Effect of Neighborhood and Individual-Level Socioeconomic Factors on Colorectal Cancer Screening Adherence.
Effect of Neighborhood and Individual-Level Socioeconomic Factors on Colorectal Cancer Screening Adherence.
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DOI：
10.3390/ijerph18094398
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发表时间：
2021-04-21
影响因子：
--
通讯作者：
Lynch SM
中科院分区：
文献类型：
--
作者：
Mayhand KN;Handorf EA;Ortiz AG;Gonzalez ET;Devlin A;Sorice KA;Esnaola N;Fisher S;Lynch SM
尽管筛查在降低结直肠癌（CRC）死亡率方面有效，但约25%的美国成年人不遵守筛查指南。先前的研究将社会经济地位（SES）与低筛查依从性联系起来，并表明邻里剥夺会影响CRC结果。我们在一项多种族横断面研究中全面调查了社区SES环境（nSES）、个人SES和种族/民族对CRC筛查依从性的影响。参与者调查评估了2017年至2018年32个个人层面的社会经济和医疗保健获取措施。参与者的数据加入了九个nSES措施，从美国人口普查在人口普查区的水平。单变量、LASSO和多变量混合效应logistic回归模型用于变量减少和相关性评估。总研究人群包括526名年龄在50-85岁的参与者; 29%的参与者未依从。在最终的多变量模型中，年龄（p = 0.02）和非西班牙裔黑人（p = 0.02）与较高的依从性几率相关。与较低依从性相关的因素是房屋租赁（与所有权）（p = 0.003），低医疗质量的感知（p = 0.006），两年内没有常规检查（p = 0.002），感知歧视（p = 0.02）和nSES剥夺（p = 0.02）。在应用综合变量方法后，发现社区和个人水平的社会经济指标有助于降低CRC筛查依从性。
Despite the effectiveness of screenings in reducing colorectal cancer (CRC) mortality, ~25% of US adults do not adhere to screening guidelines. Prior studies associate socioeconomic status (SES) with low screening adherence and suggest that neighborhood deprivation can influence CRC outcomes. We comprehensively investigated the effect of neighborhood SES circumstances (nSES), individual SES, and race/ethnicity on adherence to CRC screening in a multiethnic cross-sectional study. Participant surveys assessing 32 individual-level socioeconomic and healthcare access measures were administered from 2017 to 2018. Participant data were joined with nine nSES measures from the US Census at the census tract level. Univariate, LASSO, and multivariable mixed-effect logistic regression models were used for variable reduction and evaluation of associations. The total study population included 526 participants aged 50–85; 29% of participants were non-adherent. In the final multivariable model, age (p = 0.02) and Non-Hispanic Black race (p = 0.02) were associated with higher odds of adherence. Factors associated with lower adherence were home rental (vs. ownership) (p = 0.003), perception of low healthcare quality (p = 0.006), no routine checkup within two years (p = 0.002), perceived discrimination (p = 0.02), and nSES deprivation (p = 0.02). After comprehensive variable methods were applied, socioeconomic indicators at the neighborhood and individual level were found to contribute to low CRC screening adherence.
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