Rousset Stefano, Strippoli Elena, Senore Carlo, Spadea Teresa, Calcagno Marco, Zengarini Nicolás, Ferrante Gianluigi
Department of Public Health and Paediatrics, Post Graduate School of Medical Statistics, University of Torino, Torino, Italy.
Epidemiology Unit, ASL TO3 Piedmont Region, Collegno (TO), Italy.
BMC Public Health. 2025 Apr 1;25(1):1235. doi: 10.1186/s12889-025-22396-x.
Screening participation can be influenced by both individual socioeconomic position and contextual factors. In Italy, disparities exist regarding screening adherence, but it is important to understand the specific factors driving these disparities in specific locations according to different screening protocols. The aim of this study is to identify the impact of individual and contextual socio-economic factors on adherence to the organized colorectal cancer screening in the city of Turin, Italy.
Retrospective observational study on the population of assisted residents in Turin, eligible for colorectal screening from January 2010- June 2019. Colorectal screening in Piedmont involved inviting 58-year-old individuals to undergo a flexible sigmoidoscopy (FS) or, in case of non-adherence, a faecal immunochemical test (FIT). The program also included another protocol based directly on FIT as the first test. Adherence to the two screening protocols according to demographic/socioeconomic characteristics and contextual factors was evaluated with multilevel Poisson models.
90,227 eligible subjects (53% females) were analysed exploring adherence to FS/FIT. Lower likelihood of participation was found among males from High-Migratory-Pressure-Countries (HMPC), subjects with the lowest educational level, unemployed individuals, subjects living in rented houses, living alone/cohabiting and single parents. Among males, retirees and subjects living in more deprived areas participated more. 36,674 subjects (53% females) were analysed exploring adherence to the first FIT invitation. Adherence rate was higher among women (40% vs. 36%). Lower likelihood of participation was found among HMPC immigrants, males with the lowest educational level, people living in rented accommodation, living alone/cohabiting and single parents. Higher participation was found in retirees. In males, no differences were found between subjects living in more and less deprived areas, but a different likelihood of participation was observed across different areas of the city.
Socioeconomic and demographic characteristics influence access to organized colorectal screening in Turin. Immigrant status, low level of education, poor housing conditions and lack of social support, with some differences according to gender, emerged as the most significant barriers that should be tackled in order to increase screening participation and reduce inequalities. Contextual factors play a role only among male subjects.
筛查参与情况可能受到个体社会经济地位和环境因素的影响。在意大利，筛查依从性存在差异，但根据不同的筛查方案了解特定地区导致这些差异的具体因素很重要。本研究的目的是确定个体和环境社会经济因素对意大利都灵市有组织的结直肠癌筛查依从性的影响。
对2010年1月至2019年6月期间都灵符合结直肠癌筛查条件的受助居民进行回顾性观察研究。皮埃蒙特的结直肠癌筛查包括邀请58岁的个体接受乙状结肠镜检查（FS），或者在不依从的情况下接受粪便免疫化学检测（FIT）。该项目还包括另一种直接以FIT作为首次检测的方案。使用多水平泊松模型评估根据人口统计学/社会经济特征和环境因素对两种筛查方案的依从性。
对90227名符合条件的受试者（53%为女性）进行了分析，探讨对FS/FIT的依从性。来自高移民压力国家（HMPC）的男性、教育水平最低的受试者、失业者、租房居住者、独居/同居者和单亲父母参与的可能性较低。在男性中，退休人员和生活在更贫困地区的受试者参与度更高。对36674名受试者（53%为女性）进行了分析，探讨对首次FIT邀请的依从性。女性的依从率更高（40%对36%）。HMPC移民、教育水平最低的男性、租房居住者、独居/同居者和单亲父母参与的可能性较低。退休人员的参与度更高。在男性中，生活在较贫困和较不贫困地区的受试者之间没有差异，但在城市的不同地区观察到了不同的参与可能性。
社会经济和人口统计学特征影响都灵有组织的结直肠癌筛查的可及性。移民身份、低教育水平、恶劣的住房条件和缺乏社会支持，根据性别存在一些差异，是为了提高筛查参与率和减少不平等而应解决的最显著障碍。环境因素仅在男性受试者中起作用。
