Wang Yize R, Cangemi John R, Loftus Edward V, Picco Michael F
Division of Gastroenterology and Liver Diseases, Cooper Medical School of Rowan University, Camden, N.J., USA.
Digestion. 2014;90(1):58-62. doi: 10.1159/000363053. Epub 2014 Sep 2.
Patients with longstanding inflammatory bowel disease (IBD) involving large intestine proximal to rectum are considered to be at increased risk for colorectal cancer (CRC). One prior study showed low utilization of surveillance colonoscopy in patients with ≥ 8 years of ulcerative colitis (UC) in the USA.
To study use of surveillance colonoscopy among Medicare beneficiaries with IBD in the 2-year period prior to CRC diagnosis.
Our study sample included Medicare beneficiaries in the SEER-Medicare-linked database who were diagnosed with CRC during 2001-2005 and had ≥ 3 physician visits with ICD-9 diagnosis code for IBD prior to CRC diagnosis. Medicare beneficiaries aged >85 years without Part B coverage or enrolled in HMOs were excluded. Colonoscopy performed within 6-30 months prior to CRC diagnosis was defined as surveillance colonoscopy. The χ² test and multivariate logistic regression were used in statistical analysis.
Of 241 Medicare beneficiaries with IBD and diagnosed with CRC, 92 (38%) patients underwent ≥ 1 surveillance colonoscopy in the 2 years prior to cancer diagnosis. The use of surveillance colonoscopy was similar between Crohn's disease (28/86, 33%) and UC (64/155, 41%). In multivariate logistic regression, older age (odds ratio (OR) 0.97, 95% confidence interval (CI) 0.94-0.99) was negative associated with surveillance colonoscopy use and personal history of colon polyp (OR 2.73, 95% CI 1.09-6.87) was positively associated with surveillance colonoscopy use.
Use of surveillance colonoscopy was low among Medicare beneficiaries with IBD in the 2 years prior to CRC diagnosis.
患有累及直肠近端大肠的长期炎症性肠病（IBD）的患者被认为患结直肠癌（CRC）的风险增加。一项先前的研究表明，在美国，患有≥8年溃疡性结肠炎（UC）的患者中，监测结肠镜检查的使用率较低。
研究CRC诊断前2年中IBD医疗保险受益人的监测结肠镜检查使用情况。
我们的研究样本包括SEER - 医疗保险链接数据库中的医疗保险受益人，这些人在2001 - 2005年期间被诊断为CRC，并且在CRC诊断前有≥3次使用ICD - 9诊断代码诊断为IBD的医生就诊记录。年龄>85岁且没有B部分保险或参加健康维护组织（HMO）的医疗保险受益人被排除在外。在CRC诊断前6 - 30个月内进行的结肠镜检查被定义为监测结肠镜检查。统计分析采用χ²检验和多因素逻辑回归。
在241例患有IBD并被诊断为CRC的医疗保险受益人中，92例（38%）患者在癌症诊断前2年接受了≥1次监测结肠镜检查。克罗恩病（28/86，33%）和UC（64/155，41%）之间监测结肠镜检查的使用率相似。在多因素逻辑回归中，年龄较大（比值比（OR）0.97，95%置信区间（CI）0.94 - 0.99）与监测结肠镜检查的使用呈负相关，结肠息肉个人史（OR 2.73，95% CI 1.09 - 6.87）与监测结肠镜检查的使用呈正相关。
CRC诊断前2年中，IBD医疗保险受益人的监测结肠镜检查使用率较低。
