广州市50～74岁居民肠镜检查接受度和参与度以及影响因素分析
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摘要
目的近年来,我国大肠癌发病率和死亡率均呈明显上升趋势,而大肠癌筛查能够提高大肠癌的早诊率,改善患者的生活质量,降低大肠癌死亡率。大肠癌筛查人群的参与率显著影响筛查效果。本研究旨在对广州市50～74岁大肠癌筛查初筛对象的肠镜检查接受度、参与度及其影响因素进行调查分析,探讨态度与行为之间的差异。方法 2016-10-01-2017-06-31分别在肠镜免费区和非免费区,对参加2015-2017年广州市50～74岁大肠癌筛查的初筛人群选取1 243名居民进行面对面问卷调查,收集肠镜检查接受度、参与度情况和人口学特征。结果共计收回有效问卷1 243份,初筛人群肠镜检查接受度为91.4%(1 136/1 243),而其中接受肠镜检查的初筛阳性者肠镜检查参与度为68.9%(326/473),高于不接受度的7.3%(3/41),2χ=610.36,P<0.001。在回答愿意参加肠镜检查的初筛人群中,愿意接受肠镜检查的原因主要是"关注自己的健康,及早发现问题",选择率为97.3%(1 105/1 136);在回答不接受肠镜检查的初筛人群中,最主要的原因是"害怕做检查承受痛苦",占43.9%(47/107)。年龄大(OR=2.39,95%CI为1.52～3.77)、国营企业/民营企业(OR=2.94,95%CI为1.02～8.48)和农民(OR=3.90,95%CI为1.30～11.71)不容易接受肠镜检查。农民(OR=3.38,95%CI为1.31～8.70)和来自于肠镜检查免费区(OR=3.73,95%CI为2.31～6.01)的肠镜检查参与度高。人均年收入高肠镜检查参与度低,OR=0.52,95%CI为0.31～0.86。结论广州市50～74岁居民肠镜检查接受度较高,但参与度不高,且影响因素不同,态度和行为之间存在明显差异,需要针对公众需求,从多渠道、多方位进行宣传动员,从而让居民实现从态度到行为的转变,真正意义上提高肠镜检查参与度。
OBJECTIVE In recent years,the incidence and mortality of colorectal cancer in China are increasing significantly.Colorectal cancer screening can improve the early detection rate and the life quality of patients,and decrease the mortality of colorectal cancer.The participation rate of colorectal cancer screening significantly affects the screening effect.The aim of this study was to analyze the acceptance,participation and influence factors of colonoscopy in participating prescreening population of50-74 age years in Guangzhou Colorectal Cancer Screening Program,and discuss the difference between attitude and behavior.METHODS From 1 st October,2016 to 30 th June,2017,face-to-face questionnaire survey for 1 243 prescreening population who participated the colorectal cancer screening program from free and non-free colonoscopy districts was used to collect the colonoscopy acceptance,participation and demographic characteristics.RESULTS 1 243 questionnaires have been collected.The acceptance of colonoscopy was 91.4%(1 136/1 243).The 68.9%(326/473)of participation of colonoscopy in the population of accepting the colonoscopy was higher than 7.3%(3/41)in the population of non-acceptance(χ2=610.36,P<0.001).The most reason of acceptance was"Pay attention to my health,and find the problems as soon as possible",accounting for 97.3%(1 105/1 136).The most reason of non-acceptance was"Fear of examination and suffering",accounting for 43.9%(47/107).The older(OR=2.39,95%CI:1.52-3.77)residents from state-owned enterprises/private enterprises(OR=2.94,95%CI:1.02-8.48)and farmers(OR=3.90,95%CI:1.30-11.71)were hard to accept colonoscopy.Farmers(OR=3.38,95%CI:1.31-8.70)and residents from the free area for colonoscopy(OR=3.73,95%CI:2.31-6.01)had higher participation of colonoscopy.The residents with high annual income per capita(OR=0.52,95%CI:0.31-0.86)had lower participation.CONCLUSIONS Acceptance of colonoscopy was relatively high among population of 50-74 age years in Guangzhou,but participation is low.The influence factors are different.There is obviously difference between attitude and behavior.It is necessary to strengthen multidimensional publicizing to meet the needs of public,advance the transformation from attitude to behavior,and improve the participation of colonoscopy.
OBJECTIVE In recent years,the incidence and mortality of colorectal cancer in China are increasing significantly.Colorectal cancer screening can improve the early detection rate and the life quality of patients,and decrease the mortality of colorectal cancer.The participation rate of colorectal cancer screening significantly affects the screening effect.The aim of this study was to analyze the acceptance,participation and influence factors of colonoscopy in participating prescreening population of50-74 age years in Guangzhou Colorectal Cancer Screening Program,and discuss the difference between attitude and behavior.METHODS From 1 st October,2016 to 30 th June,2017,face-to-face questionnaire survey for 1 243 prescreening population who participated the colorectal cancer screening program from free and non-free colonoscopy districts was used to collect the colonoscopy acceptance,participation and demographic characteristics.RESULTS 1 243 questionnaires have been collected.The acceptance of colonoscopy was 91.4%(1 136/1 243).The 68.9%(326/473)of participation of colonoscopy in the population of accepting the colonoscopy was higher than 7.3%(3/41)in the population of non-acceptance(χ2=610.36,P<0.001).The most reason of acceptance was"Pay attention to my health,and find the problems as soon as possible",accounting for 97.3%(1 105/1 136).The most reason of non-acceptance was"Fear of examination and suffering",accounting for 43.9%(47/107).The older(OR=2.39,95%CI:1.52-3.77)residents from state-owned enterprises/private enterprises(OR=2.94,95%CI:1.02-8.48)and farmers(OR=3.90,95%CI:1.30-11.71)were hard to accept colonoscopy.Farmers(OR=3.38,95%CI:1.31-8.70)and residents from the free area for colonoscopy(OR=3.73,95%CI:2.31-6.01)had higher participation of colonoscopy.The residents with high annual income per capita(OR=0.52,95%CI:0.31-0.86)had lower participation.CONCLUSIONS Acceptance of colonoscopy was relatively high among population of 50-74 age years in Guangzhou,but participation is low.The influence factors are different.There is obviously difference between attitude and behavior.It is necessary to strengthen multidimensional publicizing to meet the needs of public,advance the transformation from attitude to behavior,and improve the participation of colonoscopy.
引文
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[12]石菊芳,黄慧瑶,郭兰伟,等.中国城市大肠癌高危人群对大肠腔镜筛查的接受度与支付意愿调查[J].中华预防医学杂志,2015,49(5):381-386.
[13]El-Haddad B,Dong F,Kallail KJ,et al.Association of marital status and colorectal cancer screening participation in the USA[J].Colorectal Dis,2015,17(5):108-114.
[14]于文蓁,柴红.行为改变理论在促进大肠癌筛查行为中的应用[J].基因组学与应用生物学,2017,36(10):4060-4065.
[2]Zhou Q,Li K,Lin GZ,et al.Incidence trends and age distribution of colorectal canc er by subsite in Guangzhou,2000-2011[J].Chin J Cancer,2015,34:34.
[3]向国卿,赵莹,朱佳,等.9 769例结直肠癌的构成特征及变化趋势[J].现代肿瘤医院,2016,24(20):3236-3239.
[4]Shaukat A,Mongin SJ,Geisser MS,et al.Long-term mortality after screening for colorectal cancer[J].N Engl J Med,2013,369:1106-1114.
[5]黄秋驰,叶丁,蒋曦依,等.人群结直肠癌筛检项目成本效果分析与评价[J].中华流行病学杂志,2017,38(1):65-68.
[6]Huang JL,Fang Y,Liang M,et al.Approaching the hard-toreach in organized colorectal cancer screening:an overview of individual,provider and system level coping strategies[J].AIMSPublic Health,2017,22,4(3):289-300.
[7]袁平,顾晋.2006~2015年中国大肠癌筛查人群依从性的Meta分析[J].中国肿瘤,2017,26(4):241-248.
[8]毛阿燕,董佩,严晓玲,等.北京市人群大肠癌筛查成本分析[J].中华预防医学杂志,2015,49(5):387-391.
[9]赵丽中,张伟华,马东旺,等.天津市大肠癌筛查初步结果分析[J].中国肿瘤临床,2015,42(15):760-764.
[10]Essink-Bot ML,Dekker E.Equal access to colorectal cancer screening[J].Lancet,2016,387(10020):724-726.
[11]赵宗禹,宫宁,李金平.某部大肠癌筛查中肠镜检查顺应性影响因素分析[J].山东医药,2013,53(32):43-45.
[12]石菊芳,黄慧瑶,郭兰伟,等.中国城市大肠癌高危人群对大肠腔镜筛查的接受度与支付意愿调查[J].中华预防医学杂志,2015,49(5):381-386.
[13]El-Haddad B,Dong F,Kallail KJ,et al.Association of marital status and colorectal cancer screening participation in the USA[J].Colorectal Dis,2015,17(5):108-114.
[14]于文蓁,柴红.行为改变理论在促进大肠癌筛查行为中的应用[J].基因组学与应用生物学,2017,36(10):4060-4065.