Onyenemezu Kelechi R, Ezike Tobechukwu C, Nwebonyi Stafford O, Ikwuka Obinna V, Aroh Elochukwu V
Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, USA.
Internal Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, NGA.
Cureus. 2024 Nov 19;16(11):e74014. doi: 10.7759/cureus.74014. eCollection 2024 Nov.
Colorectal cancer screening has been shown to be effective in reducing the burden of colorectal cancer. However, the screening rate has been suboptimal, and mortality due to colorectal cancer remains high. With the presence of proactive prevention strategies, low screening rates could still be due to individual factors. Following the health-belief model, this study examined the relationship between self-rated general health perception and colorectal cancer screening.
The study utilized the 2022 Behavioral Risk Factor Surveillance System (BRFSS) Annual Survey dataset. The sample size was 177,889 and included individuals aged 45-75 years. The outcome variable was a categorical variable with binary responses of screened or not screened. The main predictor variable was an ordinal variable with five responses of poor, fair, good, very good, and excellent in the assessment of self-rated general health. Other covariates were age, sex, marital status, race, insurance status, level of education, annual income, and poor physical and mental health durations. The weighting variable of the dataset was used to adjust the sample to a weighted sample size. After obtaining descriptive statistics, simple and multivariate logistic regressions were fitted to analyze the relationship between the main predictor and the outcome variables. Statistical significance was set at a 95% confidence level.
The weighted sample size was 83,303,438. Of these, 70.09% were screened and 29.91% were not screened for colorectal cancer. Excellent general health was reported by 14.80%, 34.32% very good, 32.1% good, 13.91% fair, and 4.87% had poor general health. Individuals with excellent general health perception were 25% less likely (adjusted odds ratio (AOR)=0.75; 95% CI=0.65, 0.88; p<0.0001) to be screened for colorectal cancer compared to those with poor general health perception.
This study identifies the individual's excellent health perception as a possible contributing factor to the deficiency towards the realization of the goal in the rate of screening uptake and the need for revised and improved awareness programs.
结直肠癌筛查已被证明在减轻结直肠癌负担方面有效。然而，筛查率一直未达到最佳水平，结直肠癌导致的死亡率仍然很高。尽管存在积极的预防策略，但低筛查率仍可能归因于个体因素。根据健康信念模型，本研究探讨了自我评估的总体健康认知与结直肠癌筛查之间的关系。
本研究使用了2022年行为危险因素监测系统（BRFSS）年度调查数据集。样本量为177,889，包括45至75岁的个体。结果变量是一个分类变量，有筛查或未筛查两种二元反应。主要预测变量是一个有序变量，在自我评估的总体健康状况中有差、一般、好、非常好和优秀五种反应。其他协变量包括年龄、性别、婚姻状况、种族、保险状况、教育程度、年收入以及身心健康不佳的时长。数据集的加权变量用于将样本调整为加权样本量。在获得描述性统计数据后，进行了简单和多变量逻辑回归分析，以分析主要预测变量与结果变量之间的关系。统计学显著性设定为95%置信水平。
加权样本量为83,303,438。其中，70.09%的人接受了结直肠癌筛查，29.91%的人未接受筛查。报告总体健康状况优秀的占14.80%，非常好的占34.32%，好的占32.1%，一般的占13.91%，差的占4.87%。与总体健康认知差的人相比，总体健康认知优秀的人接受结直肠癌筛查的可能性低25%（调整后的优势比（AOR）=0.75；95%置信区间=0.65，0.88；p<0.0001）。
本研究确定个体的优秀健康认知可能是导致筛查接受率未达目标的一个因素，且有必要修订和改进宣传项目。
