美国成年人憩室炎的流行病学和憩室炎后首次结直肠癌的流行率：一项基于人群的全国性研究。

Epidemiology of Diverticulitis and Prevalence of First-Ever Colorectal Cancer Postdiverticulitis in Adults in the United States: A Population-Based National Study.

机构信息

Department of Internal Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.

Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.

出版信息

Dis Colon Rectum. 2021 Feb 1;64(2):181-189. doi: 10.1097/DCR.0000000000001837.

DOI:10.1097/DCR.0000000000001837

PMID:33044246

Abstract

BACKGROUND

The incidence of acute diverticulitis is increasing, and previous studies showed a wide range of prevalence of colorectal cancer after diverticulitis. There is a lack of high-quality evidence to support performing colonoscopy after diverticulitis.

OBJECTIVE

We aimed to describe the incidence of first-ever diverticulitis and prevalence of first-ever colorectal cancer postdiverticulitis in the United States.

DESIGN

This is a retrospective cohort study.

SETTINGS

We queried a national database that contains data from 26 major integrated healthcare systems in the United States.

PATIENTS

We identified an aggregated patient cohort aged ≥18 years with a diagnosis of first-ever diverticulitis from February 2015 to February 2020, followed by first-ever colorectal cancer diagnosis, at least 1 day after and within 1 year of diverticulitis.

MAIN OUTCOME MEASURES

The incidence of first-ever diverticulitis was calculated. The prevalence and OR of first-ever colorectal cancer after diverticulitis were analyzed.

RESULTS

Among 31,778,290 individuals, we found the incidence of first-ever acute diverticulitis to be 2.9%. The prevalence of colorectal cancer within 1 year of first-ever acute diverticulitis was 0.57%, whereas the prevalence of colorectal cancer without a history of diverticulitis was 0.31% (OR = 1.8 (95% CI, 1.76-1.86)). The majority (92.3%) of the postdiverticulitis colorectal cancer were diagnosed within the first 6 months. The risk of colorectal cancer postdiverticulitis was higher in women (OR = 1.9), African Americans (OR = 2.0), and adults aged 18 to 65 years (OR = 2.3).

LIMITATIONS

We are unable to validate the diagnostic code because patient information in our database is deidentified.

CONCLUSIONS

Individuals are twice as likely to be diagnosed with colorectal cancer within 1 year of their first episode of acute diverticulitis compared with individuals without diverticulitis. We advocate for colonoscopy after the first occurrence of acute diverticulitis to screen for colorectal cancer, particularly for patients without a recent colonoscopy. See Video Abstract at http://links.lww.com/DCR/B412.

摘要

背景

急性憩室炎的发病率正在上升，先前的研究表明憩室炎后结直肠癌的患病率范围很广。目前缺乏高质量的证据支持在憩室炎后进行结肠镜检查。

目的

我们旨在描述美国首次发生憩室炎和首次发生憩室炎后结直肠癌的发病率。

设计

这是一项回顾性队列研究。

设置

我们查询了一个包含来自美国 26 个主要综合医疗系统数据的国家数据库。

患者

我们确定了一个年龄≥18 岁的汇总患者队列，这些患者在 2015 年 2 月至 2020 年 2 月期间首次被诊断为憩室炎，随后在憩室炎后至少 1 天且在 1 年内首次被诊断为结直肠癌。

主要观察指标

计算首次发生憩室炎的发病率。分析憩室炎后首次发生结直肠癌的患病率和比值比（OR）。

结果

在 31778290 人中，我们发现首次发生急性憩室炎的发病率为 2.9%。首次发生急性憩室炎后 1 年内结直肠癌的患病率为 0.57%，而无憩室炎病史的结直肠癌患病率为 0.31%（OR=1.8（95%CI，1.76-1.86））。大多数（92.3%）发生在憩室炎后的结直肠癌在 6 个月内被诊断出来。女性（OR=1.9）、非裔美国人（OR=2.0）和 18 至 65 岁的成年人（OR=2.3）发生憩室炎后结直肠癌的风险更高。