PO.PR01.01 · 预防研究
揭示加利福尼亚州亚裔美国人亚群之间的宫颈癌筛查差异
Uncovering cervical cancer screening disparities among Asian American subgroups in California
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
背景：宫颈癌在早期发现时是一种高度可预防和可治疗的恶性肿瘤。尽管有Pap检测可用，但筛查接受率存在明显的种族/族裔差异，亚裔美国女性的筛查率显著低于非西班牙裔白人（NHW）女性。为提高亚裔美国女性的宫颈癌筛查率，了解哪些亚裔亚群更倾向于筛查不足非常重要。然而，关于这一主题的研究仍然有限。我们的研究旨在检验近期Pap检测率以及不同细分亚裔亚群中与筛查接受相关的因素。
方法：使用来自2016、2018和2020年加利福尼亚州行为风险因素监测系统的横断面数据，我们根据美国预防服务工作组的最新建议（即在过去三年内接受过检测），计算了21—65岁女性中报告Pap检测为最新状态的加权患病率，涵盖六大亚裔美国亚群（印度裔、华裔、菲律宾裔、日裔、韩裔、越南裔）以及作为对照组的NHW女性。拟合多变量logistic回归，以报告Pap检测为最新状态作为结局，对种族/族裔进行回归，并校正社会人口学（年龄、教育、收入、婚姻状况、贫困状况、大都市统计区）和医疗可及性因素（是否有初级保健提供者、健康保险类型）。此外，针对在校正模型中具有统计学显著性的因素，计算了每个亚裔亚群Pap检测接受的加权患病率。
结果：我们的分析纳入了517名亚裔美国女性和3,061名NHW女性。报告Pap检测为最新状态的NHW女性比例为83%，而所有亚裔美国亚群的这一比例更低（越南裔32%，印度裔54%，日裔59%，韩裔66%，华裔67%，菲律宾裔75%）。校正协变量后，各亚裔亚群报告Pap检测为最新状态的几率低46—91%，差异最显著的是越南裔（OR=0.09，95% CI 0.02-0.33）和印度裔女性（OR=0.20，95% CI 0.08-0.45）。有趣的是，虽然所有拥有初级保健提供者的亚裔亚群Pap检测接受患病率均超过70%，但越南裔女性的这一比例仅为30%。
结论：尽管所有亚裔美国亚群报告的Pap检测指南依从性均低于NHW女性，但越南裔和印度裔女性的差异尤为显著。我们的结果还提示应进一步探讨初级保健提供者在宫颈癌筛查中的作用，尤其是在越南裔女性中。此外，我们分析中注意到的族裔特异性差异凸显了细分数据的重要性，以便适当地量身定制干预措施。
查看英文原文 English abstract
Background: Cervical cancer is a highly preventable and treatable malignancy when detected early. Despite the availability of Pap test, clear racial/ethnic disparities in screening uptake exist, with Asian American women having significantly lower rates than Non-Hispanic White (NHW) women. To improve cervical cancer screening rates among Asian American women, it is important to understand which Asian subgroups are more inclined to be underscreened. However, research on this topic remains limited. Our study aims to examine recent Pap test rates and factors associated with screening uptake across disaggregated Asian subgroups.
Methods: Using cross-sectional data from the 2016, 2018, and 2020 California Behavioral Risk Factor Surveillance System, we calculated the weighted prevalence of women ages 21-65 who reported being up-to-date with Pap test based on the most recent U.S. Preventive Services Tasks Force's recommendations (i.e., having been tested in the past three years) for the six largest Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) and NHW women as a comparison group. Multivariable logistic regression was fitted with reporting being up-to-date with Pap test as the outcome, regressing on race/ethnicity and adjusting for sociodemographic (age, education, income, marital status, poverty status, metropolitan statistical area) and access to care factors (having a primary care provider, health insurance type). In addition, the weighted prevalence of Pap test uptake for each Asian subgroup was calculated for factors found to be statistically significant in the adjusted model.
Results: Our analysis included 517 Asian American and 3,061 NHW women. While the percentage of NHW women who reported being up-to-date with Pap test was 83%, this percentage was lower for all Asian American subgroups (32% for Vietnamese, 54% for Asian Indian, 59% for Japanese, 66% for Korean, 67% for Chinese, 75% for Filipino). After adjusting for covariates, the Asian subgroups had 46-91% lower odds of reporting being up-to-date with Pap test, with the most notable disparities being among Vietnamese (OR=0.09, 95% CI 0.02-0.33) and Asian Indian women (OR=0.20, 95% CI 0.08-0.45). Interestingly, while all Asian subgroups with a primary care provider showed a prevalence of Pap test uptake of over 70%, this percentage was only 30% for Vietnamese women.
Conclusions: Although all Asian American subgroups reported lower Pap test adherence to screening guidelines than NHW women, the disparities were particularly striking for Vietnamese and Asian Indian women. Our results also suggest further exploring the role of primary care providers in the context of cervical cancer screening, particularly among Vietnamese women. Furthermore, the ethnic-specific disparities noted in our analysis highlight the importance of disaggregated data so interventions can be appropriately tailored.
利益披露 Disclosure
A. W. Lee, None..
E. Pollard, None.