中国农村子宫颈癌筛查实施5年对人群筛查率的影响  

The impact of five-year Chinese rural area cervical cancer screening program on screening rate

作　　者：包鹤龄 赵振平 张梅 王丽敏 丛舒 方利文 王临虹 

机构地区：[1]中闰疾病预防控制中心慢性非传染性疾病预防控制中心,北京100050

出　　处：《中华预防医学杂志》2018年第3期260-264,共5页Chinese Journal of Preventive Medicine

摘　　要：目的评价中国农村地区子宫颈癌筛查项目实施5年对城乡子宫颈癌筛查率（以下简称“筛查率”）的影响。方法对象来源于2013—2014年中国慢性病与危险因素监测，采用多阶段分层整群抽样，在中同内地31个省份调查了297个监测点的169632名18岁及以上研究对象，本研究将其中的65476名35～64岁女性纳入分析。依据2014年中国农村地区子宫颈癌筛查项目名单将监测点分为筛查地区与对照地区。比较不同地区社会经济水平差异；采用泰勒级数方差法估计筛查率的95％CI值；采用多因素logistic回归模型估计个体倾向评分值；采用贪婪匹配算法，根据个体的倾向评分值分别对筛查地区与对照地区调查对象进行1：1配对；采用多因素条件logistic同归模型分析子宫颈癌筛查对人群筛检率的影响。结果65476名研究对象中，筛查地区占48．6％（31794名）。匹配前，筛查地区的农村筛查率为24．0％（4763／19838，95％CI：21．8％～26．3％），高于对照地区[15．6％（2331／14942，95％CI：13．4％～17．8％）]；筛查地区的城市筛查率为28．5％（3413／11956，95％CI：26．1％-31．0％），与对照地区相近[26．3％（4923／18740，95％CI：24．1％-28．4％）]。匹配后，筛查地区的农村筛查率为23．2％f3454／14875，95％CI：20．9％～25．5％），高于对照地区[15．6％（2315／14875，95％CI：13．3％～17．8％）]；筛检地区的城市筛查率为28．7％（3202／11 146，95％CI：26．2％～31．2％），高于对照地区[23．1％（2571／11146，95％CI：20．9％～25．3％）]。多因素条件logistic回归模型分析显示，与对照地区相比，筛查地区城市（OR=1．44，95％CI：1．34～1．54）和农村（OR=1．78，95％C1：1．67—1．90）35～64岁人群子宫颈癌筛查率提高均有统计学意义。结论中国子宫颈癌筛查项目实施5年对农村和城市地区人群�Objective To assess the impact of Chinese Cervical Cancer Screening Program for Rural Area （NACCSPRA） on population-based screening rates. Methods The subjects were selected from 2013-2014 Chinese Chronic Diseases and Risk Factors Surveillance （CDRFS2013）, which adopting multi-stage stratified cluster sampling from 31 provinces. A total of 169 632 participants aged 18 years and older in 297 surveillance points were interviewed, of whom 65 476 women aged 35-64 years were included in the analysis. The surveillance points in CDRFS 2013 were divided into the screening areas and the control areas by matching points in CDRFS2014 with counties in NACCSPRA. The difference in socioeconomic status between areas was compared. The screening rates and 95% confidence interval （95%C/） were estimated by Tylar series variance method. The Propensity Score was evaluated for individuals by muhivariate logistic regression and the greedy matching method based on propensity score value was used to conduct 1 ： 1 matching sample for the screening areas and the control areas. After matching, multivariate conditional logistic regression model was fitted to assess the impact of national cervical cancer screening intervention on the likelihood of undergoing cervical cancer screening at population level. Results Among 65 476 subjects, 48.6% （n=31 794） was in the screening areas. Before matching, in the rural area the screening rate in the screening areas （24.0% （4 763/19 838）, 95%CI： 21.8%-26.3%） was higher than that in the control areas （15.6% （2 331/14 942）, 95%CI： 13.4%-17.8%）; whereas in the urban area the screening rate in the sereening areas （28.5% （3 413/11 956）, 95%CI： 26.1%-31.0%） was similar to that in the control areas （26.3% （4 923/18 740）, 95%CI： 24.1%-28.4%）. After matching, in rural area the screening rate in the screening areas （23.2% （3 454/14 875）, 95%CI： 20.9%-25.5%） was higher than that in the control areas （15.6% （2 315/14 875）, 95%CI： 13.3%-17.8%

关 键 词：子宫肿瘤 多相筛查 倾向评分 结果评价(卫生保健) 

分 类 号：R737.33[医药卫生—肿瘤]