Objective: To evaluate the compliance rate of screening colonoscopy and associated factors in high-risk populations of colorectal cancer (CRC) in urban China. Methods: CRC screening data from the Program of Cancer Screening in Urban China conducted in 12 provinces in 2012-2014 was used in the present study. All 97 445 participants were asked to take epidemiological questionnaire survey to evaluate their cancer risk. Participants who were evaluated as "high risk for CRC" were recommended to receive colonoscopy at designated hospitals. Chi-square tests were used to compare the differences of participation rates between groups. Multivariate logistic regression models were applied to explore the potential factors associated withthe compliance rate of screening colonoscopy. Results: Overall, 97 445 participants of CRC high-risk were included in this analysis, and 14 949 of them took screening colonoscopy, yielding a participation rate of 15.3%. The participation rate varied greatly across provinces, ranging from 25.2% (2 785/11 071) in Heilongjiang to 9.7% (1 698/17 515) in Liaoning. Moreover, the participation rate in 2013-2014 was significantly higher than that in 2012-2013 (17.1%(9 766/57 280) vs 12.9% (5 183/40 165), χ(2)=57.67, P<0.001) . The multivariate logistic regression analyses showed that: compared with individuals of 40-49 years old, individuals of 50-59 or 60-69 years old were more willing to accept screening colonoscopy, with OR of 1.17 (95% CI: 1.12-1.22) and 1.13 (95% CI: 1.08-1.19), respectively; compared with uneducated individuals, individuals with good educational background of equivalent to high school or higher (OR=1.29, 95% CI:1.10-1.50) were more willing to accept screening colonoscopy; compared with individuals who never took fecal occult blood tests (FOBT) before, individuals with previous positive FOBT results (OR=1.40, 95% CI:1.31-1.50) were more willing to accept screening colonoscopy; compared with individuals with no inflammatory bowel diseases (IBD), individuals with IBD (OR=1.63, 95%CI:1.56-1.69) were more willing to accept screening colonoscopy; Compared with individuals without polyp history, individuals having history of previous polyp detection (OR=1.43, 95% CI:1.37-1.50) were more willing to accept screening colonoscopy; compared to individuals with no family history of CRC, individuals with history of CRC (OR=1.60, 95% CI:1.53-1.66) were more willing to accept screening colonoscopy. Conclusion: The overall participation rate of screening colonoscopy among high-risk population of CRC in the 12 participating sites was 15.3%. The study findings indicated that age, education level, history of past fecal occult blood test, IBD, history of polyp, family history of CRC were associated with the compliance rate of colonoscopy in this population-based CRC screening program.
目的： 评价中国城市结直肠癌高危人群的结肠镜筛查依从性并探索其相关因素。 方法： 以2012—2014中国12个省份开展的城市癌症早诊早治项目中所获取的97 445例结直肠癌高危人群资料用于数据分析。所有符合研究条件的参与者均接受高危因素问卷调查以评估患癌风险，并推荐评估结果为结直肠癌高危的人群在项目的指定医院进行随后的结肠镜检查。采用χ(2)检验比较不同特征人群的结肠镜筛查参与率差异；采用多因素logistic回归模型分析与结肠镜筛查参与率相关的因素。 结果： 97 445例结直肠癌高危人群中，14 949例接受了结肠镜检查，参与率为15.3%。不同省份高危人群进行结肠镜筛查的参与率存在一定差异，黑龙江参与率最高，为25.2%（2 785/11 071），辽宁参与率最低，为9.7%（1 698/17 515）。2013—2014年度的总体筛查参与率高于2012—2013年度[17.1%（9 766/57 280）比12.9%（5 183/40 165），χ(2)=57.67，P<0.001]。多因素logistic回归分析结果提示，与40~49岁的人群相比，50~59岁（OR=1.17，95%CI：1.12~1.22）以及60~69岁（OR=1.13，95%CI：1.08~1.19）人群更易接受结肠镜检查；与未受教育的人群相比，具有高中及以上学历的人群（OR=1.29, 95%CI：1.10~1.50）更愿意接受结肠镜检查；与既往未接受过粪便潜血检测（FOBT）的人群相比，接受过FOBT且结果为阳性（OR=1.40，95%CI：1.31~1.50）的人群更愿意接受结肠镜检查；与未患有炎症性肠病（IBD）的人群相比，患有IBD的人群（OR=1.63，95%CI：1.56~1.69）更愿意接受结肠镜检查；与无肠道息肉史的人群相比，有肠道息肉史的人群(OR=1.43，95%CI：1.37~1.50)更愿意接受结肠镜检查；与无结直肠癌家族史的人群相比，有结直肠癌家族史的人群(OR=1.60，95%CI：1.53~1.66)更愿意接受结肠镜检查。 结论： 中国12个省份高危人群的结肠镜筛查总体参与率较低。年龄、受教育程度、既往FOBT检查史、患IBD、肠道息肉史、结直肠癌家族史为与结肠镜筛查依从性相关的重要因素。.
Keywords: Colonoscopes; Colorectal neoplasms; Compliance; Screening.