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Geospatial analysis of the influence of family doctor on colorectal cancer screening adherence

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Listed:
  • Fabrizio Stracci
  • Alessio Gili
  • Giulia Naldini
  • Vincenza Gianfredi
  • Morena Malaspina
  • Basilio Passamonti
  • Fortunato Bianconi

Abstract

Background: Despite the well-recognised relevance of screening in colorectal cancer (CRC) control, adherence to screening is often suboptimal. Improving adherence represents an important public health strategy. We investigated the influence of family doctors (FDs) as determinant of CRC screening adherence by comparing each FDs practice participation probability to that of the residents in the same geographic areas using the whole population geocoded. Methods: We used multilevel logistic regression model to investigate factors associated with CRC screening adherence, among 333,843 people at their first screening invitation. Standardized Adherence Rates (SAR) by age, gender, and socioeconomic status were calculated comparing FDs practices to the residents in the same geographic areas using geocoded target population. Results: Screening adherence increased from 41.0% (95% CI, 40.8–41.2) in 2006–2008 to 44.7% (95% CI, 44.5–44.9) in 2011–2012. Males, the most deprived and foreign-born people showed low adherence. FD practices and the percentage of foreign-born people in a practice were significant clustering factors. SAR for 145 (21.4%) FDs practices differed significantly from people living in the same areas. Predicted probabilities of adherence were 31.7% and 49.0% for FDs with low and high adherence, respectively. Discussion: FDs showed a direct and independent effect to the CRC screening adherence of the people living in their practice. FDs with significantly high adherence level could be the key to adherence improvement. Impact: Most deprived individuals and foreigners represent relevant targets for interventions in public health aimed to improve CRC screening adherence.

Suggested Citation

  • Fabrizio Stracci & Alessio Gili & Giulia Naldini & Vincenza Gianfredi & Morena Malaspina & Basilio Passamonti & Fortunato Bianconi, 2019. "Geospatial analysis of the influence of family doctor on colorectal cancer screening adherence," PLOS ONE, Public Library of Science, vol. 14(10), pages 1-14, October.
    • Handle: RePEc:plo:pone00:0222396
    DOI: 10.1371/journal.pone.0222396
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    1. Klaus Larsen & Jørgen Holm Petersen & Esben Budtz-Jørgensen & Lars Endahl, 2000. "Interpreting Parameters in the Logistic Regression Model with Random Effects," Biometrics, The International Biometric Society, vol. 56(3), pages 909-914, September.
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    1. Sharifah Saffinas Syed Soffian & Azmawati Mohammed Nawi & Rozita Hod & Huan-Keat Chan & Muhammad Radzi Abu Hassan, 2021. "Area-Level Determinants in Colorectal Cancer Spatial Clustering Studies: A Systematic Review," IJERPH, MDPI, vol. 18(19), pages 1-20, October.

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