From the Department of Medicine, Division of Digestive Diseases, University of Mississippi Medical Center, Jackson, and the Mississippi State Department of Health, Jackson.
South Med J. 2020 Jul;113(7):360-365. doi: 10.14423/SMJ.0000000000001115.
Mississippi has one of the highest mortality rates in colorectal cancer (CRC) and one of the lowest rates of CRC screening in the United States. The purpose of the study was to assess the characteristics of Mississippians who met the US Preventive Services Task Force (USPSTF) recommendation on CRC screening and type of the test they used.
We analyzed the data from the 2018 Mississippi Behavioral Risk Factor Surveillance System (N = 5843), which included a CRC screening module for participants who were 50 years old or older. Respondents in this module were asked when, if ever, they had last undergone a colonoscopy, sigmoidoscopy, or stool occult test. Their responses were then categorized according to their compliance with the USPSTF recommendations on CRC screening. We compared the compliance with responders' sociodemographic and risk factors. Data analysis accounted for the complex sampling design.
The majority of the CRC screening tests are colonoscopies: 60.1% of Mississippians aged 50 to 75 years had received one within 10 years. In addition, 7.8% had taken a stool test within the last year, and 1.9% had undergone sigmoidoscopy within 5 years. The prevalence of individuals aged 50 to 75 in Mississippi who met the USPSTF recommendation for CRC screening in 2018 was 62.6%. Women (65.5%), married (67.5%), those with health insurance (66.5%) or annual household income of ≥$75,000 (71.6%), those with a regular healthcare provider (68.0%), or those who quit smoking (70.4%) had higher compliance than their counterparts. After controlling for the covariates, the adults aged 50 to 75 who had health insurance or had a personal healthcare provider were 2.52 and 2.95 times more likely to be compliant, respectively ( < 0.001). Those who had quit smoking were 2.27 times more likely to be compliant with the USPSTF than current smokers ( < 0.001). Weight status, binge drinking, or physical inactivity was not associated with the CRC screening rates.
Mississippi adults aged 50 to 75 were more likely to be compliant with the CRC screening standards if they had insurance coverage or access to care. To further increase the overall CRC screening rate and for the benefit of the 70 × 2020 state initiative, certain screenings such as stool test need to be promoted and recommended by family practitioners, and certain subgroups of the population such as smokers need to be targeted and educated.
密西西比州是美国结直肠癌（CRC）死亡率最高和 CRC 筛查率最低的州之一。本研究的目的是评估符合美国预防服务工作组（USPSTF）CRC 筛查建议并使用特定筛查方法的密西西比居民的特征。
我们分析了 2018 年密西西比州行为风险因素监测系统（N=5843）的数据，该系统包括针对 50 岁及以上参与者的 CRC 筛查模块。该模块中的受访者被问及他们最后一次进行结肠镜检查、乙状结肠镜检查或粪便潜血检查的时间，如果有的话。然后，根据他们是否符合 USPSTF 对 CRC 筛查的建议对他们的回答进行分类。我们比较了符合响应者社会人口统计学和风险因素的情况。数据分析考虑了复杂的抽样设计。
大多数 CRC 筛查测试是结肠镜检查：50 至 75 岁的密西西比州人中，有 60.1%的人在 10 年内进行了一次检查。此外，7.8%的人在过去一年接受了粪便检查，1.9%的人在过去 5 年内接受了乙状结肠镜检查。2018 年，符合 USPSTF CRC 筛查建议的密西西比州 50 至 75 岁人群的患病率为 62.6%。女性（65.5%）、已婚（67.5%）、有医疗保险（66.5%）或年收入≥75,000 美元（71.6%）、有固定医疗服务提供者（68.0%）或已戒烟（70.4%）的人群比其他人群更符合建议。在控制了协变量后，有医疗保险或有个人医疗服务提供者的 50 至 75 岁成年人分别更有可能符合建议（<0.001）。与当前吸烟者相比，已戒烟者更有可能符合 USPSTF 的建议（<0.001）。体重状况、狂饮或身体活动不足与 CRC 筛查率无关。
如果密西西比州 50 至 75 岁成年人有医疗保险或获得医疗服务，他们更有可能符合 CRC 筛查标准。为了进一步提高总体 CRC 筛查率，并为 70×2020 年州倡议带来益处，需要由家庭医生推广和推荐某些筛查，如粪便检查，并针对吸烟者等特定人群进行目标教育。
