中国2个城市和2个农村地区上消化道肿瘤高危人群分布及内镜筛查依从情况分析

A comparative analysis of the distribution of the high-risk population of upper gastrointestinal cancer and endoscopic screening compliance in two urban areas and two rural areas in China

目的分析城乡上消化道肿瘤高危人群的分布, 探讨上消化道肿瘤影响内镜筛查依从情况的影响因素。方法 2015—2017年, 以中国2个农村地区(河南省罗山县、江苏省射阳县)和2个城市地区(湖南省长沙市、黑龙江省哈尔滨市)为研究现场, 以现场面对面访谈的方式对40~69岁居民开展流行病学调查及上消化道肿瘤风险评估, 并对上消化道肿瘤高危人群开展内镜筛查。采用χ^(2)检验比较农村和城市地区人群上消化道肿瘤高危者占比的差异, 农村和城市地区人群上消化道肿瘤高危人群内镜筛查依从率的影响因素分析采用多因素logistic回归分析。结果参与上消化道肿瘤筛查的40~69岁居民共48 310人, 其中, 农村地区人群占比为47.34%(22 870人), 城市地区人群占比为52.66%(25 440人)。上消化道肿瘤高危人群占比为48.71%(23 532/48 310), 农村地区高危人群占比(56.17%, 12 845/22 870)高于城市地区(42.01%, 10 687/25 440)。上消化道肿瘤高危人群参加内镜筛查依从率为46.62%(10 971/23 532), 农村和城市地区高危人群内镜筛查依从率分别为45.15%(5 799/12 845)和48.40%(5 172/10 687)。多因素logistic回归分析结果显示, 在农村地区人群中, 女性、50~69岁、学历为小学及以上、高收入、有上消化道肿瘤家族史、有胃十二指肠溃疡史、有反流性食管炎史、有浅表性胃炎史的人群有更高的内镜筛查依从率, 但有吸烟史人群的内镜筛查依从率较低(均P<0.05);城市地区人群中, 40~49岁、未接受过学校教育、低收入、有上消化道肿瘤家族史、有反流性食管炎史、有浅表性胃炎史的人群内镜参筛查依从率较高, 有吸烟史的人群内镜筛查依从率较低(均P<0.05)。结论农村人群上消化道肿瘤高危者占比高于城市人群;城市和农村上消化道肿瘤高危人群内镜筛查依从率较低, 且影响城乡人群内镜筛查依从的因素存在一定差异。

Objective To analyze and compare the distribution of the high-risk population of upper gastrointestinal(UGI)cancer and the factors influencing the compliance rate of endoscopic screening in urban China and rural China.Methods From 2015 to 2017,an epidemiological survey was conducted on residents aged 40-69 in two rural areas(Luoshan county of Henan province,Sheyang county of Jiangsu province)and two urban areas(Changsha city of Hunan province,Harbin city of Heilongjiang province).As a result,high-risk individuals were recommended for endoscopic screening.Chi-squareχ^(2) test was used to compare the high-risk rate of UGI cancer between urban and rural residents.In addition,the multivariate logistic regression model was used to analyze the factors influencing the compliance rate of endoscopic screening.Results A total of 48,310 residents aged 40-69 were enrolled in this study,including 22870(47.34%)residents from rural areas and 25440(52.66%)residents from urban areas.A total of 23532 individuals were assessed with a high risk of UGI cancer,with an overall risk rate of 48.71%.A higher proportion of participants with high risk was observed in rural China(56.17%,12845/22870)than in urban China(42.01%,10687/25440).A total of 10971 high-risk individuals with UGI cancer participated in endoscopic screening,with an overall compliance rate of 46.62%(10971/23532),45.15%(5799/12845)in rural China,and 48.40%(5172/10687)in urban China.In rural population,the compliance rate of endoscopic screening was higher in those of females,aged 50-69 years,primary school education or above,high income,a family history of UGI cancer,history of gastric and duodenal ulcer,history of reflux esophagitis,and history of superficial gastritis,but lower in smokers(P<0.05).Among the urban population,the compliance rate of endoscopic screening was higher in those aged 40-49 years,uneducated,low income,family history of UGI cancer,history of reflux esophagitis,history of superficial gastritis,but lower in smokers(P<0.05).Conclusions The proportion of participants with high risk of UGI cancer in rural areas is higher than that of urban areas.The compliance rates of endoscopic screening in urban and rural areas are low,and influencing factors of endoscopic screening exhibit some differences in rural China and urban China.