退伍军人事务部医疗保健系统中的结肠镜检查与结直肠癌死亡率：病例对照研究。

Colonoscopy and Colorectal Cancer Mortality in the Veterans Affairs Health Care System: A Case-Control Study.

机构信息

Richard L. Roudebush VA Medical Center and Indiana University School of Medicine, Indianapolis, Indiana (C.J.K., L.J.M.).

VA Medical Center, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth and the Dartmouth Institute Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (H.P., D.J.R.).

出版信息

Ann Intern Med. 2018 Apr 3;168(7):481-488. doi: 10.7326/M17-0723. Epub 2018 Mar 6.

DOI:10.7326/M17-0723

PMID:29532085

Abstract

BACKGROUND

Colonoscopy is widely used in the Veterans Affairs (VA) health care system for colorectal cancer (CRC) prevention, but its effect on CRC mortality is unknown.

OBJECTIVE

To determine whether colonoscopy is associated with decreased CRC mortality in veterans and whether its effect differs by anatomical location of CRC.

DESIGN

Case-control study.

SETTING

VA-Medicare administrative data.

PARTICIPANTS

Case patients were veterans aged 52 years or older who were diagnosed with CRC between 2002 and 2008 and died of the disease by the end of 2010. Case patients were matched to 4 control patients without prior CRC on the basis of age, sex, and facility. Conditional logistic regression was performed to calculate odds ratios (ORs) for exposure to colonoscopy, with adjustment for race, Charlson Comorbidity Index score, selected chronic conditions, nonsteroidal anti-inflammatory drug use, and family history of CRC.

MEASUREMENTS

Exposure to colonoscopy was determined from 1997 to 6 months before CRC diagnosis in case patients and to a corresponding date in control patients. Subgroup analysis was performed for patients who had undergone screening colonoscopy.

RESULTS

A total of 4964 case patients and 19 856 control patients were identified. Case patients were significantly less likely to have undergone any colonoscopy (OR, 0.39 [95% CI, 0.35 to 0.43]). Colonoscopy was associated with reduced mortality for left-sided cancer (OR, 0.28 [CI, 0.24 to 0.32]) and right-sided cancer (OR, 0.54 [CI, 0.47 to 0.63]). The results were similar for patients who had undergone screening colonoscopy (overall OR, 0.30 [CI, 0.24 to 0.38]). Sensitivity analyses that varied the interval between CRC diagnosis and colonoscopy exposure did not affect the primary findings.

LIMITATION

Unmeasured confounding.

CONCLUSION

In this study using national VA-Medicare data, colonoscopy was associated with significant reductions in CRC mortality among veterans and was associated with greater benefit for left-sided cancer than right-sided cancer.

PRIMARY FUNDING SOURCE

U.S. Department of Veterans Affairs.

摘要

背景

结肠镜检查在退伍军人事务部（VA）医疗保健系统中广泛用于结直肠癌（CRC）的预防，但它对 CRC 死亡率的影响尚不清楚。

目的

确定结肠镜检查是否与退伍军人 CRC 死亡率降低相关，以及其效果是否因 CRC 的解剖位置而异。

设计

病例对照研究。

设置

VA-医疗保险管理数据。

参与者

病例患者为年龄在 52 岁或以上的退伍军人，他们在 2002 年至 2008 年间被诊断患有 CRC，并在 2010 年底前死于该病。病例患者根据年龄、性别和机构与之前没有 CRC 的 4 名对照患者相匹配。采用条件逻辑回归计算暴露于结肠镜检查的比值比（OR），调整种族、Charlson 合并症指数评分、选定的慢性疾病、非甾体抗炎药使用和 CRC 家族史。

测量

病例患者从 CRC 诊断前 1997 年至 6 个月内和对照患者的相应日期确定暴露于结肠镜检查的情况。对接受筛查结肠镜检查的患者进行了亚组分析。

结果

共确定了 4964 名病例患者和 19856 名对照患者。病例患者进行任何结肠镜检查的可能性显著降低（OR，0.39 [95%CI，0.35 至 0.43]）。结肠镜检查与左侧癌症（OR，0.28 [CI，0.24 至 0.32]）和右侧癌症（OR，0.54 [CI，0.47 至 0.63]）的死亡率降低相关。对接受筛查结肠镜检查的患者进行的分析结果相似（总 OR，0.30 [CI，0.24 至 0.38]）。改变 CRC 诊断和结肠镜检查暴露之间的间隔的敏感性分析并未影响主要发现。