BACKGROUND Colorectal cancer (CRC) screening rates remain suboptimal, particularly in low-income and underserved populations. Mailed fecal immunochemical testing (FIT) may overcome common barriers to screening; however, the effect of mailed FIT kits may differ across important subpopulations. The goal of the current study was to examine sociodemographic and health-related factors that moderate the effect of an intervention of automated direct mail of FIT kits at health clinics serving low-income populations. METHODS This study is a secondary analysis of the Strategies and Opportunities to Stop Colon Cancer in Priority Populations (STOP CRC) study, a cluster-randomized pragmatic trial to increase uptake of CRC screening in patients seen at federally qualified health centers. The intervention involved tools embedded in the electronic medical records to enable participating clinics to mail FIT kits and related materials to eligible participants. We examined the rate of FIT completion by potential moderating characteristics using electronic health record data supplemented by the American Community Survey and the Centers for Medicare & Medicaid Services Geographic Variation datasets, linked via geocoding to patients' addresses. All patients aged 50-75 seen in participating health clinics who were eligible for CRC screening were included. RESULTS Although not always statistically significant, we saw a consistent pattern of increased FIT return rates among intervention participants compared to control participants across all subgroups studied, with incidence rate ratios (IRRs) generally ranging from 1.25 to 1.50. FIT completion in the intervention group ranged from 15 and 20% across subpopulations, typically three to six percentage points higher than the control group participants. The only moderator with a statistically significant interaction was race: persons of Asian descent showed a twofold response to the intervention (adjusted incidence rate ratio [aIRR] = 2.06, 95% confidence interval 1.41 to 3.00). CONCLUSIONS Response to a mailed FIT intervention was generally consistent across a wide range of individual and neighborhood-level patient characteristics, including typically underserved patients and those in low-resource communities. TRIAL REGISTRATION ClinicalTrials.gov, NCT01742065. Registered on 5 December 2012.

中文翻译：

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主持人通过邮寄的粪便免疫化学检测试剂盒提高大肠癌筛查率的干预措施的有效性：一项实用的随机试验的结果。

背景技术大肠癌（CRC）筛查率仍然不是最佳的，特别是在低收入和服务不足的人群中。邮寄粪便免疫化学检测（FIT）可能会克服常见的筛查障碍；但是，邮寄的FIT套件的效果在重要的亚人群中可能有所不同。当前研究的目的是研究社会人口统计学和与健康有关的因素，这些因素减轻了在服务于低收入人群的卫生诊所中自动直接邮寄FIT试剂盒的干预效果。方法：本研究是对优先人群中终止结肠癌的策略和机会的第二次分析（STOP CRC）研究，该研究是一项集群随机的务实试验，旨在增加在联邦合格卫生中心就诊的患者中进行CRC筛查的机会。干预涉及嵌入电子病历中的工具，以使参与的诊所能够将FIT套件和相关材料邮寄给符合条件的参与者。我们使用美国社区调查以及医疗保险和医疗补助服务中心地理变异数据集补充的电子健康记录数据，通过潜在的调节特征检查了FIT完成率，这些数据通过地理编码链接到患者的地址。包括所有参加健康检查的年龄在50-75岁之间且符合CRC筛查条件的患者。结果尽管在统计上并不总是很显着，但在所有研究的亚组中，与对照组的参与者相比，干预组的FIT回报率一直呈上升趋势，其发生率之比（IRR）通常为1.25至1.50。干预组的FIT完成率在亚人群中介于15％和20％之间，通常比对照组参与者高3至6个百分点。唯一具有统计学上显着性相互作用的主持人是种族：亚洲人后裔对干预表现出双重反应（调整后的发生率[aIRR] = 2.06，95％置信区间1.41至3.00）。结论对邮寄FIT干预的反应在各个个人和邻里级患者特征（包括通常服务不足的患者和资源贫乏社区的患者）中通常是一致的。试验注册ClinicalTrials.gov，NCT01742065。2012年12月5日注册。通常比对照组参与者高三到六个百分点。唯一具有统计学上显着性相互作用的主持人是种族：亚洲人后裔对干预措施有双重反应（调整后的发生率[aIRR] = 2.06，95％置信区间1.41至3.00）。结论对邮寄FIT干预的反应在各个个人和邻里级患者特征（包括通常服务不足的患者和资源贫乏社区的患者）中通常是一致的。试验注册ClinicalTrials.gov，NCT01742065。2012年12月5日注册。通常比对照组参与者高三到六个百分点。唯一具有统计学上显着性相互作用的主持人是种族：亚洲人后裔对干预表现出双重反应（调整后的发生率[aIRR] = 2.06，95％置信区间1.41至3.00）。结论对邮寄FIT干预的反应在各个个人和邻里级患者特征（包括通常服务不足的患者和资源贫乏社区的患者）中通常是一致的。试验注册ClinicalTrials.gov，NCT01742065。2012年12月5日注册。06、95％置信区间1.41至3.00）。结论对邮寄FIT干预的反应在各个个人和邻里级患者特征（包括通常服务不足的患者和资源贫乏社区的患者）中通常是一致的。试验注册ClinicalTrials.gov，NCT01742065。2012年12月5日注册。06、95％置信区间1.41至3.00）。结论对邮寄FIT干预的反应在各个个人和邻里级患者特征（包括通常服务不足的患者和资源贫乏社区的患者）中通常是一致的。试验注册ClinicalTrials.gov，NCT01742065。2012年12月5日注册。