James Tamarra M, Greiner K Allen, Ellerbeck Edward F, Feng Changyong, Ahluwalia Jasjit S
Columbia University, Mailman School of Public Health, New York, New York, USA.
Ethn Dis. 2006 Winter;16(1):228-33.
This study's primary objective was to describe colorectal cancer (CRC) screening disparities using a guideline-derived definition of CRC screening adherence while controlling for confounding factors associated with CRC screening.
This secondary data analysis of the 2000 National Health Interview Survey (NHIS) included 12,677 individuals age > or = 50 years. The primary outcome assessed was adherence to CRC screening guidelines, defined as a sigmoidoscopy or proctoscopy within the last five years, colonoscopy within the last 10 years, or home fecal occult blood test within the last 12 months. Age, race/ethnicity, gender, physical disability, household income, insurance status, education level, marriage status, rural or urban geographic area, and family history of CRC were analyzed as covariates in a logistic regression model. We assessed the association between these sociodemographic variables and receipt of physician recommendation for CRC screening among those respondents not adherent to CRC screening recommendations.
In the multivariate model, the odds for being adherent with current CRC screening recommendations were lower for Hispanics (odds ratio [OR] 0.71, 95% confidence interval [CI] 0.59-0.86) and African Americans (OR 0.82, 95% CI 0.71-0.95) than for Whites. Residents of urban areas had higher odds (OR 1.19, 95% CI 1.06-1.34) of being up-to-date than rural residents. Among subjects who were not up-to-date with CRC screening, similar disparities were noted in receipt of physician recommendation for CRC screening.
Certain groups are at increased risk of not receiving CRC screening or recommendations for screening from their physicians. Interventions to reduce these disparities should be an integral part of overall efforts to improve CRC prevention and control.
本研究的主要目的是使用基于指南的结直肠癌（CRC）筛查依从性定义来描述CRC筛查差异，同时控制与CRC筛查相关的混杂因素。
这项对2000年美国国家健康访谈调查（NHIS）的二次数据分析纳入了12677名年龄≥50岁的个体。评估的主要结局是对CRC筛查指南的依从性，定义为过去五年内进行乙状结肠镜检查或直肠镜检查、过去十年内进行结肠镜检查或过去12个月内进行家庭粪便潜血试验。年龄、种族/族裔、性别、身体残疾、家庭收入、保险状况、教育水平、婚姻状况、农村或城市地理区域以及CRC家族史在逻辑回归模型中作为协变量进行分析。我们评估了这些社会人口学变量与未遵循CRC筛查建议的受访者中接受医生CRC筛查建议之间的关联。
在多变量模型中，西班牙裔（优势比[OR]0.71，95%置信区间[CI]0.59 - 0.86）和非裔美国人（OR 0.82，95% CI 0.71 - 0.95）遵循当前CRC筛查建议的几率低于白人。城市地区居民比农村居民有更高的几率（OR 1.19，95% CI 1.06 - 1.34）保持最新筛查状态。在未进行最新CRC筛查的受试者中，在接受医生CRC筛查建议方面也发现了类似的差异。
某些群体未接受CRC筛查或未从医生处获得筛查建议的风险增加。减少这些差异的干预措施应成为改善CRC预防和控制总体努力的一个组成部分。
