Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Health Aff (Millwood). 2012 Dec;31(12):2747-54. doi: 10.1377/hlthaff.2011.1290.
Colorectal endoscopy, an effective screening intervention for colorectal cancer, is recommended for people age fifty or older, or earlier for those at higher risk. Rates of colorectal endoscopy are still far below those recommended by the US Preventive Services Task Force. This study examined whether factors such as the supply of gastroenterologists and the proportion of the local population without health insurance coverage were related to the likelihood of having the procedure, and whether these factors explained racial and ethnic differences in colorectal endoscopy. We found evidence that improving access to health care at the county and individual levels through expanded health insurance coverage could improve colorectal endoscopy use but might not be sufficient to reduce racial and ethnic disparities in colorectal cancer screening. Policy action to address these disparities will need to consider other structural and cultural factors that may be inhibiting colorectal cancer screening.
结直肠内镜检查是一种有效的结直肠癌筛查干预手段，建议 50 岁或以上人群进行检查，或对高危人群更早进行检查。然而，结直肠内镜检查的普及率仍远低于美国预防服务工作组的建议水平。本研究旨在探讨胃肠病学家的供应情况以及当地无医疗保险人口的比例等因素是否与接受该检查的可能性相关，以及这些因素是否可以解释结直肠内镜检查中存在的种族和民族差异。我们发现，通过扩大医疗保险覆盖范围，在县和个人层面上改善医疗保健服务的可及性，可以提高结直肠内镜检查的使用率，但可能不足以减少结直肠癌筛查中的种族和民族差异。为了解决这些差异，政策行动需要考虑可能阻碍结直肠癌筛查的其他结构性和文化因素。
