The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia.
Cancer Council Victoria, Melbourne, Victoria, Australia.
Aust J Rural Health. 2023 Jun;31(3):580-586. doi: 10.1111/ajr.12977. Epub 2023 Mar 13.
Colorectal cancer has geographic inequities in Australia, with higher mortality rates and lower participation in the National Bowel Cancer Screening Program (NBCSP) in remote and rural areas. The at-home kit is temperature-sensitive, necessitating a 'hot zone policy' (HZP); kits are not sent when an area's average monthly temperature is above 30°C. Australians in HZP areas are susceptible to potential screening disruptions but may benefit from well-timed interventions to improve participation. This study describes the demographics of HZP areas and estimates the impacts of potential screening changes.
The number of individuals in HZP areas was estimated, as well as correlations with remoteness, socio-economic and Indigenous status. The potential impacts of screening changes were estimated.
Over a million eligible Australians live in HZP areas, which are more likely to be remote/rural, have lower socio-economic status and higher Indigenous populations. Predictive modelling estimates that any 3-month screening disruption would increase CRC mortality rates up to 4.1 times more in HZP areas vs unaffected areas, while targeted intervention could decrease mortality rates 3.4 times more in HZP areas.
People living in affected areas would be negatively impacted by any NBCSP disruption, compounding existing inequities. However, well-timed health promotion could have a stronger impact.
澳大利亚的结直肠癌存在地理分布不均的情况，在偏远和农村地区的死亡率较高，且参与国家结直肠癌筛查计划（NBCSP）的比例较低。家用试剂盒对温度敏感，因此需要实行“热区政策”（HZP）；当一个地区的月平均温度高于 30°C 时，试剂盒将不会寄出。处于 HZP 地区的澳大利亚人可能面临潜在的筛查中断风险，但及时采取干预措施可能会提高他们的参与度。本研究描述了 HZP 地区的人口统计学特征，并估计了潜在筛查变化的影响。
估计了 HZP 地区的人数，并与偏远程度、社会经济和原住民状况进行了相关性分析。还估计了筛查变化的潜在影响。
超过 100 万符合条件的澳大利亚人居住在 HZP 地区，这些地区更偏远/农村，社会经济地位较低，原住民人口较多。预测模型估计，任何 3 个月的筛查中断都可能导致 HZP 地区的 CRC 死亡率增加 4.1 倍以上，而有针对性的干预措施可能使 HZP 地区的死亡率降低 3.4 倍以上。
任何 NBCSP 中断都会对居住在受影响地区的人产生负面影响，从而加剧现有的不平等现象。然而，及时的健康促进措施可能会产生更强烈的影响。
