ABSTRACT

Objective

Despite some progress in recent years, colorectal cancer (CRC) screening adherence in the United States is still suboptimal, particularly among disadvantaged groups. In this study, we assessed the association between socioeconomic status (SES) and self-reported screening non-adherence (SNA) in a sample of racial/ethnic minorities living in San Francisco, California.

Design/Methods

A total of 376 participants of the San Francisco version of the Health Information National Trends Survey (SF-HINTS) with ages 50–75 years were included in this cross-sectional study. SNA was defined as not reporting blood stool test within the past year and not reporting sigmoidoscopy/colonoscopy within the past 10 years. Poisson regression models with robust variance estimators were used to evaluate the relation of SES with SNA, adjusting for measured confounders. Results are reported as prevalence ratios (PR) and 95% confidence intervals (95% CI).

Results

Overall SNA was 40%. In multivariable models including all respondents, retired participants had significantly lower SNA prevalence than employed participants (PR = 0.46, 95% CI = 0.26 0.83). In stratified analyses by race/ethnicity, Black respondents with less than high school (PR = 1.93, 95% CI = 1.09, 3.43) and those with high school or equivalent (PR = 1.88, 95% CI = 1.16, 3.04) had significantly higher SNA prevalence than those with at least some college. Among non-Hispanic Asian/Pacific Islanders, those disabled had significantly higher prevalence of SNA as compared to employed people (PR = 4.26, 95% CI = 2.11, 8.60). None of the SES indicators were significantly associated to SNA among Hispanics.

Conclusions

Participants with lower SES characteristics were less likely to adhere to CRC screening guidelines and being retired was a predictor of compliance. There was evidence of heterogeneity in associations between SES and CRC screening by race/ethnicity. Life circumstances of retired people could provide insights for designing interventions aimed to improve CRC screening uptake in these priority groups. Future efforts should consider mechanisms underlying differences by race/ethnicity.

中文翻译：

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弱势多民族人群的社会经济地位和结直肠癌筛查行为

摘要

客观的

尽管近年来取得了一些进展，但美国的结直肠癌 (CRC) 筛查依从性仍然不理想，尤其是在弱势群体中。在这项研究中，我们评估了居住在加利福尼亚州旧金山的少数种族/少数族裔样本中的社会经济地位 (SES) 与自我报告的筛查不依从性 (SNA) 之间的关联。

设计/方法

共有 376 名年龄在 50-75 岁之间的旧金山版健康信息全国趋势调查 (SF-HINTS) 参与者被纳入该横断面研究。SNA 被定义为过去一年内未报告血便检查和过去 10 年内未报告乙状结肠镜检查/结肠镜检查。具有稳健方差估计量的泊松回归模型用于评估 SES 与 SNA 的关系，并针对测量的混杂因素进行调整。结果报告为流行率 (PR) 和 95% 置信区间 (95% CI)。

结果

SNA 总体为 40%。在包括所有受访者在内的多变量模型中，退休参与者的 SNA 流行率显着低于就业参与者（PR = 0.46，95% CI = 0.26 0.83）。在按种族/族裔进行的分层分析中，高中以下的黑人受访者（PR = 1.93，95% CI = 1.09，3.43）和高中或同等学历的黑人受访者（PR = 1.88，95% CI = 1.16，3.04）显着SNA 流行率高于那些至少受过一些大学教育的人。在非西班牙裔亚洲/太平洋岛民中，与就业人员相比，残疾人的 SNA 患病率显着更高（PR = 4.26, 95% CI = 2.11, 8.60）。SES 指标中没有一项与西班牙裔美国人的 SNA 显着相关。

结论

SES 特征较低的参与者不太可能遵守 CRC 筛选指南，而退休是遵守情况的预测指标。有证据表明 SES 和 CRC 筛查之间的关联存在种族/族裔的异质性。退休人员的生活情况可以为设计干预措施提供见解，以提高这些优先群体的 CRC 筛查率。未来的努力应该考虑种族/民族差异的潜在机制。