Department of Public Health, Faculty of Public Health, Ubon Ratchathani Rajabhat University, Ubon Ratchathani, Thailand.
Dongjaroen Subdistrict Health Promoting Hospital, Kham Khuan Kaeo District, Yasothon, Thailand.
Asian Pac J Cancer Prev. 2024 Nov 1;25(11):4081-4088. doi: 10.31557/APJCP.2024.25.11.4081.
This case-control study sought to explore the social determinants of health (SDH) associated with cholangiocarcinoma (CCA) risk in high-incidence regions of Thailand.
The research was conducted in two phases. Phase 1 assessed the prevalence, context, and conditions among at-risk populations for CCA in Yasothon, located in Northeast Thailand. This phase utilized a survey-based research design, employing verbal screening methods to categorize individuals into risk groups (at-risk vs. not at-risk). Phase 2 aimed to identify the SDH associated with CCA risk through a case-control study. Of 496 recruited participants, 238 cases of subjects were at risk of CCA, and 258 controls were not at risk of CCA. Data were collected using structured questionnaires. Multiple logistic regression was employed to analyze the factors associated with CCA risk.
The study revealed that 48.00% of participants were at risk for CCA, with 32.06% having a history of liver fluke eggs detected in their feces. Despite this, only 45.40% of participants engaged in adequate preventive behaviors. Analysis of SDH among the cases identified significant challenges, including high levels of poverty (49.14%), food security (52.22%), social exclusion (48.82%), inadequate housing (50.22%), and overall SDH burden (53.42%). In contrast, relatively lower levels of health inequality (48.78%) and unfavorable working conditions (51.65%) were observed. Multivariate analysis indicated that overall SDH was a significant risk factor for CCA (AOR=1.63; 95% CI: 1.09-2.46), while perceived disease severity (AOR=0.57; 95% CI: 0.39-0.83) and safe working conditions (AOR=0.61; 95% CI: 0.42-0.90) were protective factors.
Improving CCA prevention behaviors should focus on enhancing perceived severity and addressing the relevant SDH.
本病例对照研究旨在探讨与泰国高发地区胆管癌（CCA）风险相关的健康社会决定因素（SDH）。
该研究分两个阶段进行。第一阶段评估了位于泰国东北部的亚梭通高危人群中 CCA 的流行情况、背景和条件。该阶段采用基于调查的研究设计，采用口头筛查方法将个体分为风险组（有风险与无风险）。第二阶段旨在通过病例对照研究确定与 CCA 风险相关的 SDH。在招募的 496 名参与者中，有 238 名 CCA 风险患者为病例，258 名无 CCA 风险的参与者为对照。使用结构化问卷收集数据。采用多因素逻辑回归分析与 CCA 风险相关的因素。
研究显示，48.00%的参与者有患 CCA 的风险，32.06%的参与者粪便中检测到肝吸虫卵。尽管如此，只有 45.40%的参与者采取了充分的预防行为。对病例的 SDH 分析发现了重大挑战，包括高度贫困（49.14%）、粮食不安全（52.22%）、社会排斥（48.82%）、住房不足（50.22%）和总体 SDH 负担（53.42%）。相比之下，观察到较低水平的健康不平等（48.78%）和不利的工作条件（51.65%）。多变量分析表明，总体 SDH 是 CCA 的一个显著危险因素（AOR=1.63；95%CI：1.09-2.46），而感知疾病严重程度（AOR=0.57；95%CI：0.39-0.83）和安全工作条件（AOR=0.61；95%CI：0.42-0.90）是保护因素。
改善 CCA 预防行为应侧重于增强感知严重性和解决相关的 SDH。
