Influence of Age and Comorbidity on Colorectal Cancer Screening in the Elderly.
Influence of Age and Comorbidity on Colorectal Cancer Screening in the Elderly.
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DOI：
10.1016/j.amepre.2016.04.018
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发表时间：
2016-09
影响因子：
5.5
通讯作者：
PROSPR consortium
中科院分区：
文献类型：
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作者：
Klabunde CN;Zheng Y;Quinn VP;Beaber EF;Rutter CM;Halm EA;Chubak J;Doubeni CA;Haas JS;Kamineni A;Schapira MM;Vacek PM;Garcia MP;Corley DA;PROSPR consortium
专家对老年人结直肠癌筛查的建议各不相同。最近的研究表明，75岁的健康成年人可能会从筛查中受益。这项研究调查了社区环境中的一大批老年人的筛查使用和随访，以及它们如何随年龄层内的健康状况而变化。一项基于人群的纵向队列研究在2011-2012年间在三个综合医疗系统中登记的65-89岁的健康计划成员中进行，这些医疗系统参与了通过个性化方案联盟进行基于人口的研究优化筛查。共病测量使用Charlson指数。2015年进行的分析包括描述性统计和多变量建模，根据患者的合并症特定百分比估计年龄，得出两种结果：结直肠癌筛查摄取率和异常粪便血液测试的随访。在846,267名患者中，72%的患者接受了最新的结直肠癌筛查。在粪血检测呈阳性的患者中，65%的患者在3个月内接受了随访结肠镜检查。年龄为76岁的≥患者及时更新和接受随访的可能性显著低于年龄较小的患者(P<；0.001)。与年龄相比，共病的影响较小，与及时随访的相关性比与最新情况的相关性更强。在所有年龄组中，相当数量的无/低共病患者没有及时更新或没有得到及时的随访。在三个综合医疗系统中，许多年龄较大、相对健康的患者没有进行最新的筛查，一些相对年轻、健康的患者没有得到及时的随访。研究结果表明，有必要重新评估基于年龄的筛查指南，并提高老年人的筛查完成率。
Expert recommendations differ for colorectal cancer screening in the elderly. Recent studies suggest that healthy adults aged >75 years may benefit from screening. This study examined screening use and follow-up, and how they varied by health status within age strata, among a large cohort of elderly individuals in community settings. A population-based, longitudinal cohort study was conducted among health plan members aged 65–89 years enrolled during 2011–2012 in three integrated healthcare systems participating in the Population-Based Research Optimizing Screening through Personalized Regimens consortium. Comorbidity measurements used the Charlson index. Analyses, conducted in 2015, comprised descriptive statistics and multivariable modeling that estimated age by comorbidity–specific percentages of patients for two outcomes: colorectal cancer screening uptake, and follow-up of abnormal fecal blood tests. Among 846,267 patients, 72% were up-to-date with colorectal cancer screening. Of patients with a positive fecal blood test, 65% received follow-up colonoscopy within 3 months. Likelihood of being up-to-date and receiving timely follow-up was significantly lower for patients aged ≥76 years than their younger counterparts (p<0.001). Comorbidity was less influential than age, and more strongly related to timely follow-up than being up-to-date. In all age groups, considerable numbers of patients with no/low comorbidity were not up-to-date or did not receive timely follow-up. In three integrated healthcare systems, many older, relatively healthy patients were not screening up-to-date, and some relatively young, healthy patients did not receive timely follow-up. Findings suggest a need for re-evaluating age-based screening guidelines and improving screening completion among the elderly.