ArticleCancer medicine2020
How spatial accessibility to colonoscopy affects diagnostic adherences and adverse intestinal outcomes among the patients with positive preliminary screening findings.
Article in Cancer medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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5 citing papers in PubMed.
- Transportation-related factors, cancer screening, and stage at diagnosis: A scoping review.PloS one · 2026Article
- A risk scoring system for advanced colorectal neoplasia in high-risk participants to improve current colorectal cancer screening in Tianjin, China.BMC gastroenterology · 2022Article
- A risk-prediction score for colorectal lesions on 12,628 participants at high risk of colorectal cancer.Gastroenterology report · 2022Article
- Identifying the main barriers for participation in a population-based colorectal cancer screening programme in East Azerbaijan, Iran.Ecancermedicalscience · 2022Article
- How spatial accessibility to colonoscopy affects diagnostic adherences and adverse intestinal outcomes among the patients with positive preliminary screening findings.Cancer medicine · 2020Article
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7 authors.
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Abstract
backgroundColonoscopy is an important procedure for early colorectal cancer (CRC) detection, however, patients with positive preliminary screening results in China may not seek for colonoscopy to confirm the diagnosis. We evaluated the spatial accessibility of colonoscopy among the residents with positive preliminary screening results in Guangzhou, China, and investigated how colonoscopy accessibility was associated with the population adherence and adverse intestinal outcomes.
methodsThis study was based on the Guangzhou community-based CRC screening program. Spatial accessibility was measured using three metrics including travel time from home to nearest colonoscopy hospital, physician-to-population ratio (PPR) and accessibility indicator estimated with enhanced two-step floating catchment area method (E2SFCA). We used Cox regression and logistic regression to assess the association of colonoscopy accessibility with population adherence and adverse intestinal outcomes, respectively.
resultsA total of 34 606 people were identified with positive preliminary screening findings. Central areas were reported with higher E2SFCA scores, higher PPR and less travel time. The model adjusting for potential individual level confounders found that PPR > 50 (Hazard Ratio (HR) = 1.88, 95% Confidence Interval (CI): 1.79-1.97) and higher scores of E2SFCA (HR = 3.78, 95% CI: 2.07-6.92) were associated with increased adherence, although estimates were not significant in the model adjusting for both individual and district-level confounders. For adverse intestinal outcomes, the final multilevel logistic model suggested a lower risk of intestinal lesions among the residents in areas with PPR > 50 (Odds Ratio (OR) = 0.49, 95% CI: 0.24-0.99) and higher scores of E2SFCA (OR = 0.20, 95% CI: 0.05-0.82).
conclusionSignificant inequality of colonoscopy accessibility was observed across Guangzhou. The increased incidence of intestinal lesions was associated with spatial inequalities of medical resources. Policies against the spatial inequality in medical resources should be developed.
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