Cirugía Computacional, Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain.
Department of Sociology 2, Social and Communication Sciences Faculty, University of the Basque Country UPV-EHU, Leioa, Bizkaia, Spain.
Eur J Public Health. 2020 Jun 1;30(3):416-425. doi: 10.1093/eurpub/ckz236.
Colorectal cancer (CRC) is a major public health problem due to its incidence and mortality. Screening programmes help decrease its impact on the population through early detection. However, the uneven distribution of social determinants of health can cause inequalities. The aim of this study is to identify the social inequalities in the participation in CRC screening programmes.
A systematic review of the literature was carried out, searching in both health and social databases for papers published since 2000 in English, Spanish, Portuguese and French. The search strategies combined terms regarding screening, CRC, participation and social inequalities. Included papers were quantitative or qualitative primary studies analyzing gender and socioeconomic inequalities in the participation in CRC screening programmes implemented by public and private health-care providers and addressing 45- to 75-year-old population.
A total of 96 studies, described in 102 articles, were included. Most were quantitative observational studies and analyzed population-based screening programmes. They were carried out mainly in the UK (n=29) and the USA (n=18). Participation in screening programmes varied from 1.1% to 82.8% using several methods. A total of 87 studies assessed participation by sex and one focussed on men, but only two provided an analysis from a gender perspective. Although men are at a higher risk of developing CRC, they generally were less likely to participate in screening programmes. Screening attendance was higher among the least deprived areas.
Gender and socioeconomic inequalities in CRC screening participation should be addressed through the design of tailored interventions with a multidimensional focus.
由于结直肠癌（CRC）的发病率和死亡率，它是一个主要的公共卫生问题。通过早期发现，筛查计划有助于降低其对人群的影响。然而，健康社会决定因素的分布不均会导致不平等。本研究旨在确定 CRC 筛查计划参与方面的社会不平等。
对文献进行了系统的回顾，在健康和社会数据库中搜索了自 2000 年以来发表的英文、西班牙语、葡萄牙语和法语论文。搜索策略结合了筛查、CRC、参与和社会不平等方面的术语。纳入的论文是定量或定性的初级研究，分析了公共和私人医疗保健提供者实施的 CRC 筛查计划中性别和社会经济不平等参与情况，并针对 45 至 75 岁的人群。
共纳入 96 项研究，共 102 篇文章。大多数是定量观察性研究，分析了基于人群的筛查计划。它们主要在英国（n=29）和美国（n=18）进行。使用多种方法，筛查计划的参与率从 1.1%到 82.8%不等。共有 87 项研究评估了性别参与情况，其中一项专门针对男性，但只有两项从性别角度进行了分析。尽管男性患 CRC 的风险更高，但他们参与筛查计划的可能性通常较低。筛查出勤率在最不富裕地区较高。
应通过设计具有多维重点的定制干预措施来解决 CRC 筛查参与方面的性别和社会经济不平等问题。
