Division of Medical Oncology, British Columbia Cancer Agency, University of British Columbia, Vancouver, Canada.
Am J Clin Oncol. 2013 Aug;36(4):381-7. doi: 10.1097/COC.0b013e318248da66.
Our objectives were to: (1) compare colorectal cancer screening (CRCS) among US born citizens (USBs), naturalized citizens (NACs), and noncitizens (NOCs) and (2) evaluate clinical factors and potential barriers associated with CRCS in these populations.
Screening-eligible patients were identified from the 2007 California Health Interview Survey. Up-to-date CRCS was defined as a fecal occult blood test within 1 year, a sigmoidoscopy within 5 years, or a colonoscopy within 10 years. Using logistic regression, we determined the effects of immigrant status on CRCS. Stratified analyses based on location of residence, health insurance status, and English proficiency were conducted.
A total of 30,434 average-risk adults aged 50 years or older completed the survey. Only 67% of USBs, 61% of NACs, and 46% of NOCs underwent CRCS. Advanced age, male sex, high-income earners, nonsmokers, and those who were married or visited their physicians frequently were more likely to receive CRCS (all P < 0.05). Compared with USBs, both NACs and NOCs showed decreased odds of CRCS (odds ratio 0.88, 95% confidence interval, 0.74-1.06 and odds ratio 0.68, 95% confidence interval, 0.53-0.88, respectively; P = 0.011). Stratified analyses revealed that the associations between immigrants and decreased CRCS were more prominent for those who lived in rural areas, lacked insurance, or were not English proficient.
CRCS remains suboptimal, especially in new US immigrants. Improving health care access and mitigating language barriers may minimize this disparity.
我们的目标是：（1）比较美国出生公民（USBs）、归化公民（NACs）和非公民（NOCs）中的结直肠癌筛查（CRCS）情况；（2）评估这些人群中与 CRCS 相关的临床因素和潜在障碍。
从 2007 年加利福尼亚健康访谈调查中确定符合筛查条件的患者。最新的 CRCS 定义为在 1 年内进行粪便潜血试验、在 5 年内进行乙状结肠镜检查或在 10 年内进行结肠镜检查。我们使用逻辑回归来确定移民身份对 CRCS 的影响。基于居住地点、健康保险状况和英语熟练程度进行分层分析。
共有 30434 名平均风险的 50 岁及以上成年人完成了调查。只有 67%的 USBs、61%的 NACs 和 46%的 NOCs接受了 CRCS。年龄较大、男性、高收入者、不吸烟者以及已婚或经常看医生的人更有可能接受 CRCS（所有 P<0.05）。与 USBs 相比，NACs 和 NOCs 接受 CRCS 的可能性均降低（比值比 0.88，95%置信区间，0.74-1.06 和比值比 0.68，95%置信区间，0.53-0.88；P=0.011）。分层分析显示，对于居住在农村地区、缺乏保险或英语不熟练的移民，移民与 CRCS 减少之间的关联更为明显。
CRCS 仍然不理想，特别是在新移民中。改善医疗保健的获取和减轻语言障碍可能会最小化这种差异。
