PO.PR01.01 · 预防研究
社区卫生中心中拉丁裔女性乳腺X线摄影接受的邻里和语言影响
Neighborhood and language influences on mammography receipt among latinas in community health centers
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
背景：乳腺癌是美国拉丁裔女性死亡和患病的重要来源。文献表明，乳腺癌生存和诊断分期可能与邻里因素相关，但对于这些因素如何具体影响乳腺X线摄影接受则了解较少。因此，我们按语言偏好，对拉丁裔患者的乳腺X线摄影接受进行了分析，并与非西班牙裔白人女性相比，考察多种社区层面因素（交通可及性、经济水平、教育水平）。
方法：我们使用了来自21个州594家社区卫生中心就诊的59,646名50至74岁拉丁裔和非西班牙裔白人患者的电子健康记录数据，以及地理编码的普查区层面邻里数据，按邻里特征评估乳腺X线摄影完成的患病率，包括高中毕业率、社区贫困（占联邦贫困线的百分比）、拥有车辆的家庭百分比以及公共交通通勤60分钟以上的家庭百分比。我们按语言偏好对拉丁裔患者进行分层，并校正常见的个体人口学和临床特征。
结果：在样本中，3,987名患者为非西班牙裔白人，11,338名为偏好英语的拉丁裔，44,381名为偏好西班牙语的拉丁裔。拉丁裔中居住在高贫困普查区的比例更高。非西班牙裔白人女性中吸烟者的比例更高。偏好西班牙语的拉丁裔（67.2%）乳腺X线摄影接受的未校正患病率高于偏好英语的拉丁裔（57.7%）和非西班牙裔白人女性（54.6%）。在校正协变量的分析中，无论社区特征如何，偏好西班牙语的拉丁裔乳腺X线摄影处于最新状态以及在开具后完成乳腺X线摄影的患病率最高。在各社区特征之间，同一族裔语言分组内的结局患病率没有差异。
结论：在一项对全国社区卫生中心网络中按邻里层面因素分析拉丁裔和非西班牙裔白人女性乳腺X线摄影完成情况的研究中，乳腺X线摄影患病率较低。偏好西班牙语的拉丁裔乳腺X线摄影接受患病率最高。任何组别在邻里层面因素之间均无结局差异。社区卫生中心对拉丁裔乳腺癌的早期发现至关重要，但诊所应了解社区层面因素在针对性改善乳腺X线摄影完成方面的局限性，并意识到可能减少拉丁裔乳腺X线摄影的个体障碍。
查看英文原文 English abstract
Background: Breast cancer is a significant source of mortality and morbidity for Latinas in the United States. Literature has shown that breast cancer survival and diagnosis stage may be associated with neighborhood factors, but less is known about how these factors affect mammogram receipt specifically. Therefore, we performed an analysis of mammography receipt in Latina patients, by language preference, compared to non-Hispanic White women, by multiple community level factors (transportation access, economic level, education level).
Methods: We used electronic health record data from 59,646 Latina and non-Hispanic White patients between the ages of 50 and 74 receiving care at 594 community health centers across 21 states, along with geocoded census-tract-level neighborhood data to evaluate the prevalence of mammogram completion by neighborhood characteristics, including high school graduation rates, community poverty as percent of the federal poverty level, percent of households with a vehicle and with a 60+minute public transit commute. We stratified Latina patients by language preference and adjusted for common individual demographic and clinical characteristics.
Results: In the sample, 3,987 patients were non-Hispanic White, 11,338 were English-preferring Latinas, and 44,381 were Spanish-preferring Latinas. A higher proportion of Latinas lived in high poverty census tracts. A higher prevalence of non-Hispanic White women were smokers. Spanish-preferring Latinas (67.2%) had a higher unadjusted prevalence of mammogram receipt than English-preferring Latinas (57.7%) and non-Hispanic white women (54.6%). In covariate-adjusted analyses, Spanish preferring Latinas had the highest prevalence of being up-to-date with their mammograms, and of having completed mammograms if ordered, regardless of community characteristics. Across community characteristics, there was no difference in outcome prevalence within ethnicity language groupings.
Conclusion: In an analysis of mammogram completion in Latina and non-Hispanic white women by neighborhood-level factors in a national network of community health centers, mammogram
prevalence was low. Spanish-preferring Latinas had the highest prevalence of mammogram receipt.There was no outcome difference in any group across neighborhood-level factors. Community health centers are vital in the early detection of breast cancer for Latinas, but clinics should understand the limitations of community level factors in targeting improved mammogram completion and be aware of individual barriers that may reduce mammography in Latinas.
利益披露 Disclosure
J. D. Heintzman,
OCHIN Inc - contact employee through University appointment Employment.
W. Bensken, None..
M. Marino, None.