中国2013年35～69岁女性人群子宫颈癌和乳腺癌筛查率及影响因素研究

摘要

目的 分析中国35～ 69岁女性人群子宫颈癌与乳腺癌筛查率并探讨其主要影响因素.方法 利用2013年全国慢性病与危险因素监测数据,分别纳入女性35～64岁66 130人和35～69岁72 511人分析子宫颈癌和乳腺癌筛查率.基于复杂抽样和加权方法估计筛查率及95％CI;采用Rao-Scottx2检验不同人群筛查率差异;构建混合效应logistic回归模型分析筛查与主要影响因素关联性.结果 分析的样本中分别有26.7％(95％CI:24.6％～28.9％)接受过子宫颈癌筛查和22.5％ (95％CI:20.4％～ 24.6％)接受过乳腺癌筛查,城市高于农村,东部地区高于中、西部(P＜0.000 1).≥50岁女性筛查率低于35～ 49岁.低教育水平、未就业、低家庭收入和无医保女性接受筛查的可能性显著低于高社会经济水平女性(P＜0.000 1);居住在农村、西部地区与子宫颈癌筛查相关性无统计学意义,而与乳腺癌筛查可能性较低相关(P＜0.05).结论 应提高人群子宫颈癌和乳腺癌筛查覆盖率,重点提高≥50岁及低社会经济地位人群的筛查率.%Objective To estimate the cervical and breast cancer screening coverage and related factors among women aged 35-69 years who were in the National Cervical and Breast Screening Program,to provide evidence for improving cervical and breast cancer control and prevention strategy.Methods Data used in this study were abstracted from the 2013 Chinese Chronic Diseases and Risk Factors Surveillance Program.A total of 66 130 women aged 35-64 years and 72 511 women aged 35-69 years were included for this study.Weighted prevalence,(with 95％ confidence interval,CI) was calculated for complex sampling design.Rao-Scottx2 method was used to compare the screening coverage among subgroups.A random intercept equation which involved the logit-link function,was fitted under the following five levels:provincial,county,township,village and individual.Fix effects of all explanatory variables were converted into OR with 95％CI.Results In 2013,26.7％ (95％CI:24.6％-28.9％) of the 35-64 year-old women reported that they ever had been screened for cervical cancer and 22.5％ (95％ CI:20.4％-24.6％) of the 35-69 year-olds had ever undergone breast cancer screening.Lower coverage was observed among women residing in rural and central or western China than those in urban or eastern China (P＜0.000 1).The coverage among women aged 50 years or older was substantially lower than those aged 35-49 years.Those who were with low education level,unemployed,low household income and not covered by insurance,appeared fewer number on this cervical or breast cancer screening program (P＜0.000 1).Women living in rural and western China were having less chance of receiving the breast cancer screening (P＜0.05),but the difference was not statistically significant.Conclusion It is essential to strengthen the communitybased cervical and breast cancer screening programs,in order to increase the coverage.More attention should be paid to women aged 50 years or older,especially those socioeconomically disadvantaged ones.