台湾结直肠癌筛查项目对生存率和就业的影响：基于真实世界数据的全国性分析
Impact of colorectal cancer screening programme on survival and employment in Taiwan: A nationwide analysis of real-world data
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影响因子:6.7
分区:医学2区 / 胃肠肝病学3区
发表日期:2024 Dec
作者:
Wei-Ying Chen, Yi-Peng Lu, Yu-Wen Chien, Li-Jung Elizabeth Ku, Jung-Der Wang
DOI:
10.1002/ueg2.12685
摘要
结直肠癌（CRC）导致生命损失和显著的经济负担，而通过CRC筛查可以减轻这些负担。本研究评估了台湾CRC筛查项目在挽救生命和延长就业期限方面的潜在效果。通过台湾癌症登记处、国家死亡登记处、台湾CRC筛查数据库及国家健康保险理赔数据的关联，我们招募了2004年至2017年诊断的年龄在50至74岁之间的结直肠腺癌患者，并追踪至2018年。计算了预期寿命（LE）、终生就业时长（LED）、LE的损失以及LED的损失，并与年龄、性别和年份匹配的对照组进行了比较。在假设筛检发现的CRC与非筛检发现的CRC在特定阶段无差异的前提下，并根据不同阶段的分布加权比较，总的LE损失和LED损失。研究共纳入77,169例结直肠腺癌患者，包括女性31,728名（平均[标准差]年龄62.5[7.1]岁）和男性45,441名（平均[标准差]年龄62.8[6.8]岁）。女性的平均LE损失为6.0年（95%置信区间[CI] 5.7-6.3），LED损失为1.0年（95% CI 0.8-1.1）；男性的LE损失为5.1年（95% CI 4.9-5.4），LED损失为1.1年（95% CI 1.0-1.2）。在该队列中，53,678例具有筛查信息。平均而言，筛查在女性中可能挽救2.9年（95% CI 2.6-3.2）的预期寿命和0.5年（95% CI 0.4-0.6）的就业时间，男性则分别为2.7年（95% CI 2.5-3.0）和0.6年（95% CI 0.5-0.7）。台湾CRC筛查项目与挽救生命和延长就业时间相关。未来的研究应评估在考虑挽救就业损失的基础上，早期开始筛查的成本效益，并可能调整提前期偏差。
Abstract
Colorectal cancer (CRC) leads to life loss and a significant economic burden, which could be reduced by CRC screening.We assessed the potential savings of lives and employment to evaluate the effectiveness of the Taiwan CRC Screening Programme.Through interlinkages among Taiwan Cancer Registry, National Mortality Registry, Taiwan CRC Screening Database, and National Health Insurance claim data, we enroled patients with colorectal adenocarcinoma, aged 50-74 years and diagnosed during 2004-2017, and followed them up to 2018. Life expectancy (LE), lifetime employment duration (LED), loss-of-LE and loss-of-LED were calculated, compared with age-, sex- and calendar year-matched cohorts. Assuming no difference within a specific stage for screen-detected versus non-screen detected CRC and weighting them by different stage distributions, we compared the total loss-of-LE and loss-of-LED.The cohort enroled 77,169 patients with colorectal adenocarcinoma, which included 31,728 women (mean [SD] age, 62.5 [7.1] years) and 45,441 men (mean [SD] age, 62.8 [6.8] years). The mean loss-of-LE and loss-of-LED in women were 6.0 (95% confidence interval [CI] 5.7-6.3) and 1.0 (95% CI 0.8-1.1) year(s), whereas those in men were 5.1 (95% CI 4.9-5.4) and 1.1 (95% CI 1.0-1.2) years, respectively. Among the cohort, 53,678 cases had the screening information. On average, screening potentially saved 2.9 (95% CI 2.6-3.2) years of life expectancy plus 0.5 (95% CI 0.4-0.6) years of employment per case in women and 2.7 (95% CI 2.5-3.0) years plus 0.6 (95% CI 0.5-0.7) years in men, respectively.The Taiwan CRC Screening Programme is associated with the savings of lives and employment duration. Future studies are warranted to evaluate the cost-effectiveness of beginning screening at a younger age after accounting for saving employment loss and possibly adjusting lead time bias.