COLORECTAL CANCER: ASSOCIATION BETWEEN SOCIODEMOGRAPHIC VARIABLES AND THE ADHERENCE TO CANCER SCREENING

KUPPER, Bruna Elisa Catin; FERREIRA, Fabio Oliveira; NAKAGAWA, Wilson Toshihiko; CALSAVARA, Vinicius Fernando; CHULAM, Thiago Celestino; LOPES, Ademar; AGUIAR-JUNIOR, Samuel

doi:10.1590/0102-672020230002e1729

Brasil

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Original Article • ABCD, arq. bras. cir. dig. 36 • 2023 • https://doi.org/10.1590/0102-672020230002e1729 linkcopy

COLORECTAL CANCER: ASSOCIATION BETWEEN SOCIODEMOGRAPHIC VARIABLES AND THE ADHERENCE TO CANCER SCREENING

Câncer colorretal: associação entre variáveis sociodemográficas e a adesão a programas de rastreamento

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND Colorectal cancer (CRC) is a worldwide health problem whose control depends on public policy establishment and effective prevention and screening programs. In Brazil, there are few studies related to adherence to screening methods.

AIMS: The aim of this study was to evaluate the association between demographic and socioeconomic to adherence to CRC screening with fecal immunochemical test (FIT) among average-risk individuals for CRC.

METHODS: In this prospective cross-sectional study, conducted between March 2015 and April 2016, 1,254 asymptomatic individuals aged 50–75 years, participating in a hospital screening campaign in Brazil, were invited to participate in the study.

RESULTS: The adherence rate to FIT was 55.6% (697/1,254). In the multivariable logistic regression analysis, patients aged 60–75 years (odds ratio (OR)=1.30; 95% confidence interval (CI): 1.02–1.66; p=0.03), religious belief (OR=2.04; 95% CI: 1.34–3.11; p<0.01), previous fecal occult blood test (OR=2.07; 95% CI: 1.55–2.76; p<0.01), and full/part-time working status (OR=0.66; 95% CI: 0.49–0.89; p<0.01) were independently associated with adherence to CRC screening.

CONCLUSION: The results of the present study highlight the importance of considering the labor aspects when implementing screening programs, suggesting that campaigns conducted in the workplace and repeated over the years may be more effective.

HEADINGS Colorectal Neoplasms; Early Detection of Cancer; Mass Screening; Disease Prevention; Colonoscopy

Characteristics	Adherent (n=697) n (%)	Nonadherent (n=557) n (%)	p-value
Gender
Male	240 (34.4)	190 (34.1)	0.9
Female	457 (65.6)	367 (65.9)	0.9
Age, years – mean (SD)	60.6 (6.7)	58.8 (6.7)	0.001
Age – categorical variable (years)
50–59	343 (49.2)	333 (59.8)	<0.001
60–75	354 (50.8)	224 (40.2)	<0.001
Race/ethnic group
White	377 (54.1)	311 (55.8)	0.26
Black	63 (9.0)	48 (8.6)
Mixed	175 (25.1)	152 (27.3)
Indian	21 (3.0)	15 (2.7)
Asiatic	61 (8.8)	31 (5.6)
Education, years – mean (SD)	8.4 (4.3)	9 (4.2)	0.01
Education – categorical variable
No formal education	20 (2.9)	14 (2.5)	0.17
Less than high school	362 (52.0)	257 (46.2)
High school graduate	194 (27.9)	183 (32.9)
Some college or more	120 (17.2)	102 (18.3)
Total	696	556
Working status
Full/part time	355 (50.9)	343 (61.6)	<0.001
Homemaker	140 (20.1)	106 (19.0)
Unemployed/retired	202 (29.0)	108 (19.4)
Marital status
Single/divorced/widowed	280 (40.7)	227 (41.3)	0.81
Married/cohabiting	408 (59.3)	322 (58.6)	0.81
Total	688	549
Religious beliefs
Yes	653 (94.1)	493 (88.7)	0.001
No	41 (5.9)	63 (11.33)	0.001
Total	694	556
Distance between residence and hospital, km – mean (SD)	19.3 (10.7)	20 (10.5)	0.19
Distance between residence and hospital – categorical variable
<12.3 km	189 (27.1)	126 (22.7)	0.21
12.3–18.7 km	177 (25.4)	135 (24.3)
18.7–25.75 km	166 (23.8)	147 (26.4)
>25.75 km	165 (23.7)	148 (26.6)
Total	697	556
Income, dollar – mean (SD)	359.8 (357.8)	379.6 (446.7)	0.40
Income – categorical variable ($/day)
Extremely poor (<$2.50)	19 (45.2)	23 (54.8)	0.17
Moderately poor ($2.50–$4)	38 (50.7)	37 (49.3)
Vulnerable ($4–$10)	295 (59.7)	199 (40.3)
Middle class and rich (>$10)	293 (57.2)	219 (42.8)
Total	645	478
Health insurance
Yes	148 (25.0)	80 (22.5)	0.39
No	445 (75.0)	275 (77.5)	0.39
Total	593	355
Family history of CRC
Yes	68 (9.9)	50 (9.0)	0.15
No	619 (90.1)	505 (91.0)	0.15
Total	687	555
Previous FOBT
Yes	196 (28.2)	85 (15.44)	<0.001
No	499 (71.8)	467 (84.6)	<0.001
Total	695	552
Self-referred previous knowledge of FOBT
Yes	283 (40.6)	234 (42.1)	0.59
No	414 (59.4)	322 (58.0)	0.59
Total	697	556

Variables	OR	95%CI		p-value
Variables	OR	Lower	Upper	p-value
Age, years
60–75	1.53	1.22	1.92	<0.001
50–59	Ref			<0.001
Gender
Male	0.98	0.77	1.25	0.90
Female	Ref			0.90
Self-referred previous knowledge of FOBT
Yes	0.94	0.75	1.18	0.60
No	Ref			0.60
Previous FOBT
Yes	2.16	1.62	2.87	<0.001
No	Ref			<0.001
Distance between residence and hospital (km)
<12.3	Ref			0.21
12.3–18.7	0.87	0.63	1.20	0.41
18.7–25.75	0.75	0.55	1.03	0.08
>25.75	0.74	0.54	1.02	0.07
Education
No formal education	Ref			0.17
Less than high school	0.98	0.49	1.99	0.97
High school graduate	0.74	0.36	1.51	0.41
Some college or more	0.82	0.40	1.71	0.60
Family history of CRC
Yes	1.11	0.76	1.63	0.59
No	Ref
Working status
Unemployed/retired	Ref			<0.001
Full/part time	0.55	0.42	0.73	<0.001
Homemaker	0.70	0.51	1.00	0.05
Income ($/day)
Extremely poor (<$2.50)	Ref			0.17
Moderately poor ($2.50–$4)	1.24	0.58	2.65	0.57
Vulnerable ($4–$10)	1.79	0.95	3.38	0.07
Middle class and rich (>$10)	1.62	0.86	3.04	0.13
Marital status
Married or cohabitating	0.97	0.77	1.22	0.82
Single or living alone	Ref			0.82
Religious beliefs
Yes	2.03	1.35	3.07	<0.001
No	Ref			<0.001
Health insurance
Private health insurance	1.14	0.84	1.56	0.40
No health insurance	Ref			0.40

Variables	OR	Lower	Upper	p-value
Age, years
60–75	1.30	1.02	1.66	0.03
50–59	Ref			0.03
Religious beliefs
Yes	2.04	1.34	3.11	0.001
No	Ref			0.001
Previous FOBT
Yes	2.07	1.55	2.76	<0.001
No	Ref			<0.001
Employment status
Unemployed/retired	Ref			0.08
Full/part time	0.66	0.49	0.89	0.006
Homemaker	0.74	0.52	1.06	0.1

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Colégio Brasileiro de Cirurgia Digestiva Av. Brigadeiro Luiz Antonio, 278 - 6° - Salas 10 e 11, 01318-901 São Paulo/SP Brasil, Tel.: (11) 3288-8174/3289-0741 - São Paulo - SP - Brazil
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[T1FN1] SD: standard deviation; CRC: colorectal cancer; FOBT: fecal occult blood testing.