Individual and geospatial factors associated with receipt of colorectal cancer screening: a state-wide mixed-level analysis.

IF 2.6 3区医学 Q1 PRIMARY HEALTH CARE

Family Medicine and Community Health Pub Date : 2024-07-18 DOI:10.1136/fmch-2024-002983

Jennifer E Bayly, Mara A Schonberg, Marcia C Castro, Kenneth J Mukamal

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引用次数: 0

Abstract

Background: Colorectal cancer (CRC) is the second leading cause of cancer death in US adults but can be reduced by screening. The roles of individual and contextual factors, and especially physician supply, in attaining universal CRC screening remains uncertain.

Methods: We used data from adults 50-75 years old participating in the 2018 New York (NY) Behavioural Risk Factor Surveillance System linked to county-level covariates, including primary care physician (PCP) density and gastroenterologist (GI) density. Data were analysed in 2023-2024. Our analyses included (1) ecological and geospatial analyses of county-level CRC screening prevalence and (2) individual-level Poisson regression models of receipt of screening, adjusted for socioeconomic and county-level contextual variables.

Results: Mean prevalence of up-to-date CRC screening was 71% (95% CI 70% to 73%) across NY's 62 counties. County-level CRC screening demonstrated significant spatial patterning (Global Moran's I=0.14, p=0.04), consistent with the existence of county-level contextual factors. In both county-level and individual-level analyses, lack of health insurance was associated with lower likelihood of up-to-date screening (ß=-1.09 (95% CI -2.00 to -0.19); adjusted prevalence ratio 0.68 (95% CI 0.60 to 0.77)), even accounting for age, race/ethnicity and education. In contrast, county-level densities of both PCPs and GIs were completely unassociated with screening at either the county or individual level. As expected, other determinants at the individual level included education status and age.

Conclusion: In this state-wide representative analysis, physician density was completely unassociated with CRC screening, although health insurance status remains strongly related. In similar screening environments, broadened insurance coverage for CRC screening is likely to improve screening far more effectively than increased physician supply.

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与接受结直肠癌筛查相关的个人和地理空间因素：全州范围内的混合水平分析。

背景：结肠直肠癌（CRC）是美国成年人癌症死亡的第二大原因，但可以通过筛查来降低死亡率。个人因素和环境因素，尤其是医生供应，在实现普及 CRC 筛查中的作用仍不确定：我们使用了参加 2018 年纽约（NY）行为风险因素监测系统的 50-75 岁成年人的数据，这些数据与县级协变量相关联，包括初级保健医生（PCP）密度和胃肠病医生（GI）密度。对 2023-2024 年的数据进行了分析。我们的分析包括：（1）县级 CRC 筛查流行率的生态和地理空间分析；（2）接受筛查的个人级泊松回归模型，并根据社会经济和县级背景变量进行调整：纽约州 62 个县的最新 CRC 筛查平均普及率为 71%（95% CI 为 70% 至 73%）。县级 CRC 筛查表现出明显的空间模式化（Global Moran's I=0.14，p=0.04），这与县级背景因素的存在是一致的。在县级和个人层面的分析中，即使考虑到年龄、种族/民族和教育程度，缺乏医疗保险也与较低的最新筛查可能性相关（ß=-1.09 (95% CI -2.00 to -0.19)；调整患病率比为 0.68 (95% CI 0.60 to 0.77)）。相比之下，县级初级保健医生和消化科医生的密度与县级或个人水平的筛查完全无关。正如预期的那样，个人层面的其他决定因素包括教育状况和年龄：在这项具有全州代表性的分析中，尽管医疗保险状况与 CRC 筛查密切相关，但医生密度与 CRC 筛查完全无关。在类似的筛查环境中，扩大 CRC 筛查的保险范围可能比增加医生数量更有效地提高筛查率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Family Medicine and Community Health PRIMARY HEALTH CARE-

CiteScore

9.70

自引率

0.00%

发文量

审稿时长

19 weeks

期刊介绍： Family Medicine and Community Health (FMCH) is a peer-reviewed, open-access journal focusing on the topics of family medicine, general practice and community health. FMCH strives to be a leading international journal that promotes ‘Health Care for All’ through disseminating novel knowledge and best practices in primary care, family medicine, and community health. FMCH publishes original research, review, methodology, commentary, reflection, and case-study from the lens of population health. FMCH’s Asian Focus section features reports of family medicine development in the Asia-pacific region. FMCH aims to be an exemplary forum for the timely communication of medical knowledge and skills with the goal of promoting improved health care through the practice of family and community-based medicine globally. FMCH aims to serve a diverse audience including researchers, educators, policymakers and leaders of family medicine and community health. We also aim to provide content relevant for researchers working on population health, epidemiology, public policy, disease control and management, preventative medicine and disease burden. FMCH does not impose any article processing charges (APC) or submission charges.