Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts.
Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts.
Cancer Prev Res (Phila). 2023 Apr 3;16(4):229-237. doi: 10.1158/1940-6207.CAPR-22-0423.
Identifying factors associated with colorectal cancer screening utilization is important to guide colorectal cancer prevention and control programs. We evaluated trends and factors associated with previous-year fecal occult blood test (FOBT) use among Hispanic adults living in Puerto Rico and the U.S. mainland. Using data from the Behavioral Risk Factor Surveillance System (2012-2020), trends in FOBT use were analyzed using joinpoint regression to estimate annual percentage change (APC). Logistic regression stratified by location identified factors associated with FOBT use. FOBT was more common among Hispanic adults ages 50 to 75 years living in Puerto Rico than in the U.S. mainland [Puerto Rico: 20.5%[2012] to 45.6%[2020], APC = 11.4%; U.S. mainland: 9.9%[2012] to 16.7%[2020], APC = 5.9%]. Factors inversely associated with FOBT use were similar in Puerto Rico and the U.S. mainland, including lack of health insurance, not having a personal doctor, having a checkup >12 months ago, and not being able to see a doctor due to cost, as were factors associated with higher FOBT use, including older age, retirement, or having two or more chronic diseases. Among Hispanics living in the U.S. mainland, lack of exercise and less education were inversely associated with FOBT. Factors related to poor access to healthcare were associated with lower use of FOBT among Hispanics. Efforts to improve colorectal cancer screening in Hispanics are necessary to address health disparities across the colorectal cancer care continuum.
Colorectal cancer screening reduces cancer incidence and mortality. All screening modalities, including less invasive FOBT tests, are underutilized, especially in non-White and low-income populations. Evaluation of trends and factors associated with the increase in the use of colorectal cancer screening can inform programs to address the lack of screening among racial minorities.
确定与结直肠癌筛查利用相关的因素对于指导结直肠癌预防和控制计划至关重要。本研究评估了居住在波多黎各和美国大陆的西班牙裔成年人在前一年进行粪便潜血试验（FOBT）的趋势和相关因素。
利用行为风险因素监测系统（2012-2020 年）的数据，采用 Joinpoint 回归分析评估 FOBT 使用率的变化趋势，估计年度百分比变化（APC）。按地理位置进行分层的 logistic 回归分析确定了 FOBT 使用率的相关因素。
与居住在美国大陆的西班牙裔成年人相比，50 至 75 岁的居住在波多黎各的西班牙裔成年人进行 FOBT 的比例更高[波多黎各：20.5%（2012 年）至 45.6%（2020 年），APC=11.4%；美国大陆：9.9%（2012 年）至 16.7%（2020 年），APC=5.9%]。在波多黎各和美国大陆，与 FOBT 使用率降低相关的因素相似，包括缺乏健康保险、没有私人医生、上次体检时间超过 12 个月以及由于费用问题无法就诊，而与 FOBT 使用率较高相关的因素相似，包括年龄较大、退休或患有两种或更多种慢性疾病。在美国大陆居住的西班牙裔人群中，缺乏锻炼和受教育程度较低与 FOBT 呈负相关。与医疗保健获取困难相关的因素与西班牙裔人群中 FOBT 使用率较低有关。为了减少结直肠癌筛查中的种族差异，有必要努力提高西班牙裔人群的结直肠癌筛查率。
结直肠癌筛查可降低癌症发病率和死亡率。所有筛查方法，包括侵袭性较低的 FOBT 检测，利用率都较低，尤其是在非白人和低收入人群中。评估结直肠癌筛查使用率增加的趋势和相关因素，可以为解决少数民族人群缺乏筛查的问题提供信息。
