Ata Ashar, Elzey Jared D, Insaf Tabassum Z, Grau Ana M, Stain Steven C, Ahmed Nasar U
Department of Surgery, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd, Nashville, TN 37208, USA.
Cancer Detect Prev. 2006;30(2):134-43. doi: 10.1016/j.cdp.2006.02.003. Epub 2006 Apr 25.
Studies exploring CRC testing prevalence and correlates within US populations have provided limited and sometimes conflicting information. The most recent national-level reports have described US usage of CRC tests but none have considered only those tests done specifically for screening reasons as an outcome variable.
Using the NHIS 2000 sample of >or=50 year-old, we assessed screening behavior using an outcome variable accounting for (1) any combination of recommended tests (2) done within their respective time guidelines, and (3) specifically for screening purposes.
Only 25.8% (95% CI: 24.9-26.7%) of the population reported getting a test done for screening purposes within the recommended time. Most (>85%) of the FOBTs and only about 60% of endoscopies were done for screening. Among those who had an endoscopy within the recommended time, Blacks were more likely than Whites to report screening as the purpose of the test. Hispanics had the lowest test usage irrespective of test time, reason or type. Hispanics were 50% (p<0.001) less likely to be adherent, and Blacks approximately 22% (p<0.01) less likely to be adherent, than Whites. After multivariate adjustment, differences between Whites and Blacks disappeared; Hispanics remained less likely. Increasing education predicted higher adherence among Whites but only undergraduate completion did so among Blacks. Male gender predicted adherence only among Blacks and insurance only among Hispanics.
Preventive screening for CRC is lower than estimates from previous studies. Future studies should consider accounting for test purpose. Our findings need confirmation through studies based on objective data.
探索美国人群中结直肠癌（CRC）检测普及率及其相关因素的研究提供的信息有限，且有时相互矛盾。最新的国家级报告描述了美国CRC检测的使用情况，但没有一份报告将仅出于筛查目的而进行的检测作为一个结果变量来考虑。
我们使用2000年国家健康访谈调查（NHIS）中年龄≥50岁的样本，通过一个结果变量来评估筛查行为，该变量考虑了以下因素：（1）推荐检测的任何组合；（2）在各自规定时间内进行；（3）专门用于筛查目的。
只有25.8%（95%置信区间：24.9 - 26.7%）的人群报告在推荐时间内进行了用于筛查目的的检测。大多数（>85%）的粪便潜血试验（FOBT）和仅约60%的内镜检查是用于筛查的。在推荐时间内进行内镜检查的人群中，黑人比白人更有可能报告检测目的是筛查。无论检测时间、原因或类型如何，西班牙裔的检测使用率最低。与白人相比，西班牙裔坚持检测的可能性低50%（p<0.001），黑人低约22%（p<0.01）。经过多变量调整后，白人和黑人之间的差异消失；西班牙裔坚持检测的可能性仍然较低。受教育程度提高预示着白人的依从性更高，但只有本科毕业的黑人是这样。男性性别仅预示黑人的依从性，保险仅预示西班牙裔的依从性。
CRC的预防性筛查低于先前研究的估计。未来的研究应考虑检测目的。我们的研究结果需要通过基于客观数据的研究来证实。
