与年度肺癌筛查纵向依从性相关的决定因素：索赔数据分析的回顾性分析。
Determinants Associated With Longitudinal Adherence to Annual Lung Cancer Screening: A Retrospective Analysis of Claims Data.
机构信息
Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
出版信息
J Am Coll Radiol. 2021 Aug;18(8):1084-1094. doi: 10.1016/j.jacr.2021.03.003. Epub 2021 Mar 30.
OBJECTIVE
Lung cancer screening (LCS) efficacy is highly dependent on adherence to annual screening, but little is known about real-world adherence determinants. We used insurance claims data to examine associations between LCS annual adherence and demographic, comorbidity, health care usage, and geographic factors.
MATERIALS AND METHODS
Insurance claims data for all individuals with an LCS low-dose CT scan were obtained from the Colorado All Payer Claims Dataset. Adherence was defined as a second claim for a screening CT 10 to 18 months after the index claim. Cox proportional hazards regression was used to define the relationship between annual adherence and age, gender, insurance type, residence location, outpatient health care usage, and comorbidity burden.
RESULTS
After exclusions, the final data set consisted of 9,056 records with 3,072 adherent, 3,570 nonadherent, and 2,414 censored (unclassifiable) individuals. Less adherence was associated with ages 55 to 59 (hazard ratio [HR] = 0.80, 99% confidence interval [CI] = 0.67-0.94), 60 to 64 (HR = 0.83, 99% CI = 0.71-0.97), and 75 to 79 (HR = 0.79, 99% CI = 0.65-0.97); rural residence (HR = 0.56, 99% CI = 0.43-0.73); Medicare fee-for-service (HR = 0.45, 99% CI = 0.39-0.51), and Medicaid (HR = 0.50, 99% CI = 0.40-0.62). A significant interaction between outpatient health care usage and comorbidity was also observed. Increased outpatient usage was associated with increased adherence and was most pronounced for individuals without comorbidities.
CONCLUSIONS
This population-based description of LCS adherence determinants provides insight into populations that might benefit from specific interventions targeted toward improving adherence and maximizing LCS benefit. Quantifying population-based adherence rates and understanding factors associated with annual adherence are critical to improving screening adherence and reducing lung cancer death.
目的
肺癌筛查（LCS）的效果高度依赖于每年的筛查依从性，但对于真实世界中决定依从性的因素知之甚少。我们使用保险索赔数据来研究 LCS 年度依从性与人口统计学、合并症、医疗保健使用和地理因素之间的关系。
材料和方法
从科罗拉多州所有支付者索赔数据集获取所有接受 LCS 低剂量 CT 扫描的个体的保险索赔数据。依从性定义为在索引索赔后 10 至 18 个月内第二次进行筛查 CT 扫描的索赔。使用 Cox 比例风险回归来定义年度依从性与年龄、性别、保险类型、居住地点、门诊医疗保健使用和合并症负担之间的关系。
结果
排除后，最终数据集包含 9056 条记录，其中 3072 条为依从者，3570 条为不依从者，2414 条为（无法分类）记录。年龄在 55 至 59 岁（风险比 [HR] = 0.80，99%置信区间 [CI] = 0.67-0.94）、60 至 64 岁（HR = 0.83，99%CI = 0.71-0.97）和 75 至 79 岁（HR = 0.79，99%CI = 0.65-0.97）的个体依从性较低；农村居住（HR = 0.56，99%CI = 0.43-0.73）；医疗保险费用分担制（HR = 0.45，99%CI = 0.39-0.51）和医疗补助（HR = 0.50，99%CI = 0.40-0.62）。还观察到门诊医疗保健使用和合并症之间存在显著的相互作用。门诊使用量增加与依从性增加相关，并且在没有合并症的个体中最为明显。
结论
本研究基于人群的 LCS 依从性决定因素描述为特定干预措施提供了深入的见解，这些干预措施可能有助于提高依从性并最大限度地提高 LCS 获益，改善筛查的依从性并降低肺癌死亡率。
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