乳癌及大腸癌篩檢不平等評估－反轉公平假說之檢視

Assessing inequalities in breast and colorectal cancer screening-testing the inverse equity hypothesis

李佳綺(Chiach i Bonnie Lee) ； 李妙純(Miaw-Chwen Lee)

《台灣公共衛生雜誌》 37卷1期 (2018/02) Pp. 50-62

https://doi.org/10.6288/TJPH.201802_37(1).106059

摘要

目標：本研究探討乳癌及大腸癌篩檢利用之收入不平等，以及不平等與篩檢率之關係。方法：本研究資料取自2001、2005、2009、2013年國民健康訪問調查，估計45或50歲至69歲乳癌及大腸癌篩檢之與均等家戶收入關連之Erreygers集中指數（ECI）、相對不平等指數（RII）及影響不平等因素解析。結果：乳房攝影及糞便潛血篩檢率自2001年之9.2%及10.1%分別上升至2013年之46.1%及41.3%；並呈現收入愈高篩檢率愈高的現象。2001年最高收入群體之乳房攝影使用率比最低收入群體多達近一倍（RII=0.984），但到2013年下降為多5.7%（RII=0.057）。最高收入群體之糞便潛血檢查率比最低收入群體多40-60%（RII=0.377~0.634）。除了2013年乳房攝影外，兩項篩檢之使用亦都集中於高收入群體（乳房攝影ECI=0.060~0.150；糞便潛血檢查ECI=0.036~0.104）。免費政策實施前（2001、2005及2009年）收入都是影響篩檢不平等的重要因素，但免費政策實施後（2013年）教育程度為最重要因素。結論：與「反轉公平假說」一致，當篩檢率上升時，不同收入群體篩檢率差異愈小。提升篩檢率可縮減篩檢之社會不平等，有助於緩和健康不平等。

關鍵字

癌症篩檢 ； Erreygers校正集中指數 ； 相對不平等指數 ； 反轉公平假說

並列摘要

Objectives: This study analyzed income-related inequalities in breast and colorectal cancer screening in Taiwan and the relationship between inequality and screening rate. Methods: We used data from the 2001, 2005, 2009, and 2013 National Health Interview Surveys. The Erreygers concentration indices (ECI) and relative inequality indices (RII) were calculated and ECIs were decomposed. Results: In 2001, 9.2% of participants reported undergoing mammography and 10.1% reported having a fecal occult blood test (FOBT) within the previous year. Those screening rates within the previous two years increased by 46.1% and 41.3% respectively in 2013 and showed income gradients. In 2001, mammography use by the highest-income group was nearly double that of the lowest-income group (RII=0.984), while that difference in 2013 fell by 5.7% (RII=0.057). Compared with the lowest-income group, the highest income group received 40- 60% more screening for FOBT (RII=0.377 to 0.634). Except for mammography in 2013, both mammography and FOBT were concentrated in the higher income group (ECI=0.06-0.15 for mammography; ECI=0.036-0.104 for FOBT). Before the national cancer screening programs in 2001, 2005 and 2009, income was the most important contributor to inequalities in the screening rate, while education accounted for the greatest contribution in 2013. Conclusions: Consistent with the ＂inverse equity hypothesis,＂ income-related inequalities in cancer screening decreased with higher screening rates. Therefore, an increased screening rate facilitates the reduction in inequality in cancer screening and addresses health inequalities.

並列關鍵字

cancer screening ； Erreygers corrected concentration index ； relative inequality index ； inverse equity hypothesis

參考文獻

衛生福利部國民健康署：中華民國103年度(103年1月1日至103年12月31日)菸害防制及衛生保健基金附屬單位決算分決算(非營業部分)(審定本)。2014。https://www.hpa.gov.tw/File/Attach/7112/File_7184.pdf。引用2017/06/07。Health Promotion Administration, Ministry of Health and Welfare, R.O.C. (Taiwan). 2014 final account of the Taiwan Tobacco Control & Health Care Funds subsidiary agencies (non-business part) (the trial version). Available at: https://www.hpa.gov.tw/File/Attach/7112/File_7184.pdf. Accessed June 7, 2017. [In Chinese].

台北市衛生局：「台北市健康促進績優團體成果發表」，另類健康「互聯網+」 攜手拚健康。http://tcgwww.taipei.gov.tw/ct.asp?xItem=243768039&ctNode=80553&mp=10904M。引用2017/05/30。Department of Health, Taipei City Government. Achievements of the Taipei City Health Promotion Merit Group: alternative health “Internet+”, working together to promote health. Available at: http://tcgwww.taipei.gov.tw/ct.asp?xItem=243768039&ctNode=80553&mp=10904M. Accessed May 30, 2017. [In Chinese]

Health Promotion Board, Singapore (HPB). Healthy workplace ecosystem. Available at: https://www.hpb.gov.sg/workplace/healthy-workplace-ecosystem.2017/04/21. Accessed April 21, 2017.

Aurélio Peres, M,Simara Fernandes, L,Glazer Peres, K(2004).Inequality of water fluoridation in Southern Brazil -the inverse equity hypothesis revisited.Soc Sci Med.58,1181-9.

Bíró, A(2013).Discount rates and the education gradient in mammography in the UK.Health Econ.22,1021-36.