背景:有组织的乳腺癌和宫颈癌筛查计划只能为中国和其他资源匮乏国家的一小部分社会经济贫困妇女免费提供服务,然而,几乎没有证据表明这一方案是否有效影响人口一级的参与和不平等。
方法:我们使用了2014-2015年全国横断面调查的个人水平数据,用于参与乳腺癌和宫颈癌筛查。干预和比较分组的数据为2009年至2014年国家乳腺癌和宫颈癌筛查计划,该计划涵盖的县被分为干预组。我们用两种方法评估了干预对参与率和不平等程度的影响:多变量多水平逻辑回归,调整个体和地区水平的协变量;差异分析结合倾向评分匹配,估计平均干预效果。
结果:69,875名包括35-64岁的女性,21,620人分为干预组,43,669人分为比较组进行乳腺癌筛查;31,794人分为干预组,33,682人进入对照组进行宫颈癌筛查。干预组乳腺癌筛查参与率高于对照组(25.3,95%保密区间[CI],22.8%-27.7%,vs19.1,17.4-20.7%),和宫颈癌筛查(25.7%,23.8%-27.7%,vs21.5,19.6-23.5%),分别。干预显着增加了整体女性参与乳腺癌和宫颈癌筛查的可能性,农村妇女和城市妇女,而农村妇女的影响明显高于城市妇女。乳腺癌筛查对参与率的平均干预效果为增加7.5%(6.7-8.2%),宫颈癌筛查占6.8%(6.1-7.5%),分别。农村和城市之间的不平等显著减少了37-41%(P<0.001),然而,在年龄方面略有减少甚至增加,教育状况,和家庭收入。
结论:针对一小部分女性的有组织的乳腺癌和宫颈癌筛查计划可以提高人口水平的参与率。然而,它不会显著影响社会经济引入的不平等。需要进一步的研究进行时间序列分析并加强因果相关性。
BACKGROUND: Organized breast and cervical cancer screening programme could only provide services at no cost for a fraction of socioeconomic-deprived women in
China and other low-resource countries, however, little evidence exists for whether such a programme effectively affect the participation and inequalities at the population level.
METHODS: We used individual-level data from a nationally cross-sectional survey in 2014-2015 for breast and cervical cancer screening participation. Data for intervention and comparison grouping were from 2009 to 2014 national breast and cervical cancer screening programme, and counties covered by the programme were divided into intervention group. We assessed the impact of the intervention on the participation rates and the magnitude of inequalities with two approaches: multivariable multilevel logistic regressions adjusting for individual- and region-level covariates; and a difference analysis combined with propensity score matching that estimated the average intervention effect.
RESULTS: Of 69,875 included women aged 35-64 years, 21,620 were classified into the intervention group and 43,669 into the comparison group for breast cancer screening; and 31,794 into the intervention group, and 33,682 into the comparison group for cervical cancer screening. Participation rate was higher in intervention group than comparison group for breast cancer screening (25.3, 95% confidential interval [CI], 22.8-27.7%, vs 19.1, 17.4-20.7%), and cervical cancer screening (25.7, 23.8-27.7%, vs 21.5, 19.6-23.5%), respectively. Intervention significantly increased the likelihood of participation for both breast cancer and cervical cancer screening in overall women, rural women and urban women, whereas the effect was significantly higher in rural women than urban women. The average intervention effect on the participation rate was an increase of 7.5% (6.7-8.2%) for breast cancer screening, and 6.8% (6.1-7.5%) for cervical cancer screening, respectively. The inequalities were significantly decreased by 37-41% (P < 0.001) between rural and urban, however, were slightly decreased or even increased in terms of age, education status, and household income.
CONCLUSIONS: Organized breast and cervical cancer screening programme targeting for a fraction of women could increase the participation rates at population level, however, it could not significantly affect socioeconomic-introduced inequalities. Further studies are need to conduct time-series analyses and strengthen the causal correlation.