Fleming Steven T, Schoenberg Nancy E, Tarasenko Yelena N, Pearce Kevin A
University of Kentucky College of Public Health and the College of Medicine, Lexington, KY, USA.
South Med J. 2011 Dec;104(12):811-8. doi: 10.1097/SMJ.0b013e31823a8879.
The purpose of this study was to determine the relation among multiple morbidities and the prevalence of colorectal cancer (CRC) screening among older adult Appalachian residents of Kentucky. This is the first known study to address multiple morbidities exclusively with a health-disparities population.
This was a cross-sectional study of 1153 subjects, aged 50 to 76 years, from Appalachian Kentucky.
White race, post-high school education, and perception of having more than enough income on which to survive were associated with higher rates of any guideline concordant CRC screening. Statistically significant trends in the outcome of adjusted odds ratios for colonoscopy with greater number of morbidities (P < 0.05) were noted; the higher number of morbidities, the higher rates of screening.
Contrary to much existing research, within a health-disparities population, we found a dose-response relation between comorbidities and greater likelihood of CRC screening. Future research in this area should focus on explanations for this seldom-described finding. In addition, this finding has meaningful clinical and behavioral implications, including ensuring provider screening recommendation during routine office visits and outreach, perhaps through community clinics and public health departments, to extremely vulnerable populations lacking access to preventive care.
本研究旨在确定肯塔基州阿巴拉契亚地区老年居民的多种疾病与结直肠癌（CRC）筛查患病率之间的关系。这是已知的第一项专门针对健康差异人群的多种疾病的研究。
这是一项对1153名年龄在50至76岁之间的肯塔基州阿巴拉契亚受试者进行的横断面研究。
白人种族、高中后教育程度以及认为有足够维持生计的收入与任何符合指南的CRC筛查率较高相关。注意到随着疾病数量增加，结肠镜检查校正比值比结果存在统计学显著趋势（P < 0.05）；疾病数量越多，筛查率越高。
与许多现有研究相反，在健康差异人群中，我们发现合并症与CRC筛查可能性增加之间存在剂量反应关系。该领域未来的研究应聚焦于对这一鲜有描述的发现的解释。此外，这一发现具有重要的临床和行为学意义，包括在常规门诊就诊时确保医生进行筛查建议，以及通过社区诊所和公共卫生部门对缺乏预防保健机会的极度脆弱人群进行外展服务。
