中国城市大肠癌高危人群对大肠腔镜筛查的接受度与支付意愿调查

Acceptance and willingness-to-pay for colorectal colonoscopy screening among high-risk populations for coiorectal cancer in urban China

目的调查我国城市大肠癌高危人群对大肠腔镜筛查的接受度与支付意愿。方法2012--2013年在我国9个省份以高危风险模型筛查出的大肠癌高危人群且接受进一步单一肠癌腔镜筛查的居民为对象，最终纳人分析对象共1624名。对其一般情况进行了调查，并根据调查人群地区的人均国内生产总值（GDP）对人群进行了划分。主要调查了其对腔镜筛查的接受度，将完全接受及较易接受划为较易接受组，较难及很难接受划为较难接受组。支付意愿及相关因素，分别对接受度低和支付意愿低的相关变量行单因素及多因素分析。结果调查对象年龄M（P25，P75）为55．0（49．0，61．0）岁，男性占42．8％（695／1624）。调查对象中87．0％（1414／1624）较易接受肠镜检查，而13．0％（210／1624）较难接受。对两组人群进行多因素分析显示，年龄为60—69岁（OR=I．48，95％CI：1．06～2．07）、非在婚（OR=2．15，95％CI：1．25～3．70）和家里有需抚养人口（OR=I．60，95％CI：1．17～2．20）的人群较难接受肠镜检查，教育程度偏高者（初中OR=O．34，95％CI：0．22～0．52；高中OR=O．41，95％CI：0．26～0．66；大学及以上OR=O．35，95％CI：0．20～0．59）较易接受肠镜检查。在支付意愿方面，85．5％（1388／1624）愿为腔镜筛查支付一定费用。但其中82．3％（1141／1386）的个体支付额度低于100元；而14．5％（236／1624）不愿承担任何费用，多因素分析显示，事业单位和（或）公务员（OR=O．61，95％C1：0．44～0．84）以及企业单位和（或）工人（OR=O．60，95％CI：0．38—0．94）支付意愿较强，而地区人均GDP水平为中（OR=4．08，95％C1：2．75～6．33）及高水平（OR=3．26，95％C1：2．11—4．92）和较难接受肠镜筛查（OR=3．98，95％C1：2．81～5．65）的人群缺乏支付意愿。结论城市大肠癌高危人群对腔镜筛查的接受度尚可，但支付额度有限。

Objective To survey the acceptance and willingness-to-pay for colorectal cancer colonoscopy screening among high risk populations in urban China. Methods From 2012 to 2013, a Cancer Screening Program in Urban China （CanSPUC） was initiated in 9 provinces, the current survey was conducted among those participants who were evaluated as ＂high risk for colorectal cancer＂ by a risk-factor-evaluation-model （community-based） and then went through a colonoscopy screening procedure （hospital-based）. All the data were obtained through a questionnaire-based interview （face-to-face or self-completed）, mainly focusing on the acceptance and willingness-to-pay of the participants for colorectal colonoscopy screening. Results The current analysis included a total of 1 624 participants, with an median age of 55.0 years （P25=49.0, P7~=61.0 years） and an annual income per capita of 17 thousand （range： 10-25 thousand） Chinese Yuan （CNY）, 42.8% （695/1 624） of whom were males. Of all the participants, 87.0% （1 414/1 624） could totally or substantially accept the colonoscopy screening, particularly in those at higher education level （junior high school： 0R=0.34, 95%CI： 0.22-0.52; high school OR=0.41, 95%CI. 0.26-0.66; college or over OR=0.35, 95%Ch 0.20-0.59）. Of all the participants, 13.0% （210/1 624） could not or hardly accept it, particularly in those with older age （60-69 years） （OR=1.48, 95%CI： 1.06-2.07）, not in marriage （0R=2.15, 95% Ch 1.25-3.70） or with family member（s） to raise （OR=l.60, 95% Ch 1.17-2.20）. 1 388 （85.5%） of all the participants had willingness-to-pay for a long-term colonoseopy screening service, particularly in those working in public （OR=0.61, 95%CI： 0.44-0.84） or enterprise sectors （OR= 0.60, 95%CI： 0.38-0.94）, but 82.3% （1 141/1 386） of whom would only pay less than 100 CNY; 14.5% （236/1 624） of total had no willingness-to-pay, particularly in those living in areas with moderate （OR=4.08, 95%Ch 2.75-6.33）or high GDP per capita （0R=3.26, 95%Ch 2.11-4.92）, or with an absence of willingness-to-pay for colonoscopy screening （0R=3.98, 95% CI： 2.81-5.65）. Conclusions Although a larger community-based eoloreetal cancer screening program was warranted to examine the extrapolation of these findings, it suggested that the acceptance for colorectal cancer colonoscopy screening among the selected high-risk populations was considerable. The willing-to-pay was relatively high but the amount of payment was limited, the indicated subgroups with potentially less acceptance or willingness need to be more focused in the future to reach a higher participation rate. The data will also be informative in integrating the screening service into the local health insurance system.