Department of Experimental Medicine, Public Health Section, University of Perugia, Perugia, Italy.
Umbria Cancer Registry, Perugia, Italy.
PLoS One. 2019 Oct 4;14(10):e0222396. doi: 10.1371/journal.pone.0222396. eCollection 2019.
Despite the well-recognised relevance of screening in colorectal cancer (CRC) control, adherence to screening is often suboptimal. Improving adherence represents an important public health strategy. We investigated the influence of family doctors (FDs) as determinant of CRC screening adherence by comparing each FDs practice participation probability to that of the residents in the same geographic areas using the whole population geocoded.
We used multilevel logistic regression model to investigate factors associated with CRC screening adherence, among 333,843 people at their first screening invitation. Standardized Adherence Rates (SAR) by age, gender, and socioeconomic status were calculated comparing FDs practices to the residents in the same geographic areas using geocoded target population.
Screening adherence increased from 41.0% (95% CI, 40.8-41.2) in 2006-2008 to 44.7% (95% CI, 44.5-44.9) in 2011-2012. Males, the most deprived and foreign-born people showed low adherence. FD practices and the percentage of foreign-born people in a practice were significant clustering factors. SAR for 145 (21.4%) FDs practices differed significantly from people living in the same areas. Predicted probabilities of adherence were 31.7% and 49.0% for FDs with low and high adherence, respectively.
FDs showed a direct and independent effect to the CRC screening adherence of the people living in their practice. FDs with significantly high adherence level could be the key to adherence improvement.
Most deprived individuals and foreigners represent relevant targets for interventions in public health aimed to improve CRC screening adherence.
尽管筛查在结直肠癌（CRC）防控中具有明显的相关性，但筛查的依从性往往并不理想。提高依从性是一项重要的公共卫生策略。我们通过比较每个家庭医生（FD）的实践参与概率与同一地理区域的居民的概率，研究了 FD 作为 CRC 筛查依从性决定因素的影响，使用了整个人口地理编码。
我们使用多水平逻辑回归模型，调查了 333843 名首次筛查邀请者中与 CRC 筛查依从性相关的因素。使用地理编码目标人群，比较 FD 实践与同一地理区域的居民，计算了按年龄、性别和社会经济地位标准化的依从率（SAR）。
筛查依从性从 2006-2008 年的 41.0%（95%CI，40.8-41.2）增加到 2011-2012 年的 44.7%（95%CI，44.5-44.9）。男性、最贫困和外国出生的人依从性较低。FD 实践和实践中外国出生人口的比例是显著的聚类因素。145（21.4%）个 FD 实践的 SAR 与生活在同一地区的人有显著差异。FD 实践中低依从性和高依从性的预测依从率分别为 31.7%和 49.0%。
FD 对生活在其实践中的人的 CRC 筛查依从性有直接和独立的影响。具有显著高依从性水平的 FD 可能是提高依从性的关键。
最贫困的人和外国人是旨在提高 CRC 筛查依从性的公共卫生干预的重要目标。
