Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center.
Cancer Services Program of Brooklyn, Brooklyn, NY.
J Clin Gastroenterol. 2019 Nov/Dec;53(10):744-749. doi: 10.1097/MCG.0000000000001132.
Initiatives by the Centers for Disease Control and Prevention as well as the National Colorectal Cancer Roundtable aim to increase the rate of colorectal cancer (CRC) screening. We assess individual and geographic characteristics associated fecal immunochemical test (FIT) CRC screening over 3 years.
This is a retrospective study of 1500 FIT kits which were mailed or opportunistically handed to eligible participants in Brooklyn, New York from January 2014 to December 2016. Eligibility criteria included increased risk for colon cancer, uninsured or underinsured, and a minimum age of 50 years to warrant CRC screening. We looked at the association of individual demographic characteristics and FIT screening by logistic regression using SPPS version 23 software. In addition, using ArcGIS, we coded patients address and layered census tract population information to find associations.
In total, 1367 Cancer Services Participants met our study criteria. The study sample was predominantly female (95.2%) and minority (46% African American, 24.7% Hispanic, 17.3% Caucasian, 11.4% Asian) and on average 59 years old (SD, 5.7). A large majority (73%) had household incomes below $20,000/year. Approximately half (49.9%) of all Cancer Services Participants returned their FIT kit. In participants who did not return their FIT kit, the majority were African American (41%), followed by Hispanics (26.5%), Caucasians (20.6%), and Asians (11.8%). Multivariable logistic regression showed that a screening history of prior colonoscopy or FIT, gender, ethnicity, and educational attainment were significantly associated with FIT CRC screening uptake (P<0.05). Geospatial mapping showed clusters of low screening uptake in areas of high poverty. Hot-spot analysis identified areas of significant vulnerability.
FIT uptake remains suboptimal. Individual predictors as well as area poverty is associated with low screening uptake. Geospatial mapping is an effective tool for evaluating CRC screening uptake.
疾病控制与预防中心以及国家结直肠癌圆桌会议的倡议旨在提高结直肠癌（CRC）筛查率。我们评估了在 3 年内与粪便免疫化学检测（FIT）CRC 筛查相关的个体和地理特征。
这是一项回顾性研究，研究对象为 2014 年 1 月至 2016 年 12 月期间，在纽约布鲁克林通过邮寄或偶然方式向符合条件的参与者发放的 1500 份 FIT 试剂盒。纳入标准包括结直肠癌风险增加、未参保或参保不足、年龄至少 50 岁以进行 CRC 筛查。我们使用 SPPS 版本 23 软件通过逻辑回归检查个体人口统计学特征与 FIT 筛查的关联。此外，我们使用 ArcGIS 对患者的地址进行编码，并分层人口普查区的人口信息，以寻找关联。
共有 1367 名癌症服务参与者符合我们的研究标准。研究样本主要为女性（95.2%）和少数族裔（46%为非裔美国人，24.7%为西班牙裔，17.3%为白人，11.4%为亚裔），平均年龄为 59 岁（标准差，5.7 岁）。绝大多数（73%）的家庭收入低于 20000 美元/年。大约一半（49.9%）的癌症服务参与者退回了他们的 FIT 试剂盒。在未退回 FIT 试剂盒的参与者中，大多数是非裔美国人（41%），其次是西班牙裔（26.5%）、白人（20.6%）和亚裔（11.8%）。多变量逻辑回归显示，既往结肠镜检查或 FIT 筛查史、性别、族裔和教育程度与 FIT CRC 筛查的采用显著相关（P<0.05）。地理空间映射显示，在贫困程度较高的地区，筛查率较低。热点分析确定了具有显著脆弱性的区域。
FIT 利用率仍然不理想。个体预测因素以及地区贫困与低筛查率有关。地理空间映射是评估 CRC 筛查利用率的有效工具。
