LBPO.PR01 · 预防研究 · Late-Breaking
非裔加勒比队列中结肠癌筛查的患病率及预测因素：来自Living in Full Health项目的见解
Prevalence and predictors of colon cancer screening among an Afro-Caribbean cohort: Insights from the Living in Full Health project
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作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
目的：结直肠癌（CRC）是牙买加癌症死亡的第三大原因，可通过筛查癌前病变加以预防。我们评估了50岁及以上平均风险牙买加人中CRC筛查及最新筛查的患病率和预测因素。我们还将该人群中CRC筛查的频率与其他癌症（乳腺癌、宫颈癌和前列腺癌）的筛查频率进行了比较。
设计与方法：我们分析了纳入Living In Full Health（LIFE）队列研究的50-70岁牙买加人在基线访视时自我报告的CRC及其他癌症筛查行为数据。通过访谈者管理的问卷获取社会人口学信息和病史。采用多变量logistic回归识别与接受任何形式CRC筛查相关的因素。采用卡方统计将CRC筛查行为与其他性别特异性癌症进行比较。
结果：在2,496名符合CRC筛查条件的参与者中，239人（9.6%）曾接受筛查。接受筛查者明显年龄更大（平均年龄61.1±7.1对59.7±6.6岁；p=0.002）、完成中等教育（75.3%对67.1%；p=0.010）、已退休（23.8%对9.9%；p<0.001）、报告月收入较高（≥JMD$120,000）（34.5%对16.5%；p<0.001）、拥有医疗保险（40.6%对16.8%；p<0.001）、至少患有一种非传染性疾病（NCD）（75.3%对55.5%；p<0.001），以及有结肠息肉史（5.1%对0.4%；p<0.001）。不到四分之一（24.3%）的人CRC筛查处于最新状态。在多变量分析中，拥有医疗保险（OR 1.9；p=0.021）和患有NCD（OR 1.9；p=0.026）是CRC筛查的显著预测因素。月收入较低者（JMD$<28,000[OR=0.2；p=0.004]）接受筛查的可能性显著较低。没有个人医疗服务提供者（未校正OR=0.4；p=0.044）是CRC筛查未处于最新状态的唯一显著预测因素。在女性中，仅9.5%（95%CI 8.0, 11.0）曾接受至少一种CRC筛查方法，而30.5%（95%CI 28.8, 32.1）曾接受宫颈癌筛查，85.9%（95%CI 84.6, 87.2）曾至少接受一次乳腺癌筛查。在男性中，9.7%（95%CI 7.8, 11.5）接受了CRC筛查，而17.9%（95%CI 15.9, 19.9）报告接受了前列腺癌筛查。缺乏医生建议是符合条件的参与者不接受癌症筛查的最常见原因。
结论：约10%符合条件的牙买加人接受了CRC筛查。获得可负担的CRC筛查服务以及拥有推荐癌症筛查的固定医疗服务提供者，可能有助于提高牙买加的CRC筛查率。
查看英文原文 English abstract
Objective: Colorectal cancer (CRC) is the third leading cause of cancer death in Jamaica, preventable through screening for pre-malignant lesions. We assessed the prevalence and predictors of CRC screening and up-to-date screening among average risk Jamaicans 50-years and older. We also compared the frequency of CRC screening with that for other cancers (breast, cervical and prostate cancer) in this population.
Design and Methods: We analyzed data on self-reported CRC and other cancer screening practices from the baseline visit of 50-70 years old Jamaicans enrolled in the Living In Full Health (LIFE) cohort study. Socio-demographic information and medical history were obtained from an interviewer-administered questionnaire. Multivariable logistic regression was used to identify factors associated with undergoing any form of CRC screening. Chi square statistics were used to compare CRC screening practices with other sex-specific cancers.
Results: Of 2,496 participants eligible for CRC screening, 239 (9.6%) had undergone screening. Those screened were significantly older (mean age 61.1±7.1 versus 59.7±6.6 years; p= 0.002), completed secondary education (75.3% versus 67.1%; p=0.010), retired (23.8% versus 9.9%; p<0.001), report higher monthly income of ≥JMD$120,000 (34.5% versus 16.5%; p <0.001), have health insurance (40.6% versus 16.8%; p<0.001), have at least one non-communicable disease (NCD) (75.3% versus 55.5%; p<0.001), and history of colon polyps (5.1% versus 0.4%; p <0.001). Less than a quarter (24.3% ) were up-to-date for CRC screening. In multivariate analysis having health insurance (OR 1.9; p=0.021), and a NCD (OR 1.9; p=0.026) were significant predictors for CRC screening. Those with low monthly income (JMD $<28,000 [OR=0.2; p=0.004]) were significantly less likely to be screened. Not having a personal healthcare provider (unadjusted OR=0.4; p=0.044) was the only significant predictor of not being up-to-date with CRC screening. Among women while only 9.5% (95% CI 8.0, 11.0) had undergone at least one method of CRC screening, 30.5% (95% CI 28.8, 32.1) had previously screened for cervical cancer and 85.9% (95% CI 84.6, 87.2) had been screened at least once for breast cancer. Among men 9.7% (95% CI 7.8, 11.5) had CRC screening compared to 17.9% (95% CI 15.9, 19.9) who reported prostate cancer screening. Lack of physician recommendation was the most common reason for not undergoing cancer screening among eligible participants.
Conclusions: Approximately 10% of eligible Jamaicans were screened for CRC. Access to affordable CRC screening service and having a regular healthcare provider who recommends cancer screening may help to improve CRC screening uptake in Jamaica.
利益披露 Disclosure
Y. Dawkins, None..
N. Guthrie-Dixon, None..
K. T. Ashing, None..
C. Ragin, None..
M. Tulloch-Reid, None.