Effects of screening and universal healthcare on long-term colorectal cancer mortality
Effects of screening and universal healthcare on long-term colorectal cancer mortality
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DOI：
10.1093/ije/dyy182
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发表时间：
2019-04-01
影响因子：
7.7
通讯作者：
Chen, Hsiu-Hsi
中科院分区：
文献类型：
--
作者：
Lee, Yi-Chia;Hsu, Chen-Yang;Chen, Hsiu-Hsi
背景：评估两年一次的粪便免疫化学测试（FIT）和全国医疗保险（NHI）的全国结直肠癌筛查（NCCS）计划对结直肠癌（CRC）的时间趋势影响。成年人口分为3个年龄组（青年，30-49岁；中年，50-69岁；老年，70-84岁）；只有中年人才有资格获得NCCS。根据发病率和生存率的归因，通过CRC死亡率的百分比变化和95%置信区间（CI）来量化NCCS和NHI的粗效应和调整效应。结果：在3.35亿人年的随访中，确定了204362例crc事件和80771例crc相关死亡。1994-2003年（全民健康保险后）与1984-1993年相比，死亡率呈上升趋势，原因是发病率显著上升的趋势不能被全民健康保险提高的生存率所抵消。在2004- 2013年（nccs后）期间，年轻人（30-49岁）的死亡率继续增加15% (95% CI: 10-21%)，老年人（70-84岁）的死亡率继续增加8% (95% CI: 6-11%)，而中年人（50-69岁）的死亡率下降7% (95% CI: 5-9%)，这是由于显著的阶段转移和随后的生存率改善。在中年人中，发病率增加较少，但与其他年龄组相比，生存改善更多。结论：虽然全民医疗保险导致CRC生存率的提高，但基于fit的筛查对降低CRC死亡率做出了更大的贡献。
Background: To evaluate the time trends of colorectal cancer (CRC) affected by a Nationwide Colorectal Cancer Screening (NCCS) programme with biennial faecal immunochemical testing (FIT) and Nationwide Healthcare Insurance (NHI).Methods: Data from the national registries on cancer and death in Taiwan were separated into years 1984-1993, 1994-2003 and 2004-2013 based on the implementations of NHI (starting 1995) and NCCS (starting 2004). The adult population was divided into three age groups (young, 30-49; middle-aged, 50-69; and old, 70-84 years); only the middle-aged were eligible for NCCS. Crude and adjusted effects of NCCS and NHI were quantified by percentage change and 95% confidence interval (CI) with respect to CRC mortality, according to the attributions from incidence and survival.Results: Within 335 million person-years of follow-up, 204362 incident CRCs and 80771 CRC-related deaths were identified. Increasing mortality trends were noted for 1994-2003 (post-NHI) vs 1984-1993 due to remarkable increasing incidence trends that could not be offset by improved survival as a result of NHI. During 2004-13 (post-NCCS), mortality continued to increase by 15% (95% CI: 10-21%) in young adults (30-49 years) and 8% (95% CI: 6-11%) in older adults (70-84 years), whereas middle-aged adults (50-69 years) had a reduction of 7% (95% CI: 5-9%) due to a remarkable stage shift and subsequent improvement in survival. In the middle-aged adults, increased incidence was less but survival improvement was more compared with other age groups.Conclusions: Whereas universal healthcare insurance led to improvement in CRC survival, FIT-based screening has made an even greater contribution to reducing CRC mortality.