Søgaard Rikke, Diederichsen Axel, Lindholt Jes
Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 4, Odense 5000, Denmark.
Department of Cardiology, Odense University Hospital, Odense, Denmark.
Eur Heart J Open. 2023 May 23;3(3):oead055. doi: 10.1093/ehjopen/oead055. eCollection 2023 May.
To examine the impact of population screening-generated events on quality of life: invitation, positive test result, initiation of preventive medication, enrolment in follow-up at the surgical department, and preventive surgical repair.
A difference-in-difference design based on data collected alongside two randomized controlled trials where general population men were randomized to screening for cardiovascular disease or to no screening. Repeated measurements of health-related quality of life (HRQoL) were conducted up to 3 years after inclusion using all relevant scales of the EuroQol instrument: the anxiety/depression dimension, the EuroQol 5-dimension profile index (using Danish preference weights), and the visual analogue scale for global health. We compare the mean change scores from before to after events for groups experiencing vs. not experiencing the events. Propensity score matching is additionally used to provide both unmatched and matched results. Invitees reported to be marginally better off than non-invitees on all scales of the EuroQol. For events of receiving the test result, initiating preventive medication, being enrolled in surveillance, and undergoing surgical repair, we observed no impact on overall HRQoL but a minor impact of being enrolled in surveillance on emotional distress, which did not persist after matching.
The often-claimed detrimental consequences of screening to HRQoL could not be generally confirmed. Amongst the screening events assessed, only two possible consequences were revealed: a reassurance effect after a negative screening test and a minor negative impact to emotional distress of being enrolled in surveillance that did not spill over to overall HRQoL.
研究人群筛查所产生的事件对生活质量的影响，这些事件包括：收到筛查邀请、检测结果呈阳性、开始预防性药物治疗、在外科部门登记接受随访以及进行预防性手术修复。
采用差异中的差异设计，该设计基于在两项随机对照试验过程中收集的数据，在这两项试验中，将普通男性人群随机分为接受心血管疾病筛查组或不接受筛查组。使用欧洲生活质量量表（EuroQol）的所有相关量表，在纳入研究后长达3年的时间里对健康相关生活质量（HRQoL）进行重复测量：焦虑/抑郁维度、欧洲生活质量五维度概况指数（使用丹麦偏好权重）以及整体健康视觉模拟量表。我们比较了经历这些事件与未经历这些事件的组在事件前后的平均变化得分。此外，使用倾向得分匹配法来提供未匹配和匹配后的结果。在欧洲生活质量量表的所有维度上，收到邀请者的状况略好于未收到邀请者。对于收到检测结果、开始预防性药物治疗、登记接受监测以及接受手术修复这些事件，我们观察到对整体健康相关生活质量没有影响，但登记接受监测对情绪困扰有轻微影响，在匹配后这种影响不再持续。
通常所说的筛查对健康相关生活质量产生有害影响这一说法无法得到普遍证实。在评估的筛查事件中，仅发现了两种可能的后果：阴性筛查试验后的安心效应以及登记接受监测对情绪困扰产生的轻微负面影响，且这种影响并未波及整体健康相关生活质量。
