年龄、健康和功能对预期寿命有限的老年癌症筛查的影响。
Influence of Age, Health, and Function on Cancer Screening in Older Adults with Limited Life Expectancy.
机构信息
The Johns Hopkins School of Medicine, Baltimore, MD, USA.
The Johns Hopkins Center on Aging and Health, Baltimore, MD, USA.
出版信息
J Gen Intern Med. 2019 Jan;34(1):110-117. doi: 10.1007/s11606-018-4717-y. Epub 2018 Nov 6.
BACKGROUND/OBJECTIVES: We examined the relationship between cancer screening and life expectancy predictors, focusing on the influence of age versus health and function, in older adults with limited life expectancy.
DESIGN
Longitudinal cohort study SETTING: National Health and Aging Trends Study (NHATS) with linked Medicare claims.
PARTICIPANTS
Three cohorts of adults 65+ enrolled in fee-for-service Medicare were constructed: women eligible for breast cancer screening (n = 2043); men eligible for prostate cancer screening (n = 1287); men and women eligible for colorectal cancer screening (n = 3759).
MEASUREMENTS
We assessed 10-year mortality risk using 2011 NHATS data, then used claims data to assess 2-year prostate and breast cancer screening rates and 3-year colorectal cancer screening rates. Among those with limited life expectancy (10-year mortality risk > 50%), we stratified participants at each level of predicted mortality risk and split participants in each risk stratum by the median age. We assembled two sub-groups from these strata that were matched on predicted life expectancy: a "younger sub-group" with relatively poorer health/functional status and an "older sub-group" with relatively better health/functional status. We compared screening rates between sub-groups.
RESULTS
For all three cancer screenings, the younger sub-groups (average ages 73.4-76.1) had higher screening rates than the older sub-groups (average ages 83.6-86.9); screening rates were 42.9% versus 34.2% for prostate cancer screening (p = 0.02), 33.6% versus 20.6% for breast cancer screening (p < 0.001), 13.1% versus 6.7% for colorectal cancer screening in women (p = 0.006), and 20.5% versus 12.1% for colorectal cancer screening in men (p = 0.002).
CONCLUSION
Among older adults with limited life expectancy, those who are relatively younger with poorer health and functional status are over-screened for cancer at higher rates than those who are older with the same predicted life expectancy.
背景/目的：我们研究了癌症筛查与预期寿命预测指标之间的关系，重点关注在预期寿命有限的老年人中，年龄与健康和功能的关系。
设计
纵向队列研究
地点
国家健康老龄化趋势研究（NHATS）与链接的医疗保险索赔。
参与者
构建了三组 65 岁以上的参加费用报销型医疗保险的成年人队列：有资格进行乳腺癌筛查的女性（n=2043）；有资格进行前列腺癌筛查的男性（n=1287）；有资格进行结直肠癌筛查的男性和女性（n=3759）。
测量
我们使用 2011 年 NHATS 数据评估了 10 年死亡率风险，然后使用索赔数据评估了 2 年前列腺癌和乳腺癌筛查率以及 3 年结直肠癌筛查率。在预期寿命有限（10 年死亡率风险>50%）的人群中，我们根据每个预测死亡率风险水平对参与者进行分层，并按中位年龄将每个风险分层的参与者分开。我们从这些分层中组建了两个亚组，这些亚组根据预期寿命进行匹配：一个“年轻亚组”，健康/功能状况相对较差，一个“年老亚组”，健康/功能状况相对较好。我们比较了亚组之间的筛查率。
结果
对于所有三种癌症筛查，年轻亚组（平均年龄 73.4-76.1）的筛查率高于年老亚组（平均年龄 83.6-86.9）；前列腺癌筛查率为 42.9%对 34.2%（p=0.02），乳腺癌筛查率为 33.6%对 20.6%（p<0.001），女性结直肠癌筛查率为 13.1%对 6.7%（p=0.006），男性结直肠癌筛查率为 20.5%对 12.1%（p=0.002）。
结论
在预期寿命有限的老年人中，那些相对年轻、健康和功能状况较差的人比具有相同预期寿命的老年人接受癌症筛查的比例更高。
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