Inequalities in participation in an organized national colorectal cancer screening programme: results from the first 2.6 million invitations in England
Inequalities in participation in an organized national colorectal cancer screening programme: results from the first 2.6 million invitations in England
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DOI：
10.1093/ije/dyr008
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发表时间：
2011-06-01
影响因子：
7.7
通讯作者：
Wardle, Jane
中科院分区：
文献类型：
--
作者：
von Wagner, Christian;Baio, Gianluca;Wardle, Jane
背景2006年，英国启动了一项有组织的、以人群为基础的结直肠癌筛查计划，为60-69岁的成年人提供两年一次的粪便潜血试验（FOBT）。有组织的筛查计划，没有相关的财务成本，以个人应尽量减少障碍，以获得较低的社会经济地位（SES）的群体。然而，在英国计划的试点中心观察到SES在摄取方面的差异，因此本分析的目的是确定SES，种族多样性，性别和年龄在该计划的前28个月内摄取的不平等程度。超过260万60-69岁的成年人通过五个区域筛查中心邮寄了第一个FOBT工具包。摄取定义为13周内归还检测试剂盒。我们采用多元广义线性回归，以研究基于区域的社会经济剥夺，基于区域的种族，性别和age.Results摄取的变化是54%，但表现出梯度的五分之一的剥夺，范围从35%的最剥夺的五分之一，61%的最少剥夺。多变量分析证实了剥夺的独立影响，对妇女和老年人的影响更大。种族最多样化的地区的接受率（38%）也低于其他地区（52-58%），这与社会经济地位、年龄、性别和区域筛查中心无关。种族差异在男性中更为明显，但在各年龄组中相当。退回急救包的妇女多于男子（56%对51%），但也与年龄有相互作用，男性的摄入量随年龄增加而增加（60-64岁为49%; 65-69岁占53%），但妇女不占（57对56%）。结论在这个有组织的筛查计划的总体吸收率是令人鼓舞的，但尽管如此，在种族最多样化的地区，接受率很低，而且社会经济地位有明显的梯度。需要采取行动促进平等的吸收，以避免扩大癌症死亡率的不平等。
Background An organized, population-based, colorectal cancer screening programme was initiated in England in 2006 offering biennial faecal occult blood testing (FOBT) to adults aged 60-69 years. Organized screening programmes with no associated financial costs to the individual should minimize barriers to access for lower socio-economic status (SES) groups. However, SES differences in uptake were observed in the pilot centres of the UK programme, so the aim of this analysis was to identify the extent of inequalities in uptake by SES, ethnic diversity, gender and age in the first 28 months of the programme.Design Cross-sectional analysis of colorectal cancer screening uptake data.Methods Between October 2006 and January 2009, over 2.6 million adults aged 60-69 years were mailed a first FOBT kit by the five regional screening hubs. Uptake was defined as return of a test kit within 13 weeks. We used multivariate generalized linear regression to examine variation by area-based socioeconomic deprivation, area-based ethnicity, gender and age.Results Uptake was 54%, but showed a gradient across quintiles of deprivation, ranging from 35% in the most deprived quintile to 61% in the least deprived. Multivariate analyses confirmed an independent effect of deprivation, with stronger effects in women and older people. The most ethnically diverse areas also had lower uptake (38%) than other areas (52-58%) independent of SES, age, gender and regional screening hub. Ethnic disparities were more pronounced in men but equivalent across age groups. More women than men returned a kit (56 vs 51%), but there was also an interaction with age, with uptake increasing with age in men (49% at 60-64 years; 53% at 65-69 years) but not women (57 vs 56%).Conclusions Overall uptake rates in this organized screening programme were encouraging, but nonetheless there was low uptake in the most ethnically diverse areas and a striking gradient by SES. Action to promote equality of uptake is needed to avoid widening inequalities in cancer mortality.