Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M6 Toronto, Ontario, Canada.
Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M6 Toronto, Ontario, Canada; ICES, 2075 Bayview Avenue, M4N 3M5 Toronto, Ontario, Canada.
Prev Med. 2021 Jun;147:106530. doi: 10.1016/j.ypmed.2021.106530. Epub 2021 Mar 24.
Guidelines recommend regular screening for colorectal cancer (CRC). We examined the effects of chronic comorbidities on periodic CRC testing. Using linked healthcare databases from Ontario, Canada, we assembled a population-based cohort of 50-74-year olds overdue for guideline-recommended CRC screening between April 1, 2004 and March 31, 2016. We implemented multivariable recurrent events models to determine the association between comorbidities and the rate of becoming up-to-date with periodic CRC tests. The cohort included 4,642,422 individuals. CRC testing rates were significantly lower in persons with renal disease on dialysis (hazard ratio, HR 0.66, 95% confidence interval, CI 0.63 to 0.68), heart failure (HR 0.75, CI 0.75 to 0.76), respiratory disease (HR 0.84, CI 0.83 to 0.84), cardiovascular disease (HR 0.85, CI 0.84 to 0.85), diabetes (HR 0.86, 95% CI 0.86 to 0.87) and mental illness (HR 0.88, CI 0.87 to 0.88). There was an inverse association between the number of medical conditions and the rate of CRC testing (5 vs. none: HR 0.30, CI 0.25 to 0.36; 4 vs. none: HR 0.48, CI 0.47 to 0.50; 3 vs. none: HR 0.59, CI 0.58 to 0.60; 2 vs. none: HR 0.72, CI 0.71 to 0.72; 1 vs. none: HR 0.85, CI 0.84 to 0.85). Having both medical and mental comorbidities was associated with lower testing rates than either type of comorbidity alone (HR 0.72, CI 0.71 to 0.72). In summary, chronic comorbidities present a barrier to periodic guideline-recommended CRC testing. Exploration of cancer prevention gaps in these populations is warranted.
指南建议定期进行结直肠癌（CRC）筛查。我们研究了慢性合并症对定期 CRC 检测的影响。我们使用来自加拿大安大略省的链接医疗保健数据库，组建了一个基于人群的队列，该队列由 2004 年 4 月 1 日至 2016 年 3 月 31 日期间超过建议进行 CRC 筛查年龄的 50-74 岁人群组成。我们实施了多变量复发性事件模型，以确定合并症与定期 CRC 检测率之间的关联。该队列包括 4642422 人。患有透析肾病（危险比[HR]0.66，95%置信区间[CI]0.63 至 0.68）、心力衰竭（HR 0.75，CI 0.75 至 0.76）、呼吸疾病（HR 0.84，CI 0.83 至 0.84）、心血管疾病（HR 0.85，CI 0.84 至 0.85）、糖尿病（HR 0.86，95%CI 0.86 至 0.87）和精神疾病（HR 0.88，CI 0.87 至 0.88）的人群 CRC 检测率显著降低。患有多种疾病与 CRC 检测率呈负相关（5 种 vs. 无：HR 0.30，CI 0.25 至 0.36；4 种 vs. 无：HR 0.48，CI 0.47 至 0.50；3 种 vs. 无：HR 0.59，CI 0.58 至 0.60；2 种 vs. 无：HR 0.72，CI 0.71 至 0.72；1 种 vs. 无：HR 0.85，CI 0.84 至 0.85）。患有医疗和精神合并症与任何一种合并症单独相比，检测率均较低（HR 0.72，CI 0.71 至 0.72）。总之，慢性合并症对定期推荐的 CRC 检测构成了障碍。有必要探讨这些人群中癌症预防差距。
