社会人口统计学因素对初级保健中粪便免疫化学检测接受率的影响：一项回顾性研究。
Sociodemographic variations in the uptake of faecal immunochemical tests in primary care: a retrospective study.
机构信息
Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust; School of Medicine, University of Nottingham, Nottingham.
Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust; School of Medicine, University of Nottingham, Nottingham; National Institute for Health and Care Research (NIHR) Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham.
出版信息
Br J Gen Pract. 2023 Oct 26;73(736):e843-e849. doi: 10.3399/BJGP.2023.0033. Print 2023 Nov.
BACKGROUND
Faecal immunochemical test (FIT) usage for symptomatic patients is increasing, but variations in use caused by sociodemographic factors are unknown. A clinical pathway for colorectal cancer (CRC) was introduced in primary care for symptomatic patients in November 2017. The pathway was commissioned to provide GPs with direct access to FITs.
AIM
To identify whether sociodemographic factors affect FIT return in symptomatic patients.
DESIGN AND SETTING
A retrospective study was undertaken in Nottingham, UK, following the introduction of FIT as triage tool in primary care. It was mandated for all colorectal referrals (except rectal bleeding or mass) to secondary care. FIT was used, alongside full blood count and ferritin, to stratify CRC risk.
METHOD
All referrals from November 2017 to December 2021 were retrospectively reviewed. Sociodemographic factors affecting FIT return were analysed by multivariate logistic regression.
RESULTS
A total of 35 289 (90.7%) patients returned their index FIT, while 3631 (9.3%) did not. On multivariate analysis, males were less likely to return an FIT (odds ratio [OR] 1.11, 95% confidence interval [CI] = 1.03 to 1.19). Patients aged ≥65 years were more likely to return an FIT (OR 0.78 for non-return, 95% CI = 0.72 to 0.83). Unreturned FIT more than doubled in the most compared with the least deprived quintile (OR 2.20, 95% CI = 1.99 to 2.43). Patients from Asian (OR 1.82, 95% CI = 1.58 to 2.10), Black (OR 1.21, 95% CI = 0.98 to 1.49), and mixed or other ethnic groups (OR 1.29, 95% CI = 1.05 to 1.59) were more likely to not return an FIT compared with patients from a White ethnic group. A total of 599 (1.5%) CRCs were detected; 561 in those who returned a first FIT request.
CONCLUSION
FIT return in those suspected of having CRC varied by sex, age, ethnic group, and socioeconomic deprivation. Strategies to mitigate effects on FIT return and CRC detection should be considered as FIT usage expands.
背景
粪便免疫化学检测（FIT）在有症状患者中的使用正在增加，但由于社会人口因素导致的使用差异尚不清楚。2017 年 11 月，为有症状患者引入了用于结直肠癌（CRC）的临床路径，该路径旨在为全科医生提供直接使用 FIT 的途径。
目的
确定社会人口因素是否会影响有症状患者的 FIT 返回。
设计和设置
在英国诺丁汉，在将 FIT 作为初级保健中的筛查工具引入后，进行了一项回顾性研究。它被授权用于所有除直肠出血或肿块外的结直肠转诊至二级保健。FIT 与全血细胞计数和铁蛋白一起用于分层 CRC 风险。
方法
回顾性分析了 2017 年 11 月至 2021 年 12 月的所有转诊患者。通过多变量逻辑回归分析影响 FIT 返回的社会人口因素。
结果
共有 35289 名（90.7%）患者返回了他们的初始 FIT，而 3631 名（9.3%）未返回。多变量分析显示，男性更不可能返回 FIT（比值比[OR]1.11，95%置信区间[CI]为 1.03 至 1.19）。≥65 岁的患者更有可能返回 FIT（非返回的 OR 为 0.78，95%CI 为 0.72 至 0.83）。与最贫困的五分位数相比，未返回的 FIT 增加了一倍多（OR 2.20，95%CI 为 1.99 至 2.43）。与来自白人种族的患者相比，来自亚洲（OR 1.82，95%CI 为 1.58 至 2.10）、黑人（OR 1.21，95%CI 为 0.98 至 1.49）和混合或其他种族群体（OR 1.29，95%CI 为 1.05 至 1.59）的患者更有可能不返回 FIT。共发现 599 例（1.5%）CRC；561 例在返回第一份 FIT 请求的患者中发现。
结论
在疑似患有 CRC 的患者中，FIT 的返回情况因性别、年龄、种族和社会经济贫困程度而异。随着 FIT 使用的增加，应考虑采取策略来减轻对 FIT 返回和 CRC 检测的影响。
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