PDF(Pubmed)
Abstract：
BACKGROUND: Screening adherence is important in reducing colorectal cancer (CRC) incidence and mortality. Disparity in CRC screening adherence was observed in populations of different socioeconomic status (SES), but the direction and strength of the association remained unclear.
OBJECTIVE: We aimed to systematically review all the observational studies that have analyzed the association between SES and adherence to organized CRC screening based on fecal occult blood tests.
METHODS: We systematically reviewed the studies in PubMed, Embase, and Web of Science and reference lists of relevant reviews from the inception of the database up until June 7, 2023. Individual SES, neighborhood SES, and small-area SES were included, while any SES aggregated by geographic areas larger than neighbors were excluded. Studies assessing SES with any index or score combining indicators of income, education, deprivation, poverty, occupation, employment, marital status, cohabitation, and others were included. A random effect model meta-analysis was carried out for pooled odds ratios (ORs) and relative risks for adherence related to SES.
RESULTS: Overall, 10 studies, with a total of 3,542,379 participants and an overall adherence rate of 64.9%, were included. Compared with low SES, high SES was associated with higher adherence (unadjusted OR 1.73, 95% CI 1.42-2.10; adjusted OR 1.53, 95% CI 1.28-1.82). In the subgroup of nonindividual-level SES, the adjusted association was significant (OR 1.57, 95% CI 1.26-1.95). However, the adjusted association was insignificant in the subgroup of individual-level SES (OR 1.46, 95% CI 0.98-2.17). As for subgroups of the year of print, not only was the unadjusted association significantly stronger in the subgroup of early studies (OR 1.97, 95% CI 1.59-2.44) than in the subgroup of late studies (OR 1.43, 95% CI 1.31-1.56), but also the adjusted one was significantly stronger in the early group (OR 1.86, 95% CI 1.43-2.42) than in the late group (OR 1.26, 95% CI 1.14-1.39), which was consistent and robust. Despite being statistically insignificant, the strength of the association seemed lower in studies that did not adjust for race and ethnicity (OR 1.31, 95% CI 1.21-1.43) than the overall estimate (OR 1.53, 95% CI 1.28-1.82).
CONCLUSIONS: The higher-SES population had higher adherence to fecal occult blood test-based organized CRC screening. Neighborhood SES, or small-area SES, was more competent than individual SES to be used to assess the association between SES and adherence. The disparity in adherence between the high SES and the low SES narrowed along with the development of interventions and the improvement of organized programs. Race and ethnicity were probably important confounding factors for the association.
OBJECTIVE: We aimed to systematically review all the observational studies that have analyzed the association between SES and adherence to organized CRC screening based on fecal occult blood tests.
METHODS: We systematically reviewed the studies in PubMed, Embase, and Web of Science and reference lists of relevant reviews from the inception of the database up until June 7, 2023. Individual SES, neighborhood SES, and small-area SES were included, while any SES aggregated by geographic areas larger than neighbors were excluded. Studies assessing SES with any index or score combining indicators of income, education, deprivation, poverty, occupation, employment, marital status, cohabitation, and others were included. A random effect model meta-analysis was carried out for pooled odds ratios (ORs) and relative risks for adherence related to SES.
RESULTS: Overall, 10 studies, with a total of 3,542,379 participants and an overall adherence rate of 64.9%, were included. Compared with low SES, high SES was associated with higher adherence (unadjusted OR 1.73, 95% CI 1.42-2.10; adjusted OR 1.53, 95% CI 1.28-1.82). In the subgroup of nonindividual-level SES, the adjusted association was significant (OR 1.57, 95% CI 1.26-1.95). However, the adjusted association was insignificant in the subgroup of individual-level SES (OR 1.46, 95% CI 0.98-2.17). As for subgroups of the year of print, not only was the unadjusted association significantly stronger in the subgroup of early studies (OR 1.97, 95% CI 1.59-2.44) than in the subgroup of late studies (OR 1.43, 95% CI 1.31-1.56), but also the adjusted one was significantly stronger in the early group (OR 1.86, 95% CI 1.43-2.42) than in the late group (OR 1.26, 95% CI 1.14-1.39), which was consistent and robust. Despite being statistically insignificant, the strength of the association seemed lower in studies that did not adjust for race and ethnicity (OR 1.31, 95% CI 1.21-1.43) than the overall estimate (OR 1.53, 95% CI 1.28-1.82).
CONCLUSIONS: The higher-SES population had higher adherence to fecal occult blood test-based organized CRC screening. Neighborhood SES, or small-area SES, was more competent than individual SES to be used to assess the association between SES and adherence. The disparity in adherence between the high SES and the low SES narrowed along with the development of interventions and the improvement of organized programs. Race and ethnicity were probably important confounding factors for the association.
摘要：
背景：筛查依从性对降低结直肠癌（CRC）发病率和死亡率很重要。在不同社会经济地位（SES）的人群中观察到CRC筛查依从性的差异，但是该协会的方向和实力仍不清楚。
目的：我们旨在系统回顾所有基于粪便隐血试验分析SES与有组织的CRC筛查依从性之间关联的观察性研究。
方法：我们系统回顾了PubMed的研究，Embase,和WebofScience以及从数据库开始到2023年6月7日的相关评论的参考列表。个人SES，邻居SES，包括小面积SES，而任何按大于邻居的地理区域聚合的SES都被排除在外。使用任何指标或分数结合收入指标来评估SES的研究，教育,剥夺,贫穷,职业,employment,婚姻状况,同居,其他人也包括在内。对与SES相关的合并优势比（ORs）和依从性的相对风险进行了随机效应模型荟萃分析。
结果：总体而言，10研究,共有3,542,379名参与者，总体依从率为64.9%，包括在内。与低SES相比，高SES与更高的依从性相关(未校正OR1.73,95%CI1.42-2.10;校正OR1.53,95%CI1.28-1.82).在非个体水平SES的子组中，校正后相关性显著(OR1.57,95%CI1.26-1.95).然而,在个体水平SES亚组中,校正关联不显著(OR1.46,95%CI0.98~2.17).至于印刷年份的子组，不仅在早期研究的亚组（OR1.97，95％CI1.59-2.44）中的未调整关联明显强于晚期研究的亚组（OR1.43，95％CI1.31-1.56），但调整后的早期组（OR1.86，95％CI1.43-2.42）明显强于晚期组（OR1.26，95％CI1.14-1.39），这是一致和强大的。尽管在统计上微不足道，在未校正种族和民族的研究(OR1.31,95%CI1.21~1.43)中,关联强度似乎低于总体估计值(OR1.53,95%CI1.28~1.82).
结论：SES较高的人群对基于粪便潜血检测的有组织的CRC筛查有较高的依从性。邻里SES,或小面积SES，比单独的SES更有能力评估SES和依从性之间的关系。随着干预措施的发展和有组织计划的改善，高SES和低SES之间的依从性差距缩小了。种族和种族可能是该协会的重要混杂因素。
目的：我们旨在系统回顾所有基于粪便隐血试验分析SES与有组织的CRC筛查依从性之间关联的观察性研究。
方法：我们系统回顾了PubMed的研究，Embase,和WebofScience以及从数据库开始到2023年6月7日的相关评论的参考列表。个人SES，邻居SES，包括小面积SES，而任何按大于邻居的地理区域聚合的SES都被排除在外。使用任何指标或分数结合收入指标来评估SES的研究，教育,剥夺,贫穷,职业,employment,婚姻状况,同居,其他人也包括在内。对与SES相关的合并优势比（ORs）和依从性的相对风险进行了随机效应模型荟萃分析。
结果：总体而言，10研究,共有3,542,379名参与者，总体依从率为64.9%，包括在内。与低SES相比，高SES与更高的依从性相关(未校正OR1.73,95%CI1.42-2.10;校正OR1.53,95%CI1.28-1.82).在非个体水平SES的子组中，校正后相关性显著(OR1.57,95%CI1.26-1.95).然而,在个体水平SES亚组中,校正关联不显著(OR1.46,95%CI0.98~2.17).至于印刷年份的子组，不仅在早期研究的亚组（OR1.97，95％CI1.59-2.44）中的未调整关联明显强于晚期研究的亚组（OR1.43，95％CI1.31-1.56），但调整后的早期组（OR1.86，95％CI1.43-2.42）明显强于晚期组（OR1.26，95％CI1.14-1.39），这是一致和强大的。尽管在统计上微不足道，在未校正种族和民族的研究(OR1.31,95%CI1.21~1.43)中,关联强度似乎低于总体估计值(OR1.53,95%CI1.28~1.82).
结论：SES较高的人群对基于粪便潜血检测的有组织的CRC筛查有较高的依从性。邻里SES,或小面积SES，比单独的SES更有能力评估SES和依从性之间的关系。随着干预措施的发展和有组织计划的改善，高SES和低SES之间的依从性差距缩小了。种族和种族可能是该协会的重要混杂因素。
