Dreier Maren, Brinkmann Melanie, Stahmeyer Jona Theodor, Hemmerling Melissa, Krauth Christian, Walter Ulla
Hannover Medical School, Institute for Epidemiology, Social Medicine and Health System Research, Hannover, Germany; Hannover Medical School. Institute for General Practice and Palliative Care, Hannover, Germany; AOK Niedersachsen-Statutory Health Insurance of Lower Saxony, Hannover, Germany.
Dtsch Arztebl Int. 2024 Jul 26;121(15):497-504. doi: 10.3238/arztebl.m2024.0087.
The public generally has a positive view of colorectal cancer screening, but there is still room for improvement in participation rates. The aim of this study was to identify factors that are associated with intended and actual participation.
We conducted a prospective cohort study of a random sample of insurees of the AOK (a statutory health insurance carrier) in the German federal state of Lower Saxony. 50-year-old men and 55-year-old women who were eligible for their first screening colonoscopy received a written questionnaire in June 2020, three weeks after being invited to undergo colorectal cancer screening. For those who intended to do so, we used multivariable logistic regression analysis to determine any statistical associations between sociodemographic and medical characteristics and participation rates within 30 months.
82.7% of the respondents (239/298) intended to participate, and 43.3% (129/298) actually did so within 30 months. The participation rates among persons who had already decided to have a stool test or a colonoscopy were 50.7% (36/71) and 55.2% (58/105), respectively; the participation rate among undecided persons was 33.3% (19/57). The strongest association in the regression model was with an already made appointment (OR = 11.1, 95% confidence interval: [3.9; 31.8]). After exclusion of the existingappointment variable from the regression model, living in a smaller town (OR = 2.41 [1.08; 5.35]) and a stated preference for colonoscopy (OR = 2.52; [1.20; 5.27]) were positively associated with participation. Insurees with a parent affected by colorectal cancer participated less frequently, even after adjustment for prior colonoscopies (OR = 0.31 [0.12; 0.80]).
The wide gap between intended and actual participation implies that there is potential for improvement in the prevention of colorectal cancer, and that certain groups of people could benefit from targeted support in making their intention to undergo screening a reality. Because of the methodological limitations of this initial investigation, its findings need to be confirmed by further studies.
公众对结直肠癌筛查总体持积极态度，但参与率仍有提升空间。本研究旨在确定与预期参与和实际参与相关的因素。
我们对德国下萨克森州法定健康保险公司AOK的被保险人随机样本进行了一项前瞻性队列研究。符合首次筛查结肠镜检查条件的50岁男性和55岁女性在2020年6月收到一份书面问卷，这是在被邀请进行结直肠癌筛查三周后。对于那些打算进行筛查的人，我们使用多变量逻辑回归分析来确定社会人口统计学和医学特征与30个月内参与率之间的任何统计关联。
82.7%的受访者（239/298）打算参与，43.3%（129/298）在30个月内实际参与。已经决定进行粪便检测或结肠镜检查的人的参与率分别为50.7%（36/71）和55.2%（58/105）；未做决定的人的参与率为33.3%（19/57）。回归模型中最强的关联是与已经预约（比值比=11.1，95%置信区间：[3.9；31.8]）。从回归模型中排除现有预约变量后，居住在较小城镇（比值比=2.41[1.08；5.35]）和表示倾向于结肠镜检查（比值比=2.52；[1.20；5.27]）与参与呈正相关。即使在调整先前的结肠镜检查后，父母患有结直肠癌的被保险人参与频率较低（比值比=0.31[0.12；0.80]）。
预期参与和实际参与之间的巨大差距意味着结直肠癌预防方面有改进的潜力，并且某些人群可能会从有针对性地支持其将筛查意愿变为现实中受益。由于这项初步调查的方法学局限性，其结果需要进一步研究加以证实。
