학술논문
Determinants of mammography screening participation-a cross-sectional analysis of the German population-based Gutenberg Health Study (GHS).
Document Type
Academic Journal
Author
Pokora RM; Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.; Büttner M; Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.; Schulz A; Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.; Schuster AK; Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.; Merzenich H; Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.; Teifke A; Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.; Michal M; Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.; German Center for Cardiovascular Research (DZHK), partner site Rhine-Main, Mainz, Germany.; Lackner K; Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.; Münzel T; Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.; Zeissig SR; Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.; Regional Centre Würzburg, Bavarian Cancer Registry, Bavarian Health and Food Safety Authority, Würzburg, Germany.; Wild PS; Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.; German Center for Cardiovascular Research (DZHK), partner site Rhine-Main, Mainz, Germany.; Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.; Singer S; Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.; University Cancer Center Mainz, Mainz, Germany.; Wollschläger D; Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
Source
Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE
Subject
Language
English
Abstract
Purpose: We investigated the association between social inequality and participation in a mammography screening program (MSP). Since the German government offers mammography screening free of charge, any effect of social inequality on participation should be due to educational status and not due to the financial burden.
Methods: The 'Gutenberg Health Study' is a cohort study in the Rhine-Main-region, Germany. A health check-up was performed, and questions about medical history, health behavior, including secondary prevention such as use of mammography, and social status are included. Two indicators of social inequality (equivalence income and educational status), an interaction term of these two, and different covariables were used to explore an association in different logistic regression models.
Results: A total of 4,681 women meeting the inclusion criteria were included. Only 6.2% never participated in the MSP. A higher income was associated with higher chances of ever participating in a mammography screening (odds ratios (OR): 1.67 per €1000; 95%CI:1.26-2.25, model 3, adjusted for age, education and an interaction term of income and education). Compared to women with a low educational status, the odds ratios for ever participating in the MSP was lower for the intermediate educational status group (OR = 0.64, 95%CI:0.45-0.91) and for the high educational status group (0.53, 95%CI:0.37-0.76). Results persisted also after controlling for relevant confounders.
Conclusions: Despite the absence of financial barriers for participation in the MSP, socioeconomic inequalities still influence participation. It would be interesting to examine whether the educational effect is due to an informed decision.
Competing Interests: “Dr. Wild reports grants and personal fees from Boehringer Ingelheim, grants and personal fees from Novartis Pharma, grants from Philips Medical Systems, grants from Bayer AG, grants and personal fees from Sanofi-Aventis, grants and personal fees from Bayer Vital, grants and personal fees from Daiichy Sankyo, grants and personal fees from Bayer Health Care, personal fees from AstraZeneca, personal fees and non-financial support from DiaSorin, non-financial support from I.E.M., outside the submitted work; Dr. Schuster reports the professorship for ophthalmic healthcare research endowed by ‘Stiftung Auge’ and financed by ‘Deutsche Ophthalmologische Gesellschaft’ and ‘Berufsverband der Augenarzte Deutschlands e.V.’ Schuster AK received research funding from Allergan, Bayer Vital, Novartis, PlusOptix and Heidelberg Engineering; Dr. Singer reports personal fees from Pfizer, personal fees from Bristol-Myers Squibb, personal fees from Boehringer-Ingelheim, personal fees from Lilly, outside the submitted work; Dr. Wollschläger reports grants from German Federal Ministry of Education and Research, during the conduct of the study. All other authors declare no conflict of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials.”
Methods: The 'Gutenberg Health Study' is a cohort study in the Rhine-Main-region, Germany. A health check-up was performed, and questions about medical history, health behavior, including secondary prevention such as use of mammography, and social status are included. Two indicators of social inequality (equivalence income and educational status), an interaction term of these two, and different covariables were used to explore an association in different logistic regression models.
Results: A total of 4,681 women meeting the inclusion criteria were included. Only 6.2% never participated in the MSP. A higher income was associated with higher chances of ever participating in a mammography screening (odds ratios (OR): 1.67 per €1000; 95%CI:1.26-2.25, model 3, adjusted for age, education and an interaction term of income and education). Compared to women with a low educational status, the odds ratios for ever participating in the MSP was lower for the intermediate educational status group (OR = 0.64, 95%CI:0.45-0.91) and for the high educational status group (0.53, 95%CI:0.37-0.76). Results persisted also after controlling for relevant confounders.
Conclusions: Despite the absence of financial barriers for participation in the MSP, socioeconomic inequalities still influence participation. It would be interesting to examine whether the educational effect is due to an informed decision.
Competing Interests: “Dr. Wild reports grants and personal fees from Boehringer Ingelheim, grants and personal fees from Novartis Pharma, grants from Philips Medical Systems, grants from Bayer AG, grants and personal fees from Sanofi-Aventis, grants and personal fees from Bayer Vital, grants and personal fees from Daiichy Sankyo, grants and personal fees from Bayer Health Care, personal fees from AstraZeneca, personal fees and non-financial support from DiaSorin, non-financial support from I.E.M., outside the submitted work; Dr. Schuster reports the professorship for ophthalmic healthcare research endowed by ‘Stiftung Auge’ and financed by ‘Deutsche Ophthalmologische Gesellschaft’ and ‘Berufsverband der Augenarzte Deutschlands e.V.’ Schuster AK received research funding from Allergan, Bayer Vital, Novartis, PlusOptix and Heidelberg Engineering; Dr. Singer reports personal fees from Pfizer, personal fees from Bristol-Myers Squibb, personal fees from Boehringer-Ingelheim, personal fees from Lilly, outside the submitted work; Dr. Wollschläger reports grants from German Federal Ministry of Education and Research, during the conduct of the study. All other authors declare no conflict of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials.”