Rural vs Urban Residence Affects Risk-Appropriate Colorectal Cancer Screening
Rural vs Urban Residence Affects Risk-Appropriate Colorectal Cancer Screening
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DOI：
10.1016/j.cgh.2012.11.025
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发表时间：
2013-05-01
影响因子：
12.6
通讯作者：
Kinney, Anita Y.
中科院分区：
文献类型：
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作者：
Anderson, Allison E.;Henry, Kevin A.;Kinney, Anita Y.
背景和目的：对于地理因素的影响，如农村与城市居住和到结肠镜提供者的旅行时间，在普通人群中对风险适当使用结直肠癌（CRC）筛查的影响知之甚少。我们评估了地理因素对CRC筛查依从性的影响，以及家族风险群体中筛查使用的差异。方法：我们分析了2010年犹他州行为风险因素监测系统的数据，其中包括州添加的家族性CRC问题。通过使用多元逻辑回归模型，我们评估了农村与城市居住、到最近的结肠镜提供者的旅行时间以及提供者的空间可达性对遵守风险适当筛查指南的影响。研究参与者（n = 4260）是年龄在50至75岁之间的受访者。结果：66%的样本遵守了风险适宜的CRC筛查指南，在所有家族风险组中，城市和农村居民之间存在显著差异（分别为68%对57%；P < 0.001）。农村居民接受最新筛查指南的可能性低于城市居民（多变量优势比为0.65；95%可信区间为0.53-0.79）。在未经调整的分析中，农村与城市居住（P < .001）、到最近的结肠镜提供者的旅行时间（P = .003）和提供者的空间可达性（P = .012）与筛查指南的依从性显著相关。然而，在调整分析中，农村与城市居住（P < 0.001）是唯一与筛查依从性独立相关的地理变量。结论：犹他州农村和城市居民在使用风险适宜的结直肠癌筛查方面存在显著差异。到最近的结肠镜检查提供者的旅行时间和提供者的空间可达性的差异并不能解释在筛查依从性中观察到的地理差异。
BACKGROUND & AIMS: Little is known about the effects of geographic factors, such as rural vs urban residence and travel time to colonoscopy providers, on risk-appropriate use of colorectal cancer (CRC) screening in the general population. We evaluated the effects of geographic factors on adherence to CRC screening and differences in screening use among familial risk groups.METHODS: We analyzed data from the 2010 Utah Behavior Risk Factor Surveillance System, which included state-added questions on familial CRC. By using multiple logistic regression models, we assessed the effects of rural vs urban residence, travel time to the nearest colonoscopy provider, and spatial accessibility of providers on adherence to risk-appropriate screening guidelines. Study participants (n = 4260) were respondents aged 50 to 75 years.RESULTS: Sixty-six percent of the sample adhered to risk-appropriate CRC screening guidelines, with significant differences between urban and rural residents (68% vs 57%, respectively; P < .001) across all familial risk groups. Rural residents were less likely than urban dwellers to be up-to-date with screening guidelines (multivariate odds ratio, 0.65; 95% confidence interval, 0.53-0.79). In the unadjusted analysis, rural vs urban residence (P < .001), travel time to the nearest colonoscopy provider (P = .003), and spatial accessibility of providers (P = .012) were associated significantly with adherence to screening guidelines. However, rural vs urban residence (P < .001) was the only geographic variable independently associated with screening adherence in the adjusted analyses.CONCLUSIONS: There are marked disparities in use of risk-appropriate CRC screening between rural and urban residents in Utah. Differences in travel time to the nearest colonoscopy provider and spatial accessibility of providers did not account for the geographic variations observed in screening adherence.