Ethnicity is associated with genetic, environmental, lifestyle and social constructs. Difficult to define using a single variable, but strongly predictive of health outcomes and useful for planning healthcare services, it is often lacking in administrative databases, necessitating the use of a surrogate measure. A potential surrogate for ethnicity is birthplace. Our aim was to measure the agreement between birthplace and ethnicity among six major ethic groups as recorded at the population-based mammography service for British Columbia, Canada (BC).
We used records from the most-recent visits of women attending the Screening Mammography Program of British Columbia to cross-tabulate women's birthplaces and self-reported ethnicities, and separately considered results for the time periods 1990-1999 and 2000-2006. In general, we combined countries according to the system adopted by the United Nations, and defined ethnic groups that correspond to the nation groups. The analysis considered birthplaces and corresponding ethnicities for South Asia, East/Southeast Asia, North Europe, South Europe, East Europe, West Europe and all other nations combined. We used the kappa statistic to measure the concordance between self-reported ethnicity and birthplace.
Except for the 'Other' category, the most-common birthplace was East/Southeast Asia and the most-common ethnicity was East/Southeast Asian. The agreement between birthplace and self-reported ethnicity was poor overall, as evidenced by kappa scores of 0.22 in both 1990-1999 and 2000-2006. There was substantial agreement between ethnicity and birthplace for South Asians, excellent agreement for East/Southeast Asians, but poor agreement for Europeans.
Birthplace can be used as a surrogate for ethnicity amongst people with South Asian and East/Southeast Asian ethnicity in BC.
Alaska Native women have encountered many obstacles in the health care system which deter them from adhering to cancer screening recommendations. To improve access, it was necessary for us to listen to them and their attitudes about health care. As a result of this assessment, we changed our approach resulting in an overall increase in screening rates from 14% to 62%. A case example is presented to demonstrate barriers to cancer screening and our techniques for overcoming them.
INTRODUCTION: Populations eligible for public health programs are often narrowly defined and, therefore, difficult to describe quantitatively, particularly at the local level, because of lack of data. This information, however, is vital for program planning and evaluation. We demonstrate the application of a statistical method using multiple sources of data to generate county estimates of women eligible for free breast cancer screening and diagnostic services through California's Cancer Detection Programs: Every Woman Counts. METHODS: We used the small-area estimation method to determine the proportion of eligible women by county and racial/ethnic group. To do so, we included individual and community data in a generalized, linear, mixed-effect model. RESULTS: Our method yielded widely varied estimated proportions of service-eligible women at the county level. In all counties, the estimated proportion of eligible women was higher for Hispanics than for whites, blacks, Asian/Pacific Islanders, or American Indian/Alaska Natives. Across counties, the estimated proportions of eligible Hispanic women varied more than did those of women of other races. CONCLUSION: The small-area estimation method is a powerful tool for approximating narrowly defined eligible or target populations that are not represented fully in any one data source. The variability and reliability of the estimates are measurable and meaningful. Public health programs can use this method to estimate the size of local populations eligible for, or in need of, preventive health services and interventions.
A health environment screening procedure has been developed, which is a questionnaire assessing the significance of factors, such as lifestyle, habitat, genetics, public health care, mentality. The developed procedure can ascertain the contribution of each factor to the health of man or a group of individuals, thus defining the factors that may cause diseases, optimize, and individualize the organization of prophylactic care.