检查交通时间对大肠癌早期诊断的影响:回顾性队列研究

目的:分析广州市大肠癌筛查项目中初筛阳性并确诊为进展性肠道病变者的大肠癌早期诊断情况,探索到肠镜检查的医院交通时间对大肠癌早期诊断的影响,为提高大肠癌早诊率提供依据。方法:研究基于广州市大肠癌筛查项目进行,收集2015~2016年初筛阳性并在2017年年底之前确诊为进展性肠道病变者的相关资料。研究计算了到肠镜检查医院的最短公共交通时间。采用Logistic回归模型探索交通时间对大肠癌早期诊断的影响作用。结果:共有968名进展性肠道病变者被纳入到研究中,843(87.1%)人被早期诊断。多因素Logistic回归发现交通时间>60 min不利于大肠癌早诊(ORm=0.354,P=0.030)。此外,仅FOBT阳性(ORm=0.270,P=0.001)和问卷、FOBT双阳性(ORm=0.155,P<0.001)更不易早诊;教育水平初中以上(ORm=1.591,P=0.047),免费肠镜检查(ORm=2.471,P=0.011)及居住在城市地区更有可能被早期诊断(ORm=1.845,P=0.048)。结论:广州市进展性肠道病变者的大肠癌早诊率需进一步提高。交通时间是早期诊断的影响因素,在今后的肠镜检查医院的配置中,要考虑到地理均衡性。

Impact of Travel Time to Colonoscopy-Available Hospitals on the Early Detection of Colorectal Cancer:A Retrospective Cohort Study

Objective:To analyZe the early detection of colorectal cancer among the residents who were preliminary screened positive and diagnosed with progressive bowel disease in the GuangZhou colorectal cancer screening program,explore the impact of travel time on the early detection of colorectal cancer,and provide a basis for promoting the rate of early detection.Methods:This study was conducted based on the GuangZhou community-based CRC screening program.Data were collected for the individuals who were positive for preliminary screening in 2015-2016 and were diagnosed with progressive bowel disease by 2017.The public transportation travel time from home to nearest colonoscopy hospital was measured.Logistic regression was used to assess the association of colonoscopy accessibility with the early detection of colorectal cancer.Results:A total of 968 patients with progressive bowel disease were recruited in the study,and 843(87.1%)were diagnosed at early stage.Multivariate Logistic regression found that travel time more than 60 minutes was associated with decreased rate of early detection(ORm=0.354,P=0.030).In addition,only FOBT-positive(ORm=0.270,P=0.001)and questionnaires&FOBT both positive(ORm=0.155,P<0.001)were associated with decreased rate of early detection;People with higher education level(ORm=1.591,P=0.047),free colonoscopy(ORm=2.471,P=0.011)and living in urban areas(ORm=1.845,P<0.048)were more likely to be diagnosed early.Conclusion:The rate of early detection in patients with progressive bowel disease in GuangZhou needed to be further improved.The rate of early detection was associated with travel time.In the configuration of future colonoscopy hospitals,geographical balance must be considered.