PDF(Pubmed)
Abstract：
UNASSIGNED: The burden of early-onset colorectal cancer (EoCRC) has been increasing among young adult populations in the U.S. The aim of this study was to investigate the relationship between the incidence and mortality of EoCRC and the supply of gastroenterology (GI) specialists and primary care physicians (PCP).
UNASSIGNED: This was an ecological study of EoCRC cases among US counties that occurred between 2014 and 2018. Data was obtained from US cancer statistics. County-level data, including sociodemographic (eg, percentage of female, non-White residents, poverty rate, rurality) and physician supply (GI specialists and PCPs) was obtained from area health resources files. We estimated linear mixed-effects models with the county as a random effect to examine the association of physician supply with 5-year average age-adjusted EoCRC incidence and mortality. Models were adjusted for aggregate county-level socioeconomic characteristics. Multicollinearity was tested through variation inflation.
UNASSIGNED: Analysis included 855 US counties. Mean age-adjusted EoCRC incidence and mortality rates between 2014-2018 were 9.5 (standard deviation [SD]: 2.7) and 2.7 (SD: 0.8) per 100,000 persons, respectively. In the adjusted model, GI supply was associated with lower EoCRC incidence (-5.6 percentage-point change per SD; 95% confidence interval, -11.0 to -0.1) but not with EoCRC mortality (P = .558). PCP supply was associated with lower EoCRC mortality (-27.0 percentage-point change per SD; 95% confidence interval, -46.1 to -7.8) but not with EoCRC incidence (P = .077).
UNASSIGNED: Greater GI specialist supply was associated with a reduction in EoCRC incidence but not improved mortality. Study findings suggest the need for early colorectal cancer screening efforts and the potential for expanding GI services and referrals in medically underserved areas.
UNASSIGNED: This was an ecological study of EoCRC cases among US counties that occurred between 2014 and 2018. Data was obtained from US cancer statistics. County-level data, including sociodemographic (eg, percentage of female, non-White residents, poverty rate, rurality) and physician supply (GI specialists and PCPs) was obtained from area health resources files. We estimated linear mixed-effects models with the county as a random effect to examine the association of physician supply with 5-year average age-adjusted EoCRC incidence and mortality. Models were adjusted for aggregate county-level socioeconomic characteristics. Multicollinearity was tested through variation inflation.
UNASSIGNED: Analysis included 855 US counties. Mean age-adjusted EoCRC incidence and mortality rates between 2014-2018 were 9.5 (standard deviation [SD]: 2.7) and 2.7 (SD: 0.8) per 100,000 persons, respectively. In the adjusted model, GI supply was associated with lower EoCRC incidence (-5.6 percentage-point change per SD; 95% confidence interval, -11.0 to -0.1) but not with EoCRC mortality (P = .558). PCP supply was associated with lower EoCRC mortality (-27.0 percentage-point change per SD; 95% confidence interval, -46.1 to -7.8) but not with EoCRC incidence (P = .077).
UNASSIGNED: Greater GI specialist supply was associated with a reduction in EoCRC incidence but not improved mortality. Study findings suggest the need for early colorectal cancer screening efforts and the potential for expanding GI services and referrals in medically underserved areas.
摘要：
■在美国年轻成年人群中，早发性结直肠癌（EoCRC）的负担一直在增加。这项研究的目的是调查EoCRC的发病率和死亡率与胃肠病学（GI）专家和初级保健医生（PCP）之间的关系。
■这是对2014年至2018年美国各县发生的EoCRC病例的生态研究。数据来自美国癌症统计。县级数据，包括社会人口统计学(例如，女性的百分比，非白人居民,贫困率,乡村）和医生供应（GI专家和PCP）是从地区卫生资源文件中获得的。我们估计了县的线性混合效应模型作为随机效应，以检查医生供应与5年平均年龄调整后的EoCRC发病率和死亡率之间的关系。针对县级社会经济特征调整了模型。通过变异膨胀测试多重共线性。
■分析包括855个美国县。2014-2018年间，经年龄调整的EoCRC平均发病率和死亡率分别为每100,000人9.5（标准差[SD]：2.7）和2.7（标准差：0.8）。分别。在调整后的模型中，GI供应与较低的EoCRC发生率相关（每SD-5.6个百分点的变化；95%置信区间，-11.0至-0.1），但与EoCRC死亡率无关（P=.558）。PCP供应与较低的EoCRC死亡率相关(每SD-27.0个百分点的变化；95%置信区间，-46.1至-7.8），但没有EoCRC发生率（P=0.077）。
■更多的胃肠道专科医师供应与EoCRC发病率降低相关，但与死亡率改善无关。研究结果表明，需要进行早期结直肠癌筛查工作，并有可能在医疗服务不足的地区扩大胃肠道服务和转诊。
■这是对2014年至2018年美国各县发生的EoCRC病例的生态研究。数据来自美国癌症统计。县级数据，包括社会人口统计学(例如，女性的百分比，非白人居民,贫困率,乡村）和医生供应（GI专家和PCP）是从地区卫生资源文件中获得的。我们估计了县的线性混合效应模型作为随机效应，以检查医生供应与5年平均年龄调整后的EoCRC发病率和死亡率之间的关系。针对县级社会经济特征调整了模型。通过变异膨胀测试多重共线性。
■分析包括855个美国县。2014-2018年间，经年龄调整的EoCRC平均发病率和死亡率分别为每100,000人9.5（标准差[SD]：2.7）和2.7（标准差：0.8）。分别。在调整后的模型中，GI供应与较低的EoCRC发生率相关（每SD-5.6个百分点的变化；95%置信区间，-11.0至-0.1），但与EoCRC死亡率无关（P=.558）。PCP供应与较低的EoCRC死亡率相关(每SD-27.0个百分点的变化；95%置信区间，-46.1至-7.8），但没有EoCRC发生率（P=0.077）。
■更多的胃肠道专科医师供应与EoCRC发病率降低相关，但与死亡率改善无关。研究结果表明，需要进行早期结直肠癌筛查工作，并有可能在医疗服务不足的地区扩大胃肠道服务和转诊。
