PO.SHP01.01 · 科学与健康政策
在一家城市联邦合格健康中心实施多组分实施策略后按住房状况、种族和族裔划分的癌症筛查率变化，2023-2025年
Changes in cancer screening rates by housing status, race, and ethnicity following a multi-component implementation strategy at an urban Federally Qualified Health Center, 2023-2025
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
背景：
评估在一家城市FQHC实施多组分筛查策略后，无家可归患者相较于总体患者人群（按种族和族裔分层）的癌症筛查率变化。
方法：通过一项将FQHC与NCI指定癌症中心联结的全国性HRSA倡议，我们实施了针对健康社会决定因素（SDOH）的同伴导航、社区外展、即时点短信以及一场多族裔公共卫生宣传活动（“为生命而筛查癌症”）。电子健康记录和管理数据支持了对乳腺癌（女性）、宫颈癌（女性）和结直肠癌（所有成人）最新筛查率的前后描述性分析。结局按住房状况、种族和族裔进行比较。
结果：筛查趋势因癌症类型和人群而异：
• 乳腺癌：在无家可归患者中，筛查率从31.2%（567/1,816）升至35.6%（690/1,938）（+4.4个百分点）。在总体人群中，接受筛查的人数上升（8,681→9,163），但在指南将起始年龄从50岁降至40岁后，筛查率从66.8%降至65.4%（−1.4个百分点）。
• 宫颈癌：无家可归患者中筛查率保持稳定（32.0%→31.3%；−0.7个百分点），总体人群中亦如此（59.3%→60.0%；+0.7个百分点）。
• 结直肠癌：在资格从50岁扩大至45岁后，无家可归患者（29.6%→23.2%；−6.5个百分点）和总体人群（52.4%→49.0%；−3.4个百分点）中的筛查率均下降。在各癌症类型中，西班牙裔/拉丁裔患者的宫颈癌和结直肠癌筛查参与率最高，而美洲印第安人/阿拉斯加原住民、夏威夷原住民/其他太平洋岛民以及未报告群体的筛查率则一贯较低。
结论与启示：多组分策略提高了无家可归患者的乳腺癌筛查率，并适度改善了总体人群的宫颈癌筛查。结直肠癌筛查率的下降很可能反映了资格范围的扩大，而非筛查活动的减少。持续存在的差异——尤其是在美洲印第安人/阿拉斯加原住民、夏威夷原住民/其他太平洋岛民以及未报告群体中——以及相互竞争的社会经济负担，凸显了针对SDOH的干预措施的必要性。加强筛查实施将需要持续的同伴导航、基于SDOH的支持、数字化外展以及文化上量身定制的宣传。在加州高成本的环境中，政策应纳入以家庭为中心的支持、财务和住房稳定资源，并按住房状况、种族和族裔进行常规分层，以促进公平并提高筛查参与率。
查看英文原文 English abstract
Background:
To evaluate changes in cancer screening rates among patients experiencing homelessness compared with the general patient population-stratified by race and ethnicity-following implementation of a multi‑component screening strategy at an urban FQHC.
Methods: Through a national HRSA initiative linking FQHCs with NCI‑designated cancer centers, we implemented peer navigation addressing social determinants of health (SDOH), community outreach, point‑of‑care text messaging, and a multi‑ethnic public health campaign (“Cancer Screening for Life”). Electronic health record and administrative data supported a pre-post descriptive analysis of up‑to‑date breast (female), cervical (female), and colorectal cancer (all adults) screening rates. Outcomes were compared by housing status, race, and ethnicity.
Results: Screening trends varied by cancer type and population:
• Breast cancer: Among patients experiencing homelessness, screening increased from 31.2% (567/1,816) to 35.6% (690/1,938) (+4.4 pp). In the general population, the number screened rose (8,681 → 9,163), but the rate declined from 66.8% to 65.4% (−1.4 pp) after guideline changes lowering the starting age from 50 to 40.
• Cervical cancer: Screening remained stable among patients experiencing homelessness (32.0% → 31.3%; −0.7 pp) and the general population (59.3% → 60.0%; +0.7 pp).
• Colorectal cancer: Screening declined among patients experiencing homelessness (29.6% → 23.2%; −6.5 pp) and the general population (52.4% → 49.0%; −3.4 pp) after eligibility expanded from age 50 to 45. Across cancer types, Hispanic/Latino patients had the highest cervical and colorectal uptake, while American Indian/Alaska Native, Native Hawaiian/Other Pacific Islander, and Unreported groups consistently had lower rates.
Conclusions and Implications: The multi‑component strategy increased breast cancer screening among patients experiencing homelessness and modestly improved cervical screening in the general population. Colorectal declines likely reflect expanded eligibility rather than reduced screening activity. Persistent disparities-especially among American Indian/Alaska Native, Native Hawaiian/Other Pacific Islander, and Unreported groups-and competing socioeconomic burdens highlight the need for interventions addressing SDOH. Strengthening screening implementation will require sustained peer navigation, SDOH‑informed support, digital outreach, and culturally tailored messaging. In California's high‑cost environment, policies should incorporate family‑centered supports, financial and housing stability resources, and routine stratification by housing status, race, and ethnicity to advance equity and improve screening uptake.
利益披露 Disclosure
K. Tran, None..
K. T. Ashing, None..
P. Gregerson, None..
N. Nonzee, None.