Wang Ke-Sheng, Liu Xuefeng, Ategbole Muyiwa, Xie Xin, Liu Ying, Xu Chun, Xie Changchun, Sha Zhanxin
Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA. Email:
Asian Pac J Cancer Prev. 2017 Sep 27;18(9):2581-2589. doi: 10.22034/APJCP.2017.18.9.2581.
Objective: Screening for colorectal cancer (CRC) can reduce disease incidence, morbidity, and mortality. However, few studies have investigated the urban-rural differences in social and behavioral factors influencing CRC screening. The objective of the study was to investigate the potential factors across urban-rural groups on the usage of CRC screening. Methods: A total of 38,505 adults (aged ≥40 years) were selected from the 2009 California Health Interview Survey (CHIS) data - the latest CHIS data on CRC screening. The weighted generalized linear mixed-model (WGLIMM) was used to deal with this hierarchical structure data. Weighted simple and multiple mixed logistic regression analyses in SAS ver. 9.4 were used to obtain the odds ratios (ORs) and their 95% confidence intervals (CIs). Results: The overall prevalence of CRC screening was 48.1% while the prevalence in four residence groups - urban, second city, suburban, and town/rural, were 45.8%, 46.9%, 53.7% and 50.1%, respectively. The results of WGLIMM analysis showed that there was residence effect (p<0.0001) and residence groups had significant interactions with gender, age group, education level, and employment status (p<0.05). Multiple logistic regression analysis revealed that age, race, marital status, education level, employment stats, binge drinking, and smoking status were associated with CRC screening (p<0.05). Stratified by residence regions, age and poverty level showed associations with CRC screening in all four residence groups. Education level was positively associated with CRC screening in second city and suburban. Infrequent binge drinking was associated with CRC screening in urban and suburban; while current smoking was a protective factor in urban and town/rural groups. Conclusions: Mixed models are useful to deal with the clustered survey data. Social factors and behavioral factors (binge drinking and smoking) were associated with CRC screening and the associations were affected by living areas such as urban and rural regions.
结直肠癌（CRC）筛查可降低疾病发病率、发病率和死亡率。然而，很少有研究调查影响CRC筛查的社会和行为因素的城乡差异。本研究的目的是调查城乡群体在CRC筛查使用方面的潜在因素。方法：从2009年加利福尼亚健康访谈调查（CHIS）数据——关于CRC筛查的最新CHIS数据中选取了总共38505名成年人（年龄≥40岁）。加权广义线性混合模型（WGLIMM）用于处理这种层次结构数据。在SAS ver. 9.4中使用加权简单和多重混合逻辑回归分析来获得比值比（OR）及其95%置信区间（CI）。结果：CRC筛查的总体患病率为48.1%，而四个居住组——城市、二级城市、郊区和城镇/农村的患病率分别为45.8%、46.9%、53.7%和50.1%。WGLIMM分析结果表明存在居住效应（p<0.0001），并且居住组与性别、年龄组、教育水平和就业状况有显著交互作用（p<0.05）。多重逻辑回归分析显示年龄、种族、婚姻状况、教育水平、就业状况、暴饮和吸烟状况与CRC筛查相关（p<0.05）。按居住地区分层，年龄和贫困水平在所有四个居住组中均与CRC筛查相关。教育水平在二级城市和郊区与CRC筛查呈正相关。偶尔暴饮与城市和郊区的CRC筛查相关；而当前吸烟在城市和城镇/农村组中是一个保护因素。结论：混合模型有助于处理聚类调查数据。社会因素和行为因素（暴饮和吸烟）与CRC筛查相关，并且这些关联受城乡等居住地区的影响。
