Trends and Predictors for the Uptake of Colon Cancer Screening Using the Fecal Occult Blood Test in Spain from 2011 to 2017
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Study Variables
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- ‘Have you ever undergone a fecal occult blood test?’. Those who answered affirmatively were asked a second question, ‘When was the last time you had a fecal occult blood test?’ The following response options were given: “In the past 12 months”, “Over 1 year but less than 2 years ago”, “Over 2 years but less than 3 years ago”, “Over 3 years but less than 5 years ago”, “Over 5 years ago”. Subjects who reported that they had undergone FOBT within the previous two years were considered ‘uptake’, and the remaining subjects were classified ‘not-uptake’.
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- Sociodemographic variables. Age, marital status (single/married/other), nationality (Spanish born/immigrant), education level (primary/secondary/university studies) and social class (upper/median/lower). Social class is based on occupation and created using the method proposed by the Spanish Society of Epidemiology [15,16].
- -
- Health status. This included the number of self-reported chronic diseases. It was categorized into three groups according to the number of chronic diseases: “none”, “one or two” and finally “three or more” chronic diseases. The following chronic diseases were included to create this variable: high blood pressure, myocardial infarction and other heart diseases, asthma, emphysema, chronic bronchitis, chronic obstructive pulmonary disease, arthrosis, diabetes, cirrhosis, hepatic dysfunction, embolisms, ictus/stroke, malignancies and thyroid problems.
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- Lifestyle behaviors. This included the following self-reported categories: current smoking, any alcohol consumption in the previous two weeks, leisure-time, physical activity and obesity (self-reported body mass index ≥ 30 kg/m2).
2.3. Statistical Methods
3. Results
3.1. Characteristics of the Target Populations for Fecal Occult Blood Test Screening
3.2. Comparison of Uptake Rates for Fecal Occult Blood Test between 2011 SNHS and 2017 SNHS According to Sociodemographic Variables
3.3. Comparison of Uptake Rates for Fecal Occult Blood Test between SNHS 2011 and 2017 According to Health and Lifestyle-Related Variables
3.4. Predictors for Fecal Occult Blood Test Uptake According to the Date of CRC Screening Programs Implementation
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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SPANISH NATIONAL HEALTH SURVEY 2011 | |||||
---|---|---|---|---|---|
Date of FOBT Screening Implementation | |||||
Variables | Categories | Before 2011 (2679) | 2011–2016 (2105) | After 2016 (904) | Total (5688) |
N (%) | N (%) | N (%) | N (%) | ||
Gender | Male | 1330 (49.6) | 1037 (49.3) | 445 (49.2) | 2813 (49.4) |
Female | 1349 (50.4) | 1068 (50.7) | 459 (50.8) | 2876 (50.6) | |
Age groups a | Low | 1075 (40.1) | 879 (41.8) | 377 (41.7) | 2331 (41.0) |
Middle | 770 (28.7) | 582 (27.6) | 265 (29.3) | 1617 (28.4) | |
High | 834 (31.1) | 644 (30.6) | 262 (29.0) | 1740 (30.6) | |
Marital status | Married | 2038 (76.1) | 1641 (78.0) | 710 (78.6) | 4390 (77.2) |
Single | 254 (9.5) | 181 (8.6) | 90 (10.0) | 525 (9.2) | |
Other | 387 (14.4) | 283 (13.4) | 104 (11.4) | 773 (13.6) | |
Nationality | Immigrant | 197 (7.4) | 128 (6.1) | 60 (6.6) | 384 (6.8) |
Spanish | 2482 (92.6) | 1977 (93.9) | 844 (93.4) | 5304 (93.2) | |
Educational level | Primary studies | 589 (22.4) | 711 (34.5) | 178 (20.0) | 1478 (26.5) |
Secondary studies | 1690 (64.3) | 1135 (55.2) | 517 (58.1) | 3342 (59.9) | |
University studies | 351 (13.3) | 212 (10.3) | 194 (21.8) | 757 (13.6) | |
Social Class | Upper | 520 (19.9) | 368 (17.9) | 231 (26.2) | 1119 (20.2) |
Median | 988 (37.8) | 665 (32.4) | 336 (38.2) | 1989 (35.8) | |
Lower | 1107 (42.3) | 1021 (49.7) | 313 (35.6) | 2441 (44.0) | |
Chronic diseases | 0 | 979 (36.5) | 719 (34.2) | 366 (40.2) | 2062 (36.2) |
1 or 2 | 1362 (50.8) | 1096 (52.1) | 436 (48.2) | 2894 (50.9) | |
3 or more | 338 (12.6) | 290 (13.8) | 105 (11.6) | 733 (12.9) | |
Smoker | Yes | 651 (24.3) | 517 (24.6) | 208 (23.2) | 1376 (24.3) |
No | 2026 (75.7) | 1586 (75.4) | 685 (76.8) | 4297 (75.7) | |
Alcohol Consumption | Yes | 818 (68.6) | 759 (74.9) | 84 (18.5) | 1945 (73.2) |
No | 375 (31.4) | 255 (25.1) | 368 (81.5) | 713 (26.8) | |
Physical Activity | Yes | 1571 (58.7) | 1001 (47.7) | 558 (61.7) | 3229 (56.9) |
No | 1107 (41.3) | 1100 (52.2) | 343 (38.1) | 2450 (43.1) | |
Obesity | Yes | 1989 (74.2) | 1362 (64.7) | 683 (75.6) | 1256 (29.1) |
No | 558 (20.8) | 524 (24.9) | 174 (19.2) | 4034 (70.9) |
SPANISH NATIONAL HEALTH SURVEY 2017 | |||||
---|---|---|---|---|---|
Date of FOBT Screening Implementation | |||||
Variables | Categories | Before 2011 (3309) | 2011–2016 (2573) | After 2016 (1087) | Total (6969) |
N (%) | N (%) | N (%) | N (%) | ||
Gender | Male | 1623 (49.0) | 1277 (49.6) | 521 (48.0) | 3421 (49.1) |
Female | 1686 (51.0) | 1296 (50.4) | 566 (52.0) | 3547 (50.9) | |
Age groups a | Low | 1430 (43.2) | 1061 (41.3) | 474 (43.6) | 2966 (42.6) |
Middle | 905 (27.4) | 752 (29.2) | 328 (30.2) | 1985 (28.5) | |
High | 973 (29.4) | 759 (29.5) | 285 (26.2) | 2017 (28.9) | |
Marital status | Married | 2542 (76.8) | 2006 (78.0) | 858 (78.9) | 5407 (77.6) |
Single | 324 (9.8) | 214 (8.3) | 100 (9.2) | 638 (9.2) | |
Other | 443 (13.4) | 352 (13.7) | 129 (11.9) | 924 (13.3) | |
Nationality | Immigrant | 318 (9.6) | 170 (6.6) | 137 (12.6) | 624 (9.0) |
Spanish | 2991 (90.4) | 2403 (93.4) | 950 (87.4) | 6344 (91.0) | |
Educational level | Primary studies | 951 (29.1) | 882 (34.9) | 232 (21.5) | 2065 (30.0) |
Secondary studies | 1763 (53.8) | 1273 (50.3) | 572 (53.1) | 3609 (52.4) | |
University studies | 566 (17.3) | 374 (14.8) | 273 (25.4) | 1214 (17.6) | |
Social Class | Upper | 625 (19.2) | 406 (16.0) | 274 (25.6) | 1304 (19.0) |
Median | 1166 (35.9) | 884 (34.8) | 383 (35.8) | 2434 (35.5) | |
Lower | 1456 (44.8) | 1252 (49.2) | 413 (38.6) | 3121 (45.5) | |
Chronic diseases | 0 | 1373 (41.5) | 933 (36.3) | 456 (42.0) | 2762 (39.6) |
1 or 2 | 1574 (47.6) | 1296 (50.4) | 519 (47.7) | 3389 (48.6) | |
3 or more | 362 (10.9) | 344 (13.3) | 112 (10.3) | 818 (11.7) | |
Smoker | Yes | 880 (26.6) | 667 (25.9) | 264 (24.3) | 1811 (26.0) |
No | 2426 (73.3) | 1904 (74.1) | 823 (75.7) | 5153 (74.0) | |
Alcohol Consumption | Yes | 1002 (30.3) | 786 (30.6) | 344 (31.7) | 4836 (69.4) |
No | 2307 (69.7) | 1786 (69.4) | 743 (68.3) | 2132 (30.6) | |
Physical Activity | Yes | 2119 (36.0) | 1655 (64.4) | 386 (35.5) | 4475 (64.2) |
No | 1190 (36.0) | 916 (35.6) | 701 (64.5) | 2492 (35.8) | |
Obesity | Yes | 633 (19.6) | 605 (24.3) | 216 (20.4) | 1455 (21.5) |
No | 2591 (80.4) | 1887 (75.7) | 846 (79.6) | 5324 (78.5) |
Date of FOBT Screening Implementation | |||||||||
---|---|---|---|---|---|---|---|---|---|
Before 2011 | 2011–2016 | After 2016 | TOTAL | ||||||
Variables | Categories | SNHS 2011 (2679) | SNHS 2017 (3309) | SNHS 2011 (2105) | SNHS 2017 (2573) | SNHS 2011 (904) | SNHS 2017 (1087) | SNHS 2011 (5688) | SNHS 2017 (6969) |
% (95% CI) | % (95% CI) | % (95% CI) | % (95% CI) | % (95% CI) | % (95% CI) | % (95% CI) | % (95% CI) | ||
Gender | Male d,e,f,g | 10.0 (8.5–11.8) | 32.3 (30.1–34.7) | 4.1 (3.0–5.5) | 14.1 (12.3–16.1) | 3.2 (1.9–5.2) | 9.3 (7.0–12.0) | 6.7 (5.8–7.7) | 22.0 (20.7–23.4) |
Female d,e,f,g | 9.5 (8.1–11.2) | 33.1 (30.9–35.4) | 4.6 (3.5–6.0) | 12.3 (10.6–14.2) | 3.5 (2.0–5.4) | 8.2(6.2–10.7) | 6.8 (5.9–7.7) | 21.6 (20.2–22.9) | |
Age groups a,c | Low d,e,f,g | 9.1 (7.4–10.9) | 24.8 (22.6–27.1) | 4.2 (3.0–5.7) | 10.7 (9.0–12.8) | 2.8 (1.4–4.8) | 9.5 (7.1–12.5) | 6.2 (5.3–7.3) | 17.3 (16.0–18.7) |
Middle d,e,f,g | 9.0 (7.1–11.2) | 38.7 (35.6–42.0) | 4.3 (3.4–5.4) | 13.6 (11.3–16.2) | 3.6 (1.8–6.4) | 8.4 (5.7–11.7) | 6.4 (5.3–7.7) | 24.2 (22.4–26.2) | |
High d,e,f,g | 11.4 (9.4–13.7) | 38.9 (35.8–42.0) | 5.2 (2.9–8.1) | 16.2 (13.7–18.9) | 4.0 (2.1–6.9) | 8.0 (5.4–11.8) | 7.8 (6.6–9.1) | 26.0 (24.1–28.0) | |
Marital status | Married d,e,f,g | 10.3 (9.1–11.7) | 33.5 (31.7–35.3) | 4.3 (3.4–5.4) | 13.4 (12.0–15.0) | 3.6 (2.4–5.3) | 8.8 (7.0–10.8) | 7.0 (6.3–7.8) | 22.1 (21.1–23.3) |
Single d,e,g | 7.4 (4.8–11.3) | 31.5 (26.5–36.6) | 3.2 (1.1–6.4) | 12.3 (8.3–17.1) | 3.5 (0.9–8.6) | 4.6 (2.0–10.7) | 5.3 (3.6–7.5) | 20.8 (17.8–24.1) | |
Other d,e,f,g | 8.5 (5.9–11.5) | 29.4 (25.3–33.8) | 5.2 (2.9–8.1) | 12.1 (9.1–16.0) | 1.4 (0.1–4.5) | 11.9 (7.0–18.0) | 6.3 (4.7–8.2) | 20.4 (17.9–23.1) | |
Nationality b,c | Immigrant d,e,f,g | 5.3 (2.8–9.2) | 12.0 (8.8–15.9) | 2.4 (0.7–6.4) | 9.5 (5.8–14.7) | 0.0 (-) | 10.0 (5.5–15.5) | 3.5 (2.0–5.8) | 10.9 (8.7–13.6) |
Spanish d,e,f,g | 10.1 (9.0–11.4) | 34.9 (33.2–36.7) | 4.5 (3.6–5.5) | 13.4 (12.1–14.8) | 3.6 (2.4–5.0) | 8.6 (6.9–10.5) | 7.0 (6.3–7.7) | 22.9 (21.8–23.9) | |
Educational level | Primary d,e,f,g | 9.0 (6.9–11.6) | 32.1 (29.1–35.1) | 4.2 (2.9–5.8) | 11.4 (9.4–13.6) | 1.8 (0.5–4.6) | 8.9 (5.6–12.9) | 5.8 (4.7–7.1) | 20.6 (19.0–22.5) |
Secondary d,e,f,g | 10.1 (8.7–11.6) | 33.0 (30.9–35.3) | 4.1 (3.1–5.4) | 14.4 (12.5–16.4) | 3.3 (1.9–5.0) | 7.1 (5.2–9.4) | 7.0 (6.2–7.9) | 22.3 (21.0–23.7) | |
University e,f,g | 10.5 (7.7–14.1) | 33.4 (29.7–37.4) | 4.3 (2.1–7.7) | 14.2 (10.8–17.9) | 5.2 (2.8–9.3) | 12.2 (8.7–16.5) | 7.4 (5.7–9.4) | 22.7 (20.4–25.1) | |
Social Class c | Upper d,e,f,g | 11.7 (9.2–14.7) | 33.6 (29.9–37.3) | 4.2 (2.4–6.6) | 15.2 (11.9–18.8) | 3.0 (1.2–5.6) | 12.1 (8.7–16.4) | 7.5 (6.1–9.2) | 23.4 (21.2–25.8) |
Median d,e,f,g | 10.7 (8.9–12.8) | 34.4 (31.8–37.2) | 3.9 (2.7–5.7) | 14.2 (12.0–16.6) | 3.6 (2.0–6.2) | 7.4 (5.1–10.3) | 7.2 (6.2–8.5) | 22.8 (21.2–24.5) | |
Lower d,e,f,g | 8.3 (6.8–10.0) | 31.7(29.3–34.1) | 4.7 (3.5–6.1) | 11.7 (10.1–13.6) | 3.7 (1.9–6.1) | 8.2 (5.7–11.0) | 6.2 (5.3–7.2) | 20.6 (19.2–22.0) |
Date of FOBT Screening Implementation | |||||||||
---|---|---|---|---|---|---|---|---|---|
Before 2011 | 2011–2016 | After 2016 | TOTAL | ||||||
Variable | Categories | SNHS 2011 (2679) | SNHS 2017 (3309) | SNHS 2011 (2105) | SNHS 2017 (2573) | SNHS 2011 (904) | SNHS 2017 (1087) | SNHS 2011 (5688) | SNHS 2017 (6969) |
% (95% CI) | % (95% CI) | % (95% CI) | % (95% CI) | % (95% CI) | % (95% CI) | % (95% CI) | % (95% CI) | ||
Chronic diseases a,b | 0 c,d,f | 6.0 (4.6–7.6) | 27.7 (25.3–30.1) | 2.5 (1.4–3.7) | 11.7 (9.8–13.9) | 3.8 (2.1–6.1) | 5.5 (3.7–7.9) | 4.4 (3.6–5.3) | 18.6 (17.2–20.1) |
1 or 2 c,d,e,f | 11.5 (9.9–13.4) | 36.4 (34.1–38.9) | 4.3 (3.2–5.6) | 13.2 (11.4–15.1) | 3.4 (1.9–5.4) | 11.8 (9.1–14.7) | 7.6 (6.6–8.6) | 23.8 (22.4–25.2) | |
3 or more c,d,e,f | 13.7 (10.3–17.7) | 35.8 (31.0–40.9) | 9.3 (6.3–13.2) | 17.2 (13.5–21.5) | 1.8 (0.4–6.1) | 8.1 (4.2–14.7) | 10.3 (8.3–12.7) | 24.2 (21.4–27.3) | |
Smoker b | Yes c,d,e,f | 7.7 (5.8–9.9) | 25.7 (22–9-28.7) | 5.7 (3.9–7.9) | 10.4 (8.2–12.9) | 1.5 (0.4–3.9) | 7.2(4.6–10.9) | 6.0 (4.8–7.4) | 17.4 (15.7–19.2) |
No c,d,e,f | 10.5 (9.2–11.9) | 35.3 (33.5–37.3) | 3.9 (3.0–5.0) | 14.1 (12.6–15.8) | 3.9 (2.6–5.6) | 9.3 (7.4–11.3) | 7.0 (6.3–7.8) | 23.4 (22.2–24.5) | |
Alcohol Consumption | Yes c,d,e,f | 11.6 (8.5–15.0) | 32.9 (31.0–34.9) | 3.8 (2.1–7.0) | 13.1 (11.6–14.7) | 0.6 (0.1–5.4) | 9.1 (7.2–11.3) | 7.5 (5.8–9.7) | 22.0 (19.7–23.2) |
No c,d,e,f | 8.9 (7.1–11.1) | 32.3 (29.4–35.2) | 4.3 (3.0–5.0) | 13.3 (11.0–15.8) | 3.8 (2.3–6.3) | 8.0 (5.5–11.2) | 6.2 (5.1–7.3) | 21.4 (20.8–23.1) | |
Physical Activity b | Yes c,d,e,f | 10.8 (9.3–12.4) | 34.3 (32.3–36.4) | 3.0 (2.1–4.1) | 14.5 (12.9–16.3) | 2.9 (1.7–4.5) | 9.5 (7.5–11.8) | 6.7 (5.8–7.8) | 23.1 (21.9–24.4) |
No c,d,f | 8.3 (6.7–10.0) | 30.0 (27.4–32.6) | 5.9 (4.5–7.5) | 10.7 (8.9–12.9) | 4.2 (2.4–6.7) | 7.4(5.1–10.3) | 6.8 (6.0–7.7) | 19.4 (17.9–21.0) | |
Obesity | Yes c,d,f | 11.6 (9.1–14.4) | 33.3 (29.8–37.1) | 4.7 (3.1–6.8) | 13.7 (11.2–16.7) | 3.7 (1.5–7.3) | 8.1 (4.9–12.1) | 6.3 (5.6–7.1) | 22.2 (21.0–23.3) |
No c,d,e,f | 9.3 (8.1–10.7) | 33.1 (31.3–34.9) | 3.5 (2.6–4.6) | 13.0 (11.6–14.6) | 3.2 (2.0–4.7) | 9.0(7.3–11.2) | 7.7 (6.2–9.2) | 21.4 (19.4–23.6) |
Date of FOBT Screening Implementation | |||||
---|---|---|---|---|---|
Before 2011 | 2011–2016 | After 2016 | Total | ||
Variables | Categories | OR (95% CI) | OR (95% CI) | OR (95% CI) | OR (95% CI) |
Age groups a | Low | 1 | 1 | 1 | 1 |
Middle | 1.54 (1.31–1.82) | NS | NS | 1.39 (1.22–1.58) | |
High | 1.59 (1.35–1.89) | 1.42 (1.09–1.85) | NS | 1.47 (1.28–1.68) | |
Nationality | Immigrant | 0.30 (0.21–0.42) | NS | NS | 0.42 (0.32–0.54) |
Spanish | 1 | 1 | 1 | 1 | |
Educational level | Primary studies | 1 | 1 | 1 | 1 |
Secondary studies | 1.33 (1.13–1.56) | 1.45 (1.14–1.84) | NS | 1.31 (1.15–1.49) | |
University studies | 1.41 (1.15–1.74) | 1.47 (1.06–2.06) | NS | 1.47 (1.28–1.68) | |
Chronic diseases | None | 1 | 1 | 1 | 1 |
1 or 2 | 1.47 (1.27–1.70) | NS | NS | 1.42 (1.26–1.59) | |
3 or more | 1.48 (1.18–1.84) | 1.88 (1.38–2.58) | 1.87 (1.24–2.82) | 1.58 (1.33–1.89) | |
Smoker | Yes | 1 | 1 | 1 | 1 |
No | 1.44 (1.23–1.68) | NS | NS | 1.34 (1.18–1.52) | |
Year of SNHS | 2011 | 1 | 1 | 1 | 1 |
2017 | 5.01 (4.31–5.84) | 3.59 (2.80–4.60) | 2.69 (1.75–4.14) | 4.38 (3.87–4.96) | |
CRC screening implementation | Before 2011 | NA | NA | NA | 4.70 (3.86–5.73) |
2011–2016 | NA | NA | NA | 1.50 (1.21–1.85) | |
After 2017 | NA | NA | NA | 1 |
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Zamorano-Leon, J.J.; López-de-Andres, A.; Álvarez-González, A.; Maestre-Miquel, C.; Astasio-Arbiza, P.; López-Farré, A.; de-Miguel-Diez, J.; Jiménez-García, R.; Albaladejo-Vicente, R. Trends and Predictors for the Uptake of Colon Cancer Screening Using the Fecal Occult Blood Test in Spain from 2011 to 2017. Int. J. Environ. Res. Public Health 2020, 17, 6222. https://doi.org/10.3390/ijerph17176222
Zamorano-Leon JJ, López-de-Andres A, Álvarez-González A, Maestre-Miquel C, Astasio-Arbiza P, López-Farré A, de-Miguel-Diez J, Jiménez-García R, Albaladejo-Vicente R. Trends and Predictors for the Uptake of Colon Cancer Screening Using the Fecal Occult Blood Test in Spain from 2011 to 2017. International Journal of Environmental Research and Public Health. 2020; 17(17):6222. https://doi.org/10.3390/ijerph17176222
Chicago/Turabian StyleZamorano-Leon, José Javier, Ana López-de-Andres, Ana Álvarez-González, Clara Maestre-Miquel, Paloma Astasio-Arbiza, Antonio López-Farré, Javier de-Miguel-Diez, Rodrigo Jiménez-García, and Romana Albaladejo-Vicente. 2020. "Trends and Predictors for the Uptake of Colon Cancer Screening Using the Fecal Occult Blood Test in Spain from 2011 to 2017" International Journal of Environmental Research and Public Health 17, no. 17: 6222. https://doi.org/10.3390/ijerph17176222