Socioeconomic and ethnic inequities within organised colorectal cancer screening programmes worldwide
Socioeconomic and ethnic inequities within organised colorectal cancer screening programmes worldwide
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DOI：
10.1136/gutjnl-2016-313311
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发表时间：
2018-04-01
期刊：
影响因子：
24.5
通讯作者：
Essink-Bot, M. L.
中科院分区：
文献类型：
--
作者：
de Klerk, C. M.;Gupta, S.;Essink-Bot, M. L.
目的 结直肠癌 (CRC) 筛查计划可以降低结直肠癌死亡率。然而，如果亚群体的参与情况不同，筛查计划的实施可能会造成或加剧社会经济和种族健康不平等。我们确定了哪些有组织的项目体现了社会经济和种族亚群体参与不平等的特征，并评估了收集特定群体数据的项目之间亚群体参与的差异。设计本研究通过对国家或地区筛选项目的领导者进行文献回顾和调查，确定了已发表和未发表的有关按社会经济地位和种族划分的参与数据。我们评估了提供粪便潜血测试 (FOBT) 进行筛查的计划。主要结果是筛查参与率。结果 在 24 个符合纳入标准的有组织的 FOBT 筛查计划中，参与率范围为 21% 至 73%。大多数计划（13/24，54%）没有收集按社会经济地位和种族划分的参与数据。在提供按社会经济地位划分的参与数据的 11 个项目中，90%（28/31 出版物）报告社会经济地位较低的群体的参与度较低。不同社会经济梯度之间的差异为中度（66% vs 71%）到严重（35% vs 61%）。只有六个项目报告了按种族划分的参与结果。尽管可用于评估的数据有限，但种族差异是中等的。 结论 在世界范围内有组织的 CRC 筛查项目中，社会经济地位和种族的参与差异往往没有得到评估。然而，在衡量时发现，不同社会经济地位的参与存在显着差异。可用于评估种族不平等的数据有限。为了避免加剧健康不平等，筛查计划应系统地监测社会经济地位和种族的参与情况，并调查和解决参与率低的决定因素。
Objective Colorectal cancer (CRC) screening programmes can reduce CRC mortality. However, the implementation of a screening programme may create or exacerbate socioeconomic and ethnic health inequities if participation varies by subgroup. We determined which organised programmes characterise participation inequities by socioeconomic and ethnic subgroups, and assessed the variation in subgroup participation among programmes collecting group-specific data.Design Employing a literature review and survey among leaders of national or regional screening programmes, this study identified published and unpublished data on participation by socioeconomic status and ethnicity. We assessed programmes offering faecal occult blood tests (FOBT) for screening. Primary outcome was screening participation rate.Results Across 24 organised FOBT-screening programmes meeting the inclusion criteria, participation rates ranged from 21% to 73%. Most programmes (13/24, 54%) did not collect data on participation by socioeconomic status and ethnicity. Among the 11 programmes with data on participation by socioeconomic status, 90% (28/31 publications) reported lower participation among lower socioeconomic groups. Differences across socioeconomic gradients were moderate (66% vs 71%) to severe (35% vs 61%). Only six programmes reported participation results by ethnicity. Ethnic differences were moderate, though only limited data were available for evaluation.Conclusions Across organised CRC screening programmes worldwide, variation in participation by socioeconomic status and ethnicity is often not assessed. However, when measured, marked disparities in participation by socioeconomic status have been observed. Limited data were available to assess inequities by ethnicity. To avoid exacerbating health inequities, screening programmes should systematically monitor participation by socioeconomic status and ethnicity, and investigate and address determinants of low participation.