Comparison of Two Adult Health Check-up Regimes: An experience from an Urban-Rural-Aboriginal Mixed Type Area, Nantou County, Taiwan
HUANG, CHIH-CHUNG (2006)
2006
Kansanterveystiede - Public Health
Lääketieteellinen tiedekunta - Faculty of Medicine
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Hyväksymispäivämäärä
2006-01-30
Julkaisun pysyvä osoite on
https://urn.fi/urn:nbn:fi:uta-1-15335
https://urn.fi/urn:nbn:fi:uta-1-15335
Tiivistelmä
Background: Despite a number of studies addressing uptake of health check-up, very few studies were conducted to assess two screening regimes with one served on institution basis and the other on out-reaching basis from aspect of geographical and socio-demographic inequality in accessing to health check-up.
Aims: The current study aimed to assess whether two screening regimes complement each other in terms of coverage rate and explore whether geographical or socio-demographic inequality exists and how socio-demographic features affect uptake of two screening regimes.
Methods: Study population was based on 198,834 residents from an urban-rural-aboriginal mixed type area, Nantou County, located in central Taiwan. Data on uptake of two health check-up programs, one featured by reach-in service and one featured by out-reaching service, and socio-demographic variables were collected. Coverage rate for the combination of two screening regimes was calculated by two age cohorts and the overlapping rate between the two regimes was also calculated. The association between socio-demographic variables and uptake of each screening regime or both was assessed by logistic regression model with adjustment for health status and severity of health. The independence of two screening regimes given socio-demographic variables was also evaluated.
Results: For the young cohort, the overall coverage rate was 8.65% for AHPS only with 10.5% for female and 6.8% for male. The NCIS gives an incremental 6.1% of coverage rate to AHPS. Attendant involved in both program was only 1.4%. For the elderly cohort, the overall coverage rate was 21.9% for AHPS only with 22% for female and 21.8% for male. The NCIS adds an incremental 6.2% of coverage rate to AHPS. Attendant involved in both program was only 3.8%. The overlapping rate was small. Of total of 28,140 attenders in the AHPS, only approximately 2.04% (4,049) re-attend NCIS. After interaction assessment, gender difference in uptake of two screening regimes was modified by place of residence. After being stratified by place of residence and gender, all socio-demographic variables were statistically related to uptake of each or both of screening regimes after controlling for health status and the severity of health. For the elderly cohort, there was lacking of interaction terms between any of two variables and the main effects of all socio-demographic variables were statistically significant. For the part of independence of two screening regimes, all socio-demographic variables, medical utilization, and the severity of health made additional 14.13% contribution to uptake of outreaching service given uptake of reach-in service for the elderly cohort whereas the corresponding figure was 37.64% for the young cohort.
Conclusions: The present study compared two health check-up programs, reach-in service and out-reaching service, to assess geographic and socio-demographic inequality in uptake of two programs. Although out-reaching service did not substantially enhance the absolute coverage rate of reach-in service two programs complement each other in solving geographic and socio-demographic inequality in uptake of preventive services.
Key words:
health check-up, out-reaching screening, community-based integrated screening, geographical inequality, urban-rural-aboriginal mixed type area
Aims: The current study aimed to assess whether two screening regimes complement each other in terms of coverage rate and explore whether geographical or socio-demographic inequality exists and how socio-demographic features affect uptake of two screening regimes.
Methods: Study population was based on 198,834 residents from an urban-rural-aboriginal mixed type area, Nantou County, located in central Taiwan. Data on uptake of two health check-up programs, one featured by reach-in service and one featured by out-reaching service, and socio-demographic variables were collected. Coverage rate for the combination of two screening regimes was calculated by two age cohorts and the overlapping rate between the two regimes was also calculated. The association between socio-demographic variables and uptake of each screening regime or both was assessed by logistic regression model with adjustment for health status and severity of health. The independence of two screening regimes given socio-demographic variables was also evaluated.
Results: For the young cohort, the overall coverage rate was 8.65% for AHPS only with 10.5% for female and 6.8% for male. The NCIS gives an incremental 6.1% of coverage rate to AHPS. Attendant involved in both program was only 1.4%. For the elderly cohort, the overall coverage rate was 21.9% for AHPS only with 22% for female and 21.8% for male. The NCIS adds an incremental 6.2% of coverage rate to AHPS. Attendant involved in both program was only 3.8%. The overlapping rate was small. Of total of 28,140 attenders in the AHPS, only approximately 2.04% (4,049) re-attend NCIS. After interaction assessment, gender difference in uptake of two screening regimes was modified by place of residence. After being stratified by place of residence and gender, all socio-demographic variables were statistically related to uptake of each or both of screening regimes after controlling for health status and the severity of health. For the elderly cohort, there was lacking of interaction terms between any of two variables and the main effects of all socio-demographic variables were statistically significant. For the part of independence of two screening regimes, all socio-demographic variables, medical utilization, and the severity of health made additional 14.13% contribution to uptake of outreaching service given uptake of reach-in service for the elderly cohort whereas the corresponding figure was 37.64% for the young cohort.
Conclusions: The present study compared two health check-up programs, reach-in service and out-reaching service, to assess geographic and socio-demographic inequality in uptake of two programs. Although out-reaching service did not substantially enhance the absolute coverage rate of reach-in service two programs complement each other in solving geographic and socio-demographic inequality in uptake of preventive services.
Key words:
health check-up, out-reaching screening, community-based integrated screening, geographical inequality, urban-rural-aboriginal mixed type area