔白人,和453名妇女(加权,300万女性[2.7%])属于其他种族和/或种族(包括阿拉斯加原住民和美洲印第安人[加权,955000名妇女(0.8%)]和其他单一和多个种族或种族[加权,200万妇女(1.8%)])。2019年,21至29岁女性的逾期筛查率(29.1%)明显高于30至65岁女性(21.1%;P<.001)。在这两个年龄组中,从2005年到2019年,未进行最新筛查的女性比例显著增加(从14.4%增加到23.0%;P<.001).在亚洲和非西班牙裔白人种族和种族中发现了更高的逾期筛查率(31.4%vs20.1%;P=0.01),那些识别为LGBQ+(性别认同没有评估,因为一个小样本)与异性恋(32.0%vs22.2%;P<.001),生活在农村和城市地区的人(26.2%对22.6%;P=.04),没有保险的人与有私人保险的人(41.7%对18.1%;P<.001)。没有在所有群体中接受及时筛查的最常见原因是缺乏知识,从47.2%的女性确定为LGBQ+到64.4%的西班牙裔女性不等。以前接受人乳头瘤病毒疫苗不是没有最新筛查的主要原因(<1%的应答)。从2005年到2019年,在30至65岁的女性中,作为未接受筛查的主要原因,缺乏机会显着减少(从21.8%降至9.7%),而缺乏知识(从45.2%到54.8%)和未收到卫生保健专业人员的建议(从5.9%到12.0%)的显着增加。
这项横断面研究发现,与美国预防服务工作组指南一致的宫颈癌筛查在2005年至2019年间在美国有所下降,据报道,缺乏知识是接受及时筛查的最大障碍。针对患者知识和提供者沟通的活动可能有助于提高筛查率,和文化适应的干预措施是必要的,以减少现有的差距。
Cervical cancer screening rates are suboptimal in the US. Population-based assessment of reasons for not receiving screening is needed, particularly among women from historically underserved demographic groups.
To estimate changes in US Preventive Service Task Force
guideline-concordant cervical cancer screening over time and assess the reasons women do not receive up-to-date screening by sociodemographic factors.
This pooled population-based cross-sectional study used data from the US National Health Interview Survey from 2005 and 2019. A total of 20 557 women (weighted, 113.1 million women) aged 21 to 65 years without previous hysterectomy were included. Analyses were conducted from March 30 to August 19, 2021.
Sociodemographic factors, including age, race and ethnicity, sexual orientation, rurality of residence, and health insurance type.
Primary outcomes were US Preventive Services Task Force
guideline-concordant cervical cancer screening rates and self-reported primary reasons for not receiving up-to-date screening. For 2005, up-to-date screening was defined as screening every 3 years for women aged 21 to 65 years. For 2019, up-to-date screening was defined as screening every 3 years with a Papanicolaou test alone for women aged 21 to 29 years and screening every 3 years with a Papanicolaou test alone or every 5 years with high-risk human papillomavirus testing or cotesting for women aged 30 to 65 years. Population estimation included sampling weights.
Among 20 557 women (weighted, 113.1 million women) included in the study, most were aged 30 to 65 years (16 219 women; weighted, 86.3 million women [76.3%]) and had private insurance (13 571 women; weighted, 75.8 million women [67.0%]). With regard to race and ethnicity, 997 women (weighted, 6.9 million women [6.1%]) were Asian, 3821 women (weighted, 19.5 million women [17.2%]) were Hispanic, 2862 women (weighted, 14.8 million women [13.1%]) were non-Hispanic Black, 12 423 women (weighted, 69.0 million women [61.0%]) were non-Hispanic White, and 453 women (weighted, 3.0 million women [2.7%]) were of other races and/or ethnicities (including Alaska Native and American Indian [weighted, 955 000 women (0.8%)] and other single and multiple races or ethnicities [weighted, 2.0 million women (1.8%)]). In 2019, women aged 21 to 29 years had a significantly higher rate of overdue screening (29.1%) vs women aged 30 to 65 years (21.1%; P < .001). In both age groups, the proportion of women without up-to-date screening increased significantly from 2005 to 2019 (from 14.4% to 23.0%; P < .001). Significantly higher rates of overdue screening were found among those of Asian vs non-Hispanic White race and ethnicity (31.4% vs 20.1%; P = .01), those identifying as LGBQ+ (gender identity was not assessed because of a small sample) vs heterosexual (32.0% vs 22.2%; P < .001), those living in rural vs urban areas (26.2% vs 22.6%; P = .04), and those without insurance vs those with private insurance (41.7% vs 18.1%; P < .001). The most common reason for not receiving timely screening across all groups was lack of knowledge, ranging from 47.2% of women identifying as LGBQ+ to 64.4% of women with Hispanic ethnicity. Previous receipt of a human papillomavirus vaccine was not a primary reason for not having up-to-date screening (<1% of responses). From 2005 to 2019, among women aged 30 to 65 years, lack of access decreased significantly as a primary reason for not receiving screening (from 21.8% to 9.7%), whereas lack of knowledge (from 45.2% to 54.8%) and not receiving recommendations from health care professionals (from 5.9% to 12.0%) increased significantly.
This cross-sectional study found that cervical cancer screening that was concordant with US Preventive Services Task Force
guidelines decreased in the US between 2005 and 2019, with lack of knowledge reported as the biggest barrier to receiving timely screening. Campaigns addressing patient knowledge and provider communication may help to improve screening rates, and cultural adaptation of interventions is needed to reduce existing disparities.