Adefemi Kazeem, Knight John C, Zhu Yun, Wang Peizhong Peter
Division of Population Health and Applied Health Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada.
The Beatrice Hunter Cancer Research Institute, Dalhousie University, Halifax, NS, Canada.
BMC Glob Public Health. 2024 May 6;2(1):28. doi: 10.1186/s44263-024-00061-6.
Colorectal cancer (CRC) poses a significant public health challenge in Canada, with the Atlantic provinces bearing a particularly high burden. The implementation of population-based colon screening programs is aimed to address this concern. However, limited research exists on the effect of these programs especially in Canada. This study aimed to examine the impact of the first few years of the CRC screening programs in the Atlantic provinces of Canada by assessing changes in screening uptake, barriers, and predictors of screening among eligible populations.
Employing a repeated cross-sectional design, this study analyzed data from a representative sample of 7614 respondents in 2010 and 6850 in 2017 from the Atlantic provinces aged 50-74 years, extracted from the Canadian Community Health Survey (CCHS). The outcomes measured were CRC screening rates, changes in predictors of screening uptake, and barriers to participation. Potential predictors examined included age, sex, income, education, smoking, and health status.
The proportion of adults aged 50-74 years who meet CRC screening requirements increased from 42% in 2010 to 54% in 2017 yet below the national target of 60%. New Brunswick reported the most significant increase in screening prevalence (18%, p < 0.05). Participation in fecal tests increased from 19.6 to 32.4%. Despite these improvements, disparities in screening participation remained, with lower uptake observed among individuals with lower income and education levels. Age (> 60 years, OR = 2.09, p < 0.01), the presence of multiple chronic health conditions (OR = 2.11, p < 0. 01), being female (OR = 1.21, p < 0.01), married status (OR = 1.21, p < 0.05), access to regular healthcare (OR = 1.91, p < 0.01), and nonsmoking status (OR = 2.55, p < 0.01) were identified as significant predictors of CRC screening uptake.
This study shows that while CRC screening uptake increased across the Atlantic provinces between 2010 and 2017, barriers to and disparities in screening participation persist. This highlights the need for targeted interventions to improve awareness, access, and screening uptake, particularly among disadvantaged groups, to promote equitable healthcare outcomes. Continued efforts should focus on reducing barriers to screening and leveraging available evidence to inform interventions aimed at mitigating the CRC burden in the region.
结直肠癌（CRC）在加拿大构成了重大的公共卫生挑战，大西洋省份的负担尤为沉重。实施基于人群的结肠癌筛查计划旨在解决这一问题。然而，关于这些计划的效果，尤其是在加拿大的相关研究有限。本研究旨在通过评估符合条件人群中筛查接受率、障碍及筛查预测因素的变化，来检验加拿大大西洋省份CRC筛查计划最初几年的影响。
本研究采用重复横断面设计，分析了从加拿大社区健康调查（CCHS）中提取的2010年7614名和2017年6850名来自大西洋省份、年龄在50 - 74岁的具有代表性样本的数据。测量的结果包括CRC筛查率、筛查接受预测因素的变化以及参与的障碍。所考察的潜在预测因素包括年龄、性别、收入、教育程度、吸烟状况和健康状况。
50 - 74岁符合CRC筛查要求的成年人比例从2010年的42%增至2017年的54%，但仍低于60%的全国目标。新不伦瑞克省的筛查患病率增幅最为显著（18%，p < 0.05）。粪便检测的参与率从19.6%增至32.4%。尽管有这些改善，但筛查参与方面的差异依然存在，收入和教育水平较低的个体接受率较低。年龄（> 60岁，OR = 2.09，p < 0.01）、存在多种慢性健康状况（OR = 2.11，p < 0.01）、女性（OR = 1.21，p < 0.01）、婚姻状况（OR = 1.21，p < 0.05）、能获得常规医疗保健（OR = 1.91，p < 0.01）以及不吸烟状态（OR = 2.55，p < 0.01）被确定为CRC筛查接受的显著预测因素。
本研究表明，虽然2010年至2017年期间大西洋省份的CRC筛查接受率有所提高，但筛查参与的障碍和差异依然存在。这凸显了需要有针对性的干预措施来提高意识、可及性和筛查接受率，特别是在弱势群体中，以促进公平的医疗保健结果。持续的努力应集中在减少筛查障碍，并利用现有证据为旨在减轻该地区CRC负担的干预措施提供信息。
