Individual and geospatial factors associated with receipt of colorectal cancer screening:a state-wide mixed-level analysis

作     者：Jennifer E Bayly Mara A Schonberg Marcia C Castro Kenneth J Mukamal 

作者机构：Beth Israel Deaconess Medical CenterBostonMassachusettsUSA Harvard Medical SchoolBostonMassachusettsUSA Department of Global Health and PopulationHarvard T H Chan School of Public HealthBostonMassachusettsUSA 

出 版 物：《Family Medicine and Community Health》 (家庭医学与社区卫生（英文）)

年 卷 期：2024年第12卷第S02期

页      面：18-25页

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

基　　金：funded by National Institute on Aging(K24AG065525,K24AG071906) Health Resources and Services Administration(T32HP32715) supported by the Health Resources and Services Administration(HRSA)of the U.S Department of Health and Human Services(HHS)as part of an award totaling$550,341 with 158%percentage financed with non-governmental sources 

主　　题：state screening county 

摘      要：Background Colorectal cancer(CRC)is the second leading cause of cancer death in US adults but can be reduced by *** roles of individual and contextual factors,and especially physician supply,in attaining universal CRC screening remains *** We used data from adults 50-75 years old participating in the 2018 New York(NY)Behavioural Risk Factor Surveillance System linked to county-level covariates,including primary care physician(PCP)density and gastroenterologist(GI)*** were analysed in *** analyses included(1)ecological and geospatial analyses of county-level CRC screening prevalence and(2)individual-level Poisson regression models of receipt of screening,adjusted for socioeconomic and county-level contextual *** Mean prevalence of up-to-date CRC screening was 71%(95%CI 70%to 73%)across NY’s 62 ***-level CRC screening demonstrated significant spatial patterning(Global Moran’s I=0.14,p=0.04),consistent with the existence of county-level contextual *** both county-level and individual-level analyses,lack of health insurance was associated with lower likelihood of up-to-date screening(?−1.09(95%CI−2.00 to-0.19);adjusted prevalence ratio 0.68(95%CI 0.60 to 0.77)),even accounting for age,race/ethnicity and *** contrast,county-level densities of both PCPs and GIs were completely unassociated with screening at either the county or individual *** expected,other determinants at the individual level included education status and *** In this state-wide representative analysis,physician density was completely unassociated with CRC screening,although health insurance status remains strongly *** similar screening environments,broadened insurance coverage for CRC screening is likely to improve screening far more effectively than increased physician supply.