将结直肠癌筛查推广到美国所有人群

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY
Seo Hyun Kim , Divya P. Prajapati , Samir Gupta
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引用次数: 0

摘要

在这篇叙述性综述中,我们概述了目前结直肠癌(CRC)筛查在美国人口中的覆盖范围;不同年龄和社会人口群体中持续存在的 CRC 不公平现象以及流行病学和人口结构的变化如何增加了实现最佳覆盖范围的紧迫性;以及优化筛查在整个人口中的覆盖范围和影响的当前和未来策略。CRC 筛查可以挽救生命,但筛查覆盖人群(包括不同年龄和社会人口群体)的差异很大。在美国,CRC 筛查的参与率仍然不足 60%,而且随着时间的推移一直停滞不前。据观察,年龄较小、具有美国印第安人/阿拉斯加原住民、亚裔和西班牙裔背景、拥有医疗补助保险以及新近移民的人群参与筛查的比例较低。由于 CRC 流行病学和美国人口结构的变化,解决筛查覆盖率不足的问题变得越来越重要。最近的趋势表明,早期(50 岁)和中年(50-60 岁)发病的 CRC 和非定位分期 CRC 有所增加,多个种族/族裔群体之间的 CRC 结果持续不公平。这些趋势是在美国人口越来越多地由来自不同背景的人组成的背景下出现的,而这些人的筛查率较低,CRC 的不良后果发生率较高。通过借鉴以往有影响力政策的成功经验,实施循证筛查干预措施,并开发新的策略来应对患者、临床医生、医疗保健系统和政策层面的挑战,可以优化筛查范围。肠胃病学家、其他临床医生和公共卫生倡导者在这些层面的积极变革中发挥着重要作用。总之,需要优化 CRC 筛查的覆盖范围,这是改善美国所有人群健康公平性的一个紧迫机会。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Extending the Reach of Colorectal Screening to all Populations in the United States

In this narrative review, we provide an overview of the current reach of colorectal cancer (CRC) screening in the US population; how persistent inequities in CRC across age and sociodemographic groups and changes in epidemiology, as well as population structure, have increased the urgency of achieving optimal reach; and current and future strategies for optimizing the reach and impact of screening across the population. CRC screening saves lives, but reach across the population, including across age and sociodemographic groups, is highly variable. CRC screening participation in the United States remains at under 60% and has been stagnant over time. Lower screening participation is observed for individuals of younger age; of American Indian/Alaska Native, Asian, and Hispanic backgrounds; with Medicaid insurance; and with recent immigration. Addressing suboptimal reach is increasingly important due to changing CRC epidemiology and US population structure. Recent trends demonstrate increases in early (<50 years) and middle age (50-60 years) onset of CRC and nonlocalized-stage CRC, as well as persistent inequities in CRC outcomes among multiple racial/ethnic groups. These trends exist in a context where the US population is increasingly composed of individuals from diverse backgrounds associated with lower screening rates and higher rates of adverse CRC outcomes. Screening reach can be optimized by building on successes of previous impactful policies, implementing evidence-based interventions for screening, and developing novel strategies that address challenges at patient, clinician, healthcare system, and policy levels. Gastroenterologists, other clinicians, and public health advocates have a major role in leading positive change at each of these levels. Overall, the need to optimize the reach of CRC screening represents a pressing opportunity for improving health equity across all populations in the United States.

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来源期刊
CiteScore
2.10
自引率
50.00%
发文量
60
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