Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, NE, USA.
Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Cancer Med. 2022 Dec;11(24):5013-5024. doi: 10.1002/cam4.4842. Epub 2022 May 29.
African Americans (AAs) have had lower colorectal cancer (CRC) screening rates, higher incidence rate, and earlier mean age at onset. The 2017 U.S. Multi-Society Task Force (MSTF) recommended initiating CRC screening at age 45 for AAs and age 50 for non-AAs.
To investigate the impact of the 2017 MSTF's race-specific guidelines on CRC screening rate among young AAs.
DESIGN, SETTING, AND PARTICIPANTS: We used the 2015 and 2018 National Health Interview Survey to provide nationally representative estimates. The study sample included adults aged between 45 and 75 without a history of CRC, excluding screening recipients for diagnosis or surveillance purposes.
The outcome is a binary variable of CRC screening. Primary independent variables were age and race category (non-AAs aged 45-49, AAs 45-49, non-AAs 50-75, AAs 50-75), a binary variable indicating before or after the 2017 MSTF guideline (2015 vs. 2018), and their interaction terms. We employed a multivariable logistic model, adjusting for individual characteristics, and accounting for complex survey design.
Among the total sample (n = 21,735), CRC screening rate increased from 54.6% in 2015 to 58.5% in 2018 (p < 0.01). By age and race, the screening rate exhibited an increase for all age and race groups except for young non-AAs. Compared to young non-AAs, the adjusted predicted probability (APP) of screening for young AAs was significantly higher by 0.10 (average marginal effect, 0.10; 95% confidence interval, 0.01-0.19) in 2018, while the difference was insignificant in 2015. Racial differences in screening among older adults were not significant in both years. The CRC screening rate was substantially lower among young AAs compared to older AAs (17.2% vs. 65.5% in 2018).
The race-specific recommendation is an effective policy tool to increase screening uptake and would contribute to reducing cancer disparities among racial/ethnic minorities.
非裔美国人（African Americans，AAs）的结直肠癌（colorectal cancer，CRC）筛查率较低，发病率较高，发病平均年龄较早。2017 年美国多学会工作组（Multi-Society Task Force，MSTF）建议非裔美国人从 45 岁开始，而非非裔美国人从 50 岁开始进行 CRC 筛查。
研究 2017 年 MSTF 针对特定种族的指南对年轻非裔美国人 CRC 筛查率的影响。
设计、地点和参与者：我们使用 2015 年和 2018 年全国健康访谈调查（National Health Interview Survey）提供全国代表性估计。研究样本包括年龄在 45 至 75 岁之间、无 CRC 病史的成年人，不包括为诊断或监测目的进行筛查的患者。
结局为 CRC 筛查的二分类变量。主要的独立变量是年龄和种族类别（非裔美国人 45-49 岁、45-49 岁的非裔美国人、非裔美国人 50-75 岁、50-75 岁的非裔美国人）、一个表示在 2017 年 MSTF 指南之前或之后的二分类变量（2015 年与 2018 年）及其交互项。我们采用多变量逻辑模型，调整个体特征，并考虑到复杂的调查设计。
在总样本（n=21735）中，CRC 筛查率从 2015 年的 54.6%上升至 2018 年的 58.5%（p<0.01）。按年龄和种族划分，除年轻非裔美国人外，所有年龄和种族组的筛查率均有所上升。与年轻非裔美国人相比，2018 年年轻非裔美国人的筛查预测概率（adjusted predicted probability，APP）显著高出 0.10（平均边缘效应，0.10；95%置信区间，0.01-0.19），而 2015 年的差异不显著。在这两年中，老年成年人的筛查种族差异均不显著。与老年非裔美国人相比，年轻非裔美国人的 CRC 筛查率明显较低（2018 年分别为 17.2%和 65.5%）。
针对特定种族的建议是增加筛查参与率的有效政策工具，将有助于减少少数族裔的癌症差异。
