Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Rm. 541, No. 17, Xuzhou Rd, Taipei, 100, Taiwan.
Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.
Int J Colorectal Dis. 2020 Feb;35(2):239-247. doi: 10.1007/s00384-019-03468-y. Epub 2019 Dec 13.
To reduce colorectal cancer morbidity and mortality in Taiwan, a nationwide screening program with fecal immunochemical test was implemented from January 2004. This study evaluated the influence of this screening program through the controlled interrupted time series analysis.
The controlled interrupted time series analysis was performed using the Poisson regression model with simple linear spline function adjusted for 5-year age-groups and the birth cohort. A sensitivity analysis was performed to re-estimate the effect of the screening program.
The expected age-adjusted colorectal cancer mortality rates (by setting the effect of the screening program to zero) for both genders were close to the observed rates during 2004-2013 and were dramatically higher than the observed rates thereafter. The average annual percent changes in colorectal cancer mortality revealed an increasing trend for the age-groups 0-49 and ≥ 75 years and a decreasing trend for the age-groups 50-69 and 70-74 years for 2014-2017. Compared with 1991-2003, the adjusted mortality rate ratios were 0.93 (0.86-1.00) and 1.07 (1.00-1.15) in 2014-2017 for the screening and control groups. Regarding the percent changes, reductions of 7.49% between 1991-2003 and 2014-2017 and 14.76% between the control and screening groups were observed.
The nationwide screening program effectively reduced colorectal cancer mortality. Including individuals aged 70-74 years into the target population of the screening program as well as including medical centers and clinics in the program to promote the screening test effectively reduced colorectal cancer mortality.
为降低台湾地区结直肠癌发病率和死亡率，自 2004 年 1 月起实施了全国性粪便免疫化学检测筛查计划。本研究通过控制中断时间序列分析评估了该筛查计划的影响。
采用泊松回归模型和简单线性样条函数进行控制中断时间序列分析，调整了 5 岁年龄组和出生队列。进行了敏感性分析以重新估计筛查计划的效果。
设定筛查计划的效果为零时，男性和女性的预期年龄调整结直肠癌死亡率均接近 2004-2013 年的观察值，此后观察值明显升高。2014-2017 年，结直肠癌死亡率的年平均百分比变化在 0-49 岁和≥75 岁年龄组呈上升趋势，在 50-69 岁和 70-74 岁年龄组呈下降趋势。与 1991-2003 年相比，2014-2017 年筛查组和对照组的调整死亡率比值分别为 0.93（0.86-1.00）和 1.07（1.00-1.15）。就百分比变化而言，1991-2003 年与 2014-2017 年之间减少了 7.49%，对照组与筛查组之间减少了 14.76%。
全国性筛查计划有效降低了结直肠癌死亡率。将 70-74 岁人群纳入筛查计划的目标人群，并将医疗中心和诊所纳入该计划以有效推广筛查检测，这进一步降低了结直肠癌死亡率。
