Wernli Karen J, Hubbard Rebecca A, Johnson Eric, Chubak Jessica, Kamineni Aruna, Green Beverly B, Rutter Carolyn M
Authors' Affiliation: Group Health Research Institute, Seattle, Washington
Authors' Affiliation: Group Health Research Institute, Seattle, Washington.
Cancer Epidemiol Biomarkers Prev. 2014 Jul;23(7):1230-7. doi: 10.1158/1055-9965.EPI-13-1360. Epub 2014 May 3.
We describe patterns of colorectal cancer screening uptake in a U.S. insured population as individuals become newly eligible for screening at age 50 and assess temporal trends and patient characteristics with screening uptake.
We identified a cohort of 81,223 men and women who were members of Group Health and turned 50 years old from 1996 to 2010. We ascertained receipt of colorectal cancer screening within five years. Time to screening was estimated by year of cohort entry using cumulative incidence curves and Cox proportional hazards models-estimated patient characteristics associated with screening uptake.
Stool-based screening tests were the most common, 72% of first screening tests. The proportion of individuals initiating colorectal cancer screening via colonoscopy increased from 8% in 1996 to 1998 to 33% in 2008 to 2010. Patient factors associated with increased colorectal cancer screening were: turning 50 more recently (2008-2010; Ptrend < 0.0001) or Asian race [HR, 1.14; 95% confidence interval (CI), 1.10-1.19]. Patient factors associated with decreased screening were: being a woman (HR, 0.70; 95% CI, 0.68-0.72), Native American (HR, 0.68; 95% CI, 0.60-0.78), or Pacific Islander race (HR, 0.82; 95% CI, 0.72-0.95), and having prevalent diabetes (HR, 0.78; 95% CI, 0.75-0.82) and higher body mass index (Ptrend < 0.0001).
Patient characteristics associated with initiation of colorectal cancer screening in a newly eligible population are similar to characteristics associated with overall screening participation in all age-eligible adults. Our results identify patient populations to target in outreach programs.
Disparities in receipt of colorectal cancer screening are evident from onset of an age-eligible cohort, identifying key groups for future interventions for screening.
我们描述了美国参保人群中结直肠癌筛查的接受模式，这些人在50岁时开始符合筛查条件，并评估筛查接受情况的时间趋势和患者特征。
我们确定了一组81223名男女，他们是健康集团的成员，在1996年至2010年期间年满50岁。我们确定了他们在五年内接受结直肠癌筛查的情况。通过队列进入年份，使用累积发病率曲线和Cox比例风险模型估计筛查接受情况的时间，并估计与筛查接受相关的患者特征。
基于粪便的筛查测试最为常见，占首次筛查测试的72%。通过结肠镜检查开始结直肠癌筛查的个体比例从1996年至1998年的8%增加到2008年至2010年的33%。与结直肠癌筛查增加相关的患者因素包括：最近年满50岁（2008 - 2010年；Ptrend < 0.0001）或亚洲种族[风险比（HR），1.14；95%置信区间（CI），1.10 - 1.19]。与筛查减少相关的患者因素包括：女性（HR，0.70；95% CI，0.68 - 0.72）、美洲原住民（HR，0.68；95% CI，0.60 - 0.78）或太平洋岛民种族（HR，0.82；95% CI，0.72 - 0.95），以及患有糖尿病（HR，0.78；95% CI，0.75 - 0.82）和较高的体重指数（Ptrend < 0.0001）。
在新符合条件的人群中，与开始结直肠癌筛查相关的患者特征与所有符合年龄条件的成年人总体筛查参与相关的特征相似。我们的结果确定了在推广项目中需要针对的患者群体。
从符合年龄条件的队列开始，结直肠癌筛查接受情况的差异就很明显，这为未来筛查干预确定了关键群体。
