Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105E McGavran-Greenberg Hall, Chapel Hill, NC, CB #7411, USA.
Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Cancer Causes Control. 2023 Dec;34(Suppl 1):187-198. doi: 10.1007/s10552-023-01723-w. Epub 2023 Jun 7.
Assessing factors associated with being up-to-date with colorectal cancer (CRC) screening is important for identifying populations for which targeted interventions may be needed.
This study used Medicare and private insurance claims data for residents of North Carolina to identify up-to-date status in the 10th year of continuous enrollment in the claims data and in available subsequent years. USPSTF guidelines were used to define up-to-date status for multiple recommended modalities. Area Health Resources Files provided geographic and health care service provider data at the county level. A generalized estimating equation logistic regression model was used to examine the association between individual- and county-level characteristics and being up-to-date with CRC screening.
From 2012-2016, 75% of the sample (n = 274,660) age 59-75 was up-to-date. We identified several individual- (e.g., sex, age, insurance type, recent visit with a primary care provider, distance to nearest endoscopy facility, insurance type) and county-level (e.g., percentage of residents with a high school education, without insurance, and unemployed) predictors of being up-to-date. For example, individuals had higher odds of being up-to-date if they were age 73-75 as compared to age 59 [OR: 1.12 (1.09, 1.15)], and if living in counties with more primary care physicians [OR: 1.03 (1.01, 1.06)].
This study identified 12 individual- and county-level demographic characteristics related to being up-to-date with screening to inform how interventions may optimally be targeted.
评估与结直肠癌（CRC）筛查及时相关的因素对于确定需要针对性干预的人群非常重要。
本研究使用北卡罗来纳州居民的医疗保险和私人保险索赔数据，在索赔数据的连续 10 年和随后的可用年份中确定最新状态。USPSTF 指南用于定义多种推荐方法的最新状态。地区卫生资源档案提供了县级的地理和医疗服务提供商数据。使用广义估计方程逻辑回归模型检查个体和县级特征与 CRC 筛查及时之间的关联。
在 2012-2016 年期间，样本中 75%（n=274660）年龄在 59-75 岁的人是最新的。我们确定了几个个体（例如，性别、年龄、保险类型、最近与初级保健提供者的就诊、与最近内窥镜设施的距离、保险类型）和县级（例如，具有高中教育程度、没有保险和失业的居民百分比）预测因素与筛查及时相关。例如，与年龄 59 岁相比，年龄在 73-75 岁的个体及时接受筛查的可能性更高[OR：1.12（1.09，1.15）]，并且居住在初级保健医生较多的县的个体[OR：1.03（1.01，1.06）]。
本研究确定了 12 个与筛查及时相关的个体和县级人口统计学特征，以了解如何最佳地针对干预措施。
