Chatterjee Sharmila, Chattopadhyay Amit, Levine Paul H
Center for Global Health and Development, University of Nebraska Medical Center, College of Public Health, 984341 Nebraska Medical Center, Omaha, NE 68198-4341, USA.
Mohammed Bin Rashid University of Medicine and Health Sciences, Bldg 14, MBR-AMC, Dubai Healthcare City, Dubai, United Arab Emirates; Case Western Reserve University School of Dental Medicine, Department of Oral Medicine, Cleveland, OH, USA; MHMC Orthodontics Residency Program, Atlanta, GA, USA.
J Epidemiol Glob Health. 2015 Dec;5(4 Suppl 1):S1-9. doi: 10.1016/j.jegh.2015.08.001. Epub 2015 Sep 4.
This study aims to investigate the incidence and determinants of colorectal cancer (CRC) and its screening in District of Columbia (DC), and identify modifiable risk factors. Data (2000-2009) from the DC Cancer Registry, Behavioral Risk Factor Surveillance System (BRFSS-DC) and Surveillance Epidemiology and End Results (SEER) were used to estimate CRC incidence in eight DC Wards. Risk factors and CRC screening were analyzed using uni-, bi-, and multivariable statistical methods with survey procedures in SAS (version 9.2) including binary, unconditional multivariable logistic regression analysis. Factors measured included stage of diagnosis, age, gender, race/ethnicity, smoking, alcohol, exercise, body weight, health insurance, education, employment, and income. Over the study time, CRC screening increased from 48.4% to 68.6%. Mean age at diagnosis was 67 years. CRC incidence is high in DC. Furthermore, CRC incidence rates in DC below 50 years' age were higher than the SEER18 average. Disparities exist between CRC incidence and screening among DC Wards. Identified risk factors for CRC are smoking, obesity, and low physical activity; screening was less prevalent among the uninsured and low socio-economic group. Local variations in CRC occurrence exist and may vary from average national experiences. Identification of local regions which vary from national trends in disease occurrence is important for comprehensive understanding of the disease in the community.
本研究旨在调查哥伦比亚特区（DC）结直肠癌（CRC）的发病率、决定因素及其筛查情况，并确定可改变的风险因素。利用DC癌症登记处、行为风险因素监测系统（BRFSS-DC）和监测、流行病学与最终结果（SEER）的数据（2000 - 2009年）来估计DC八个选区的CRC发病率。使用单变量、双变量和多变量统计方法，并采用SAS（版本9.2）中的调查程序进行分析，包括二元、无条件多变量逻辑回归分析，分析的因素包括诊断阶段、年龄、性别、种族/民族、吸烟、饮酒、运动、体重、健康保险、教育程度、就业情况和收入。在研究期间，CRC筛查率从48.4%上升至68.6%。诊断时的平均年龄为67岁。DC的CRC发病率较高。此外，DC 50岁以下人群的CRC发病率高于SEER18的平均水平。DC各选区之间在CRC发病率和筛查方面存在差异。确定的CRC风险因素为吸烟、肥胖和缺乏体育锻炼；在未参保者和社会经济地位较低的群体中，筛查的普及程度较低。CRC的发生存在局部差异，可能与全国平均情况不同。识别疾病发生情况与全国趋势不同的局部地区，对于全面了解社区中的疾病非常重要。
