The Prevalence and Management of Atrial Fibrillation in New Zealand Māori Detected through an Abdominal Aortic Aneurysm Screening Program

BACKGROUND

Atrial fibrillation (AF) screening was incorporated into an abdominal aortic aneurysm screening (AAA) program for New Zealand (NZ) Māori.

METHODS

AF screening was performed as an adjunct to AAA screening of Māori men aged 60-74 years and women aged 65-74 years registered with primary health care practices in Auckland, NZ. Pre-existing AF was determined through coded diagnoses or medications in the participant's primary care record. Subsequent audit of the record assessed accuracy of pre-screening coding, medication use and clinical follow-up.

RESULTS

Among 1,933 people successfully screened, the prevalence of AF was 144 (7.4%), of which 46 (2.4% of the cohort) were patients without AF coded in the medical record. More than half of these were revealed to be known AF but that was not coded. Thus, the true prevalence of newly detected AF was 1.1% (n=21). An additional 48 (2.5%) of the cohort had been coded as AF but were not in AF at the time of screening. Among the 19 at-risk screen-detected people with AF, 10 started appropriate anticoagulation therapy within 6 months. Of the nine patients who did not commence anticoagulation therapy, five had a subsequent adverse clinical outcome in the follow-up period, including one with ischaemic stroke; two had contraindications to anticoagulants. Among those with previously diagnosed AF, the proportion receiving anticoagulation therapy rose from 57% pre-screening to 83% at 6 months post-screening (p<0.0001); among newly diagnosed AF the proportion rose from 0% to 53% (p<0.01).

CONCLUSIONS

AF screening is a feasible low-cost adjunct to AAA screening with potential to reduce ethnic inequities in stroke incidence. However, effective measures are needed to ensure that high-risk newly diagnosed AF is managed according to best practice guidelines.

Socioeconomic inequality in organized and opportunistic screening for gastric cancer: results from the Korean National Cancer Screening Survey 2009-2022

Objectives

This study aimed to evaluate the socioeconomic inequality in gastric cancer (GC) screening in Korea. Socioeconomic inequality was assessed using both organized and opportunistic screening according to income and educational level.

Methods

GC screening data were obtained from the 2009-2022 Korean National Cancer Screening Survey. The final analysis included 47,163 cancer-free men and women. The weighted cancer screening rate was estimated using joinpoint regression. The inequality indices were measured in terms of both the absolute slope index of inequality (SII) and the relative index of inequality (RII) using the Poisson regression model.

Results

The organized screening rate for GC increased from 38.2% in 2009 to 70.8% in 2022, whereas the opportunistic screening rate decreased from 18.8 to 4.5%. Regarding educational inequality, a negative SII value was observed [-3.5, 95% confidence interval (CI), -7.63-0.83%] in organized screening, while a positive SII (9.30%; 95% CI, 6.69-11.91%) and RII (1.98%; 95% CI, 1.59-2.46) were observed in opportunistic screening. Furthermore, income inequality was not found in organized GC screening; however, overall SII and RII for opportunistic screening were 7.72% (95% CI, 5.39-10.5) and 1.61 (95% CI, 1.42-1.81), respectively.

Conclusion

Organized screening rates have grown gradually over time and account for the majority of GC screenings in South Korea. While no socioeconomic inequalities were found in organized screening, significant socioeconomic inequalities were found in opportunistic screening.

Socio-economic Inequality of Utilization of Cancer Testing in Europe: A Cross-Sectional Study

There are currently screening programmes for breast, cervical and colorectal cancer in many European countries. However, the uptake of cancer screening in general may vary within and between countries. The aim of this study is to assess the inequalities in testing utilization by socio-economic status and whether the amount of inequality varies across European regions. We conducted an analysis based on cross-sectional data from the second wave of the European Health Interview Survey from 2013 to 2015. We analysed the use of breast, cervical, and colorectal cancer testing by socio-economic position (household income, educational level and employment status), socio-demographic factors, self-perceived health and smoking behaviour, by using multinomial logistic models, and inequality measurement based on the Slope index of inequality (SII) and Relative index of inequality (RII). The results show that the utilization of mammography (Odds Ratio (OR) = 0.55, 95% confidence interval (95%CI):0.50–0.61), cervical smear tests (OR = 0.60, 95%CI:0.56–0.65) and colorectal testing (OR = 0.82, 95%CI:0.78–0.86) was overall less likely among individuals within a low household income compared to a high household income. Also, individuals with a non-EU country of birth, low educational level and being unemployed (or retired) were overall less likely to be tested. The income-based inequality in breast (SII = 0.191;RII = 1.260) and colorectal testing utilization (SII = 0.161;RII = 1.487) was the greatest in Southern Europe. For cervical smears, this inequality was greatest in Eastern Europe (SII = 0.122;RII = 1.195). We concluded that there is considerable inequality in the use of cancer tests in Europe, with inequalities associated with household income, educational level, employment status, and country of birth.

A organização do rastreamento do câncer do colo uterino por uma equipe de Saúde da Família no Rio de Janeiro, Brasil

Introdução: O rastreamento organizado do câncer do colo do útero ainda é um desafio a ser vencido em todo o Brasil. Objetivo: Descrever a intervenção de uma equipe de Saúde da Família para a melhoria da qualidade das ações de rastreamento desta condição. Métodos: A intervenção foi estruturada a partir das recomendações nacionais para o rastreamento do câncer do colo do útero e das evidências disponíveis na literatura para aumento da participação popular em programas de rastreamento. Funcionalidades do sistema de prontuário eletrônico local foram fundamentais para a viabilização da proposta. A partir da reorientação de práticas assistenciais e administrativas, foi estabelecido e mantido por 15 meses um programa organizado de rastreamento do câncer do colo do útero nesta equipe de Saúde da Família. Resultados: No mês anterior ao início da intervenção, as equipes da unidade de saúde e da área programática apresentavam uma cobertura média de 10% da população alvo rastreada. Ao final de 15 meses, a equipe-intervenção atingiu uma cobertura de 44%, em contraste com a média de 22% das demais equipes da unidade, e 25% da área programática. Conclusões: Quando uma equipe de Saúde da Família empreende esforços para a organização do rastreamento do câncer do colo do útero, bons resultados podem ser alcançados no aumento da cobertura populacional. Esperamos que outras equipes possam se beneficiar da divulgação desta experiência e tomem para si a responsabilidade de organizar o rastreamento do câncer do colo do útero, impactando positivamente sobre a saúde de suas comunidades.

Human papilloma virus vaccination programs reduce health inequity in most scenarios: a simulation study

BACKGROUND

The global and within-country epidemiology of cervical cancer exemplifies health inequity. Public health programs may reduce absolute risk but increase inequity; inequity may be further compounded by screening programs. In this context, we aimed to explore what the impact of human papillomavirus (HPV) vaccine might have on health equity allowing for uncertainty surrounding the long-term effect of HPV vaccination programs.

METHODS

A simple static multi-way sensitivity analysis was carried out to compare the relative risk, comparing after to before implementation of a vaccination program, of infections which would cause invasive cervical cancer if neither prevented nor detected, using plausible ranges of vaccine effectiveness, vaccination coverage, screening sensitivity, screening uptake and changes in uptake.

RESULTS

We considered a total number of 3,793,902 scenarios. In 63.9% of scenarios considered, vaccination would lead to a better outcome for a population or subgroup with that combination of parameters. Regardless of vaccine effectiveness and coverage, most simulations led to lower rates of disease.

CONCLUSIONS

If vaccination coverage and screening uptake are high, then communities are always better off with a vaccination program. The findings highlight the importance of achieving and maintaining high immunization coverage and screening uptake in high risk groups in the interest of health equity.