Social determinants of breast cancer screening: a multilevel analysis of proximal and distal factors related to the practice of mammography.

IF 3.7 3区医学 Q2 ONCOLOGY Cancer Epidemiology Biomarkers & Prevention Pub Date : 2024-10-03 DOI:10.1158/1055-9965.EPI-24-1001

Daiana Denis Sarmiento, Natalia Tumas, Sofia Aynelen Pereyra, Graciela Fabiana Scruzzi, Sonia Alejandra Pou

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Abstract

Background: Mammography is crucial for early breast cancer detection. In Latin America, Argentina faces a significant breast cancer burden, with varying mammography rates. The social factors influencing mammography practices remain unclear. This study aimed to identify the proximal and distal social determinants of this practice among Argentinean women using a multilevel approach.

Methods: This nationwide cross-sectional study included 4,924 women aged 50-70 participating in the 2018 National Risk Factor Survey of Argentina. Two-level logistic models were used to estimate measures of association (ORs) between timely mammography practice (within the last 2 years) and selected covariates (sociodemographics, proximal environment, and distal-level variables). The intraclass correlation coefficient (ICC) and proportional change in variance (PCV) were calculated.

Results: 62.8% of women underwent timely mammography. Age (OR=0.96; 95%CI 0.94-0.97), health insurance (OR=2.22; 95%CI 1.87-2.63), education (OR=2.1; 95%CI 1.74-2.64), and income (OR=1.56; 95%CI 1.23-1.97) were associated with mammography practice. Women in non-marital (OR=0.61; 95%CI 0.52-0.72) or larger households (OR=0.61; 95%CI 0.51-0.63) were less likely to have timely mammograph; living in a larger city was positively associated (OR=1.28; 95%CI 1.12-1.46). Women in provinces with higher physician density (OR=1.06; 95%CI 1.01-1.11) and lower maternal mortality ratio (OR=0.9; 95%CI 0.87-0.96) had higher chances of timely mammography. The ICC and PCV suggested that the explored healthcare indicators largely explained the macro-contextual effect.

Conclusions: Multilevel factors influenced mammography practices in Argentina. The results highlight disparities linked to sociodemographic characteristics and healthcare resources.

Impact: Efforts to address social inequalities in breast cancer screening must consider multilevel determinants, including in healthcare settings.

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乳腺癌筛查的社会决定因素：与乳房 X 射线照相术相关的近端和远端因素的多层次分析。

背景介绍乳房 X 射线照相术对早期乳腺癌检测至关重要。在拉丁美洲，阿根廷面临着严重的乳腺癌负担，但乳房 X 射线照相术的普及率却参差不齐。影响乳房 X 射线照相做法的社会因素仍不清楚。本研究采用多层次方法，旨在确定阿根廷妇女进行乳房 X 射线照相术的近端和远端社会决定因素：这项全国性横断面研究纳入了参加2018年阿根廷全国风险因素调查的4924名50-70岁女性。研究采用两级逻辑模型来估算及时进行乳腺放射摄影（过去两年内）与选定协变量（社会人口学、近端环境和远端变量）之间的关联度（ORs）。计算了类内相关系数（ICC）和方差比例变化（PCV）：结果：62.8%的妇女及时进行了乳腺 X 射线检查。年龄（OR=0.96；95%CI 0.94-0.97）、医疗保险（OR=2.22；95%CI 1.87-2.63）、教育程度（OR=2.1；95%CI 1.74-2.64）和收入（OR=1.56；95%CI 1.23-1.97）与乳腺 X 射线照相实践相关。非婚家庭（OR=0.61；95%CI 0.52-0.72）或人口较多的家庭（OR=0.61；95%CI 0.51-0.63）的妇女不太可能及时进行乳腺X光检查；居住在较大城市的妇女则与此呈正相关（OR=1.28；95%CI 1.12-1.46）。在医生密度较高（OR=1.06；95%CI 1.01-1.11）和孕产妇死亡率较低（OR=0.9；95%CI 0.87-0.96）的省份，妇女及时接受乳腺放射摄影的几率较高。ICC和PCV表明，所探讨的医疗指标在很大程度上解释了宏观背景的影响：结论：多层次因素影响了阿根廷的乳腺放射摄影实践。结果凸显了与社会人口特征和医疗资源相关的差异：影响：要解决乳腺癌筛查中的社会不平等问题，就必须考虑多层次的决定因素，包括在医疗保健环境中。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cancer Epidemiology Biomarkers & Prevention 医学-公共卫生、环境卫生与职业卫生

CiteScore

6.50

自引率

2.60%

发文量

538

审稿时长

1.6 months

期刊介绍： Cancer Epidemiology, Biomarkers & Prevention publishes original peer-reviewed, population-based research on cancer etiology, prevention, surveillance, and survivorship. The following topics are of special interest: descriptive, analytical, and molecular epidemiology; biomarkers including assay development, validation, and application; chemoprevention and other types of prevention research in the context of descriptive and observational studies; the role of behavioral factors in cancer etiology and prevention; survivorship studies; risk factors; implementation science and cancer care delivery; and the science of cancer health disparities. Besides welcoming manuscripts that address individual subjects in any of the relevant disciplines, CEBP editors encourage the submission of manuscripts with a transdisciplinary approach.