在新冠疫情大流行之前和期间，在一个拥有全民保险的大型组织中，结直肠癌筛查存在种族/民族和社会经济差异。
Racial/ethnic and socioeconomic disparities in colorectal cancer screening in a large organization with universal insurance before and during the coronavirus disease 2019 pandemic.
机构信息
Division of Gastroenterology, Rabin Medical Center, Clalit Health Services, Israel.
Tel Aviv University, Israel.
出版信息
J Med Screen. 2024 Jun;31(2):85-90. doi: 10.1177/09691413231214186. Epub 2023 Nov 14.
OBJECTIVES
Israel is regarded as a country with a developed economy and a moderate income inequality index. In this population-based study, we aimed to measure the inequalities in colorectal cancer screening within Clalit Health, an organization with universal insurance, before and during the coronavirus disease 2019 pandemic.
SETTING
Retrospective analysis within Clalit Health Services, Israel.
METHODS
We evaluated the rate of being up to date with screening (having a colonoscopy within 10 years or a fecal occult blood test within 1 year) and the colonoscopy completion rate (having a colonoscopy within 6 months of a positive fecal occult blood test) among subjects aged 50-75 in 2019-2021.
RESULTS
In 2019, out of 918,135 subjects, 61.3% were up to date with screening; high socioeconomic status: 65.9% (referent), medium-socioeconomic status: 60.1% (odds ratio 0.81, 95% confidence interval 0.80-0.82), low-socioeconomic status: 59.0% (odds ratio 0.75, 95% confidence interval 0.74-0.75); Jews: 61.9% (referent), Arabs: 59.7% (odds ratio 0.91, 95% confidence interval 0.90-0.92), Ultraorthodox-Jews: 51.7% (odds ratio 0.77, 95% confidence interval 0.75-0.78). Out of 21,308 with a positive fecal occult blood test, the colonoscopy completion rate was 51.8%; high-socioeconomic status: 59.8% (referent), medium-socioeconomic status: 54.1% (odds ratio 0.79, 95% confidence interval 0.73-0.86), low-socioeconomic status: 45.5% (odds ratio 0.60, 95% confidence interval 0.56-0.65); Jews: 54.7% (referent), Ultraorthodox-Jews: 51.4% (odds ratio 0.91, 95% confidence interval 0.90-0.92), Arabs: 44.7% (odds ratio 0.77, 95% confidence interval 0.75-0.78). In 2020-2021, there was a slight drop in the rate of being up to date with screening, while most of the discrepancies were kept or slightly increased with time.
CONCLUSIONS
We report significant inequalities in colorectal cancer screening before and during the coronavirus disease 2019 pandemic in Israel, despite a declared policy of equality and universal insurance.
目的
以色列被认为是一个经济发达、收入不平等指数适中的国家。在这项基于人群的研究中，我们旨在衡量在 2019 年冠状病毒病大流行之前和期间，拥有全民保险的克拉利特健康服务组织（Clalit Health Services）中，结直肠癌筛查的不平等情况。
背景
以色列克拉利特健康服务组织的回顾性分析。
方法
我们评估了 2019-2021 年间年龄在 50-75 岁的人群中，接受筛查（10 年内进行结肠镜检查或 1 年内进行粪便潜血检查）的比例和结肠镜检查完成率（在粪便潜血检查阳性后 6 个月内进行结肠镜检查）。
结果
在 2019 年，918135 名受试者中，61.3%的人接受了筛查；高社会经济地位：65.9%（参照），中社会经济地位：60.1%（比值比 0.81，95%置信区间 0.80-0.82），低社会经济地位：59.0%（比值比 0.75，95%置信区间 0.74-0.75）；犹太人：61.9%（参照），阿拉伯人：59.7%（比值比 0.91，95%置信区间 0.90-0.92），极端正统派犹太人：51.7%（比值比 0.77，95%置信区间 0.75-0.78）。在 21308 例粪便潜血检查阳性的患者中，结肠镜检查完成率为 51.8%；高社会经济地位：59.8%（参照），中社会经济地位：54.1%（比值比 0.79，95%置信区间 0.73-0.86），低社会经济地位：45.5%（比值比 0.60，95%置信区间 0.56-0.65）；犹太人：54.7%（参照），极端正统派犹太人：51.4%（比值比 0.91，95%置信区间 0.90-0.92），阿拉伯人：44.7%（比值比 0.77，95%置信区间 0.75-0.78）。在 2020-2021 年，接受筛查的比例略有下降，但大多数差异随着时间的推移保持不变或略有增加。
结论
尽管有平等和全民保险的宣言政策，但在 2019 年冠状病毒病大流行之前和期间，我们报告了以色列结直肠癌筛查方面存在显著的不平等现象。
Zotero 插件