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Abstract：
BACKGROUND: Socioeconomic inequalities in the uptake of colorectal cancer screening are well documented, but the implications on inequities in health gain remain unclear.
METHODS: Sixty-year-olds were randomly recruited from the Swedish population between March 2014 and March 2020 and invited to undergo either 2 rounds of fecal immunochemical testing (FIT) 2 years apart (n = 60 137) or primary colonoscopy just once (n = 30 400). By linkage to Statistics Sweden\'s registries, we obtained socioeconomic data. In each defined socioeconomic group, we estimated the cumulative yield of advanced neoplasia in each screening arm (intention-to-screen analysis). In the biennial FIT arm, we predicted the probability of exceeding the yield in the primary colonoscopy arm by linear extrapolation of the cumulative yield to (hypothetical) additional rounds of FIT.
RESULTS: In the lowest income group, the yield of advanced neoplasia was 1.63% (95% confidence interval [CI] = 1.35% to 1.93%) after 2 rounds of FIT vs 1.93% (95% CI = 1.49% to 2.40%) in the primary colonoscopy arm. Extrapolation to a third round of FIT implied a 86% probability of exceeding the yield in the primary colonoscopy arm. In the highest income group, we found a more pronounced yield gap between the 2 screening strategies-2.32% (95% CI = 2.15% to 2.49%) vs 3.71% (95% CI = 3.41% to 4.02%)- implying a low (2%) predicted probability of exceeding yield after a third round of FIT.
CONCLUSIONS: Yield of advanced neoplasia from 2 rounds of FIT 2 years apart was poorer as compared with primary colonoscopy, but the difference was less in lower socioeconomic groups.
BACKGROUND: ClinicalTrials.gov identifier NCT02078804.
METHODS: Sixty-year-olds were randomly recruited from the Swedish population between March 2014 and March 2020 and invited to undergo either 2 rounds of fecal immunochemical testing (FIT) 2 years apart (n = 60 137) or primary colonoscopy just once (n = 30 400). By linkage to Statistics Sweden\'s registries, we obtained socioeconomic data. In each defined socioeconomic group, we estimated the cumulative yield of advanced neoplasia in each screening arm (intention-to-screen analysis). In the biennial FIT arm, we predicted the probability of exceeding the yield in the primary colonoscopy arm by linear extrapolation of the cumulative yield to (hypothetical) additional rounds of FIT.
RESULTS: In the lowest income group, the yield of advanced neoplasia was 1.63% (95% confidence interval [CI] = 1.35% to 1.93%) after 2 rounds of FIT vs 1.93% (95% CI = 1.49% to 2.40%) in the primary colonoscopy arm. Extrapolation to a third round of FIT implied a 86% probability of exceeding the yield in the primary colonoscopy arm. In the highest income group, we found a more pronounced yield gap between the 2 screening strategies-2.32% (95% CI = 2.15% to 2.49%) vs 3.71% (95% CI = 3.41% to 4.02%)- implying a low (2%) predicted probability of exceeding yield after a third round of FIT.
CONCLUSIONS: Yield of advanced neoplasia from 2 rounds of FIT 2 years apart was poorer as compared with primary colonoscopy, but the difference was less in lower socioeconomic groups.
BACKGROUND: ClinicalTrials.gov identifier NCT02078804.
摘要：
背景：结直肠癌筛查中的社会经济不平等是有据可查的，但对健康不平等的影响仍不清楚。
方法：在3月之间从瑞典人口中随机招募了60岁的年轻人，2014年3月,2020年，并邀请间隔2年进行粪便免疫化学检测（FIT）（n=60,137）或仅进行一次结肠镜检查（PCOL；n=30,400）。通过与瑞典统计局的登记册的联系，我们获得了社会经济数据。在每个定义的社会经济群体中，我们估计了每个筛查组中晚期肿瘤(AN)的累积产量(意向筛查分析).我们预测了在第三轮FIT：Pr{AN_FIT3>AN_PCOL}后PCOL臂中超过产量的概率。
结果：在最低收入组中，经过两轮FIT后，AN的收益率为1.63%(95%置信区间[CI]=1.35%至1.93%)，与PCOL组的1.93%(95%CI=1.49%至2.40%)相关。我们预测Pr{AN_FIT3>AN_PCOL}=0.86。在最高收入群体中，我们发现两种筛选策略之间的收益率差距更为明显，2.32%（95%CI=2.15%至2.49%）与3.71%（95%CI=3.41%至4.02%），和非常低的Pr{AN_FIT3>AN_PCOL}(=0.02)。
结论：从FIT相隔2年和PCOL得出的AN收益率，分别,更穷，但差异较小，在较低的社会经济群体中。该结果对于有组织的结直肠癌筛查中的健康公平性评估是有价值的。
背景：ClinicalTrials.gov编号NCT02078804。
方法：在3月之间从瑞典人口中随机招募了60岁的年轻人，2014年3月,2020年，并邀请间隔2年进行粪便免疫化学检测（FIT）（n=60,137）或仅进行一次结肠镜检查（PCOL；n=30,400）。通过与瑞典统计局的登记册的联系，我们获得了社会经济数据。在每个定义的社会经济群体中，我们估计了每个筛查组中晚期肿瘤(AN)的累积产量(意向筛查分析).我们预测了在第三轮FIT：Pr{AN_FIT3>AN_PCOL}后PCOL臂中超过产量的概率。
结果：在最低收入组中，经过两轮FIT后，AN的收益率为1.63%(95%置信区间[CI]=1.35%至1.93%)，与PCOL组的1.93%(95%CI=1.49%至2.40%)相关。我们预测Pr{AN_FIT3>AN_PCOL}=0.86。在最高收入群体中，我们发现两种筛选策略之间的收益率差距更为明显，2.32%（95%CI=2.15%至2.49%）与3.71%（95%CI=3.41%至4.02%），和非常低的Pr{AN_FIT3>AN_PCOL}(=0.02)。
结论：从FIT相隔2年和PCOL得出的AN收益率，分别,更穷，但差异较小，在较低的社会经济群体中。该结果对于有组织的结直肠癌筛查中的健康公平性评估是有价值的。
背景：ClinicalTrials.gov编号NCT02078804。
