2019 年美国 65 岁或以上成年人按预期寿命 10 年的差异接受癌症筛查和免疫接种的情况。
Variation in Receipt of Cancer Screening and Immunizations by 10-year Life Expectancy among U.S. Adults aged 65 or Older in 2019.
机构信息
Division of Geriatrics, Gerontology and Palliative Care, Department of Medicine, University of California, San Diego, CA, USA.
Medical Care Services, County of San Diego Health and Human Services Agency, San Diego, CA, USA.
出版信息
J Gen Intern Med. 2024 Feb;39(3):440-449. doi: 10.1007/s11606-023-08439-2. Epub 2023 Oct 2.
IMPORTANCE
The likelihood of benefit from a preventive intervention in an older adult depends on its time-to-benefit and the adult's life expectancy. For example, the time-to-benefit from cancer screening is >10 years, so adults with <10-year life expectancy are unlikely to benefit.
OBJECTIVE
To examine receipt of screening for breast, prostate, or colorectal cancer and receipt of immunizations by 10-year life expectancy.
DESIGN
Analysis of 2019 National Health Interview Survey.
PARTICIPANTS
8,329 non-institutionalized adults >65 years seen by a healthcare professional in the past year, representing 46.9 million US adults.
MAIN MEASURES
Proportions of breast, prostate, and colorectal cancer screenings, and immunizations, were stratified by 10-year life expectancy, estimated using a validated mortality index. We used logistic regression to examine receipt of cancer screening and immunizations by life expectancy and sociodemographic factors.
KEY RESULTS
Overall, 54.7% of participants were female, 41.4% were >75 years, and 76.4% were non-Hispanic White. Overall, 71.5% reported being current with colorectal cancer screening, including 61.4% of those with <10-year life expectancy. Among women, 67.0% reported a screening mammogram in the past 2 years, including 42.8% with <10-year life expectancy. Among men, 56.8% reported prostate specific antigen screening in the past two years, including 48.3% with <10-year life expectancy. Reported receipt of immunizations varied from 72.0% for influenza, 68.8% for pneumococcus, 57.7% for tetanus, and 42.6% for shingles vaccination. Lower life expectancy was associated with decreased likelihood of cancer screening and shingles vaccination but with increased likelihood of pneumococcal vaccination.
CONCLUSIONS
Despite the long time-to-benefit from cancer screening, in 2019 many US adults age >65 with <10-year life expectancy reported undergoing cancer screening while many did not receive immunizations with a shorter time-to-benefit. Interventions to improve individualization of preventive care based on older adults' life expectancy may improve care of older adults.
重要性
预防干预措施对老年人的获益可能性取决于其获益时间和成年人的预期寿命。例如，癌症筛查的获益时间>10 年，因此预期寿命<10 年的成年人不太可能获益。
目的
根据预期寿命检查接受乳腺癌、前列腺癌或结直肠癌筛查和接受免疫接种的情况。
设计
对 2019 年全国健康访谈调查的分析。
参与者
过去一年由医疗保健专业人员就诊的 8329 名非机构化 65 岁以上成年人，代表 4690 万美国成年人。
主要措施
根据 10 年预期寿命对乳腺癌、前列腺癌和结直肠癌筛查和免疫接种的比例进行分层，使用经过验证的死亡率指数进行估计。我们使用逻辑回归检查了根据预期寿命和社会人口因素接受癌症筛查和免疫接种的情况。
主要结果
总体而言，参与者中 54.7%为女性，41.4%>75 岁，76.4%为非西班牙裔白人。总体而言，71.5%报告接受了结直肠癌筛查，包括<10 年预期寿命的人群中有 61.4%。在女性中，67.0%报告在过去 2 年内进行了乳房 X 光检查，包括<10 年预期寿命的人群中有 42.8%。在男性中，56.8%报告在过去两年内进行了前列腺特异性抗原筛查，包括<10 年预期寿命的人群中有 48.3%。报告的免疫接种情况各不相同，流感为 72.0%，肺炎球菌为 68.8%，破伤风为 57.7%，带状疱疹为 42.6%。较低的预期寿命与癌症筛查和带状疱疹疫苗接种的可能性降低有关，但与肺炎球菌疫苗接种的可能性增加有关。
结论
尽管癌症筛查的获益时间很长，但在 2019 年，许多<10 年预期寿命的美国 65 岁以上成年人报告接受了癌症筛查，而许多人没有接受获益时间较短的免疫接种。基于老年人的预期寿命来改善个性化预防保健干预措施可能会改善老年人的护理。
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