National disparities in colorectal cancer screening in patients with comorbid conditions: an analysis of the Behavioral Risk Factor Surveillance System
National disparities in colorectal cancer screening in patients with comorbid conditions: an analysis of the Behavioral Risk Factor Surveillance System
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DOI：
10.1515/jom-2021-0066
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发表时间：
2021-07-01
影响因子：
1.5
通讯作者：
Hartwell, Micah
中科院分区：
文献类型：
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作者：
Greiner, Benjamin;Gandhi, Ronak;Hartwell, Micah
背景：美国每年约有 53,200 人死于结直肠癌 (CRC)，这表明需要加强筛查工作。一些研究表明，患有合并症的患者使用乳房X光检查的比例更高，这反映了随访的增加。另一项研究发现，与非肥胖患者相比，肥胖患者接受结直肠癌筛查的可能性较小。然而，尚无研究评估多种合并症对 CRC 筛查的影响。 目的： 分析合并症患者与健康患者的 CRC 筛查率，并评估合并症诊断数量是否影响筛查率。 方法： 使用 2018 年和 2019 年行为危险因素监测系统 (BRFSS) 对接受 CRC 筛查的患者进行横断面分析。如果受访者对以下任一问题回答“是”，则被归类为接受过 CRC 筛查：“您曾经进行过血便测试吗？”或“您曾经做过乙状结肠镜检查/结肠镜检查吗？” 50岁以下的受访者被排除在外。构建加权多元逻辑回归模型以确定调整后的风险比（ARR）。置信区间 (CI) 为 95%。结果：我们确定了 279,784 名符合纳入标准的受访者。其中，79.7%（样本 n=222,879；人口 N=46,304,360）的受访者接受了 CRC 筛查。患有糖尿病、高血压、皮肤癌、慢性阻塞性肺病（COPD）、关节炎、抑郁症和慢性肾病的患者比没有合并症的患者更有可能接受筛查。患有和不患有心血管疾病的患者之间的筛查率没有统计学上的显着差异。与具有 0 种合并症的患者相比，具有 1 种合并症的患者接受筛查的可能性明显更高（ARR，1.11；CI，1.09-1.12），具有 2 至 4 种合并症的患者（ARR，1.2；CI，1.18-1.22）也明显更有可能接受筛查。患有 5 种或更多合并症的患者接受筛查的可能性显着低于患有 2 至 4 种疾病的患者（ARR，1.12；CI，1.1-1.14）。结论：患有一种或多种合并症的患者比没有合并症的患者更有可能接受筛查，但患有 5 种或更多疾病的患者比患有 2 到 4 种疾病的患者接受筛查的可能性更低。这表明，与仅诊断出少数疾病的患者相比，医生可能会更加疲劳，并且不太可能向患有多种合并症的患者推荐 CRC 筛查。这项研究的结果通过确定合并症的数量和进行结直肠癌筛查的可能性之间的相互作用来补充文献。
Context: Each year, approximately 53,200 people die in the U.S. from colorectal cancer (CRC), indicating a need to increase screening efforts. Some studies have suggested mammography use is higher in patients with comorbid conditions, a reflection of increased follow up. Another study found that patients with obesity were less likely to be screened for CRC than nonobese patients. However, no study has assessed the impact of multiple comorbidities on CRC screening.Objectives: To analyze CRC screening rates in patients with comorbidities compared with healthy patients, and to assess whether the number of comorbid diagnoses impacted screening rates.Methods: A cross sectional analysis of patients who received CRC screening was performed using the 2018 and 2019 Behavioral Risk Factor Surveillance System (BRFSS). Respondents were classified as having had CRC screening if they answered "yes" to either of the following: "Have you ever had a blood stool test?" or "Have you ever had a sigmoidoscopy/colonoscopy?" Respondents younger than age 50 were excluded. A weighted multivariate logistic regression model was constructed to determine adjusted risk ratios (ARR). Confidence intervals (CI) were reported at 95%.Results: We identified 279,784 respondents who met inclusion criteria. Of those, 79.7% (sample n=222,879; population N=46,304,360) of respondents had received CRC screening. Patients with diabetes, hypertension, skin cancer, chronic obstructive pulmonary disease (COPD), arthritis, depression, and chronic kidney disease were significantly more likely to be screened than those without comorbidities. There was no statistically significant difference in screening rates between patients with and without cardiovascular disease. Compared with patients with zero comorbidities, those with one were significantly more likely to receive screening (ARR, 1.11; CI, 1.09-1.12) as were those with two to four (ARR, 1.2; CI, 1.18-1.22). Patients with five or more comorbidities were significantly less likely to be screened than those with two to four (ARR, 1.12; CI, 1.1-1.14).Conclusions: Patients with one or more comorbidities were more likely to be screened than those without comorbidities, but those with five or more conditions were less likely to be screened than patients with two to four conditions. This indicates that physicians may be more fatigued and less likely to recommend CRC screening to patients with many comorbidities compared with patients diagnosed with only a few conditions. The results of this study add to the literature by identifying an interaction between the number of comorbidities and likelihood of being screened for CRC.