Sonoda Kento, Sales Joanne, Bello Jennifer K, Grucza Richard A, Scherrer Jeffrey F
Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri.
The AHEAD Institute, Saint Louis University School of Medicine, St. Louis, Missouri.
AJPM Focus. 2024 Mar 1;3(3):100218. doi: 10.1016/j.focus.2024.100218. eCollection 2024 Jun.
There is limited evidence on colorectal cancer screening among individuals with a substance use disorder. This study aims to investigate the association between personal history of a substance use disorder and colorectal cancer colonoscopy screening completion rates.
This retrospective cohort study analyzed 176,300 patients, of whom 171,973 had no substance use disorder and 4,327 had a substance use disorder diagnosis from electronic health record data (January 1, 2008-December 31, 2022) in a Midwestern healthcare system. Baseline was January 1, 2013, and a 10-year follow-up period ran through December 31, 2022. The outcome was receipt of colonoscopy in the 10-year follow-up period. Patients were aged 50-65 years at baseline, meaning that they were eligible for a colonoscopy through the entirety of the 10-year follow-up period. Covariates included demographics (age, race, and neighborhood SES), health services utilization, psychiatric and physical comorbidities, and prior colonoscopy or fecal occult blood testing. Entropy balancing was used to control for confounding in weighted log-binomial models calculating RR and 95% CIs.
Patients were on average aged 57.1 (±4.5) years, 58.2% were female, 81.0% were White, and 16.9% were of Black race. The most prevalent comorbidities were obesity (29.6%) and hypertension (29.4%), followed by smoking/nicotine dependence (21.0%). The most prevalent psychiatric comorbidity was depression (6.4%), followed by anxiety disorder (4.5%). During the 10-year follow-up period, 40.3% of eligible patients completed a colorectal cancer colonoscopy screening test, and individuals with a substance use disorder diagnosis were significantly less likely to receive a colorectal cancer colonoscopy screening test both prior to and after controlling for confounding (RR=0.73; 95% CI=0.70, 0.77 and RR=0.81; 95% CI=0.74, 0.89, respectively). Results were not modified by sex, race, psychiatric comorbidity, or neighborhood SES.
Personal history of substance use disorder was independently associated with lower screening completion rates. Healthcare professionals should recognize unique barriers among individuals with substance use disorder and then address them individually as a multidisciplinary team in the outpatient setting to reduce this health disparity.
关于物质使用障碍患者的结直肠癌筛查证据有限。本研究旨在调查物质使用障碍个人史与结直肠癌结肠镜检查完成率之间的关联。
这项回顾性队列研究分析了176,300名患者，其中171,973人没有物质使用障碍，4,327人有物质使用障碍诊断，数据来自中西部医疗系统的电子健康记录（2008年1月1日至2022年12月31日）。基线为2013年1月1日，为期10年的随访期至2022年12月31日。结局是在10年随访期内接受结肠镜检查。患者基线年龄为50 - 65岁，这意味着他们在整个10年随访期内都符合结肠镜检查条件。协变量包括人口统计学特征（年龄、种族和邻里社会经济地位）、医疗服务利用情况、精神和身体合并症以及既往结肠镜检查或粪便潜血试验。在计算RR和95%CI的加权对数二项式模型中，使用熵平衡来控制混杂因素。
患者平均年龄为57.1（±4.5）岁，58.2%为女性，81.0%为白人，16.9%为黑人。最常见的合并症是肥胖（29.6%）和高血压（29.4%），其次是吸烟/尼古丁依赖（21.0%）。最常见的精神合并症是抑郁症（6.4%），其次是焦虑症（4.5%）。在10年随访期内，40.3%的符合条件患者完成了结直肠癌结肠镜筛查试验，在控制混杂因素之前和之后，有物质使用障碍诊断的个体接受结直肠癌结肠镜筛查试验的可能性均显著降低（RR分别为0.73；95%CI = 0.70, 0.77和RR = 0.81；95%CI = 0.74, 0.89）。结果不受性别、种族、精神合并症或邻里社会经济地位的影响。
物质使用障碍个人史与较低的筛查完成率独立相关。医疗保健专业人员应认识到物质使用障碍患者中的独特障碍，然后在门诊环境中作为多学科团队分别加以解决，以减少这种健康差距。
