Age-related disparities in cancer screening: Analysis of 2001 behavioral risk factor surveillance system data
Age-related disparities in cancer screening: Analysis of 2001 behavioral risk factor surveillance system data
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DOI：
10.1370/afm.118
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发表时间：
2004-09-01
影响因子：
4.4
通讯作者：
Doescher, MP
中科院分区：
文献类型：
--
作者：
Jerant, AF;Franks, P;Doescher, MP
虽然很少有研究探讨与年龄相关的医疗保健差距，但一些研究人员认为，这种差距普遍不利于老年人，主要归因于医疗保健系统中的年龄歧视。我们比较了50岁及以上人群中结直肠癌筛查与乳腺癌和前列腺癌筛查的年龄相关模式。方法：我们分析了2001年行为风险因素监测系统（BRFSS）中所有年龄在50岁及以上的成年人（N = 88,213）的数据，这是一项具有全国代表性的个人健康行为电话调查。主要结局指标为5年年龄组男性和女性使用粪便潜血检查、乙状结肠镜检查或结肠镜检查进行结直肠癌筛查的调整患病率；妇女乳房x光检查率；男性前列腺特异性抗原（PSA）筛查率。结果：在调整种族/民族、教育水平、收入、健康保险和自我评估健康状况后，预测报告的结直肠癌筛查（所有模式）从患者50岁到70 - 74岁显著增加（66.0%，标准误差[SE] 0.8%），保持不变直到80岁，然后下降。结直肠癌筛查中年龄相关的增加仅限于60岁以上的白人患者。报道的PSA筛查增加到75 - 79岁（79.3%,SE 1.1%），然后下降，而乳房x线摄影筛查在55 - 59岁达到高峰（83.3%,SE 1.2%），然后下降。结论：循证和非循证癌症筛查干预措施似乎都存在显著的年龄相关差异。癌症筛查中与年龄相关的差异问题是复杂的，在某些服务中老年人受益，而在其他服务中老年人受益。
PURPOSE Although few studies have explored age-related health care disparities, some researchers have asserted such disparities uniformly disfavor the elderly and are largely attributable to ageism in the health care system. We compared age-related patterns of screening for colorectal cancer with those for breast and prostate cancer in persons aged 50 years and older.METHODS We analyzed data for all adults aged 50 years and older (N = 88,213) in the 2001 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative, telephone-administered survey of personal health behaviors. Main outcome measures were adjusted prevalence by 5-year age-groups of colorectal cancer screening using fecal occult blood testing, flexible sigmoidoscopy, or colonoscopy for men and women; rates of mammography screening for women; and rates of prostate-specific antigen (PSA) screening for men.RESULTS After adjustment for race/ethnicity, education level, income, health insurance, and self-rated health, predicted reported colorectal cancer screening (all modalities) increased significantly from when patients reached age 50 years until 70 to 74 years (66.0%, standard error [SE] 0.8%), remained constant until age 80 years, and then declined. The age-related gain in colorectal cancer screening was confined to whites among patients older than 60 years. Reported PSA screening increased until age 75 to 79 years (79.3%, SE 1.1%) and then declined, whereas reported mammography screening peaked at age 55 to 59 years (83.3%, SE 1.2%) and then declined.CONCLUSIONS Significant age-related disparities appear to exist for both evidence-based and non-evidence-based cancer-screening interventions. The issue of age-related disparities in cancer screening is complex, with the direction of disparity favoring the elderly for some services yet disfavoring them for others.