Objective To examine the effect of excess body weight on adherence and lesion detection in colorectal cancer(CRC)screening.Methods A cross-sectional analysis was conducted within an opportunistic CRC screening program...Objective To examine the effect of excess body weight on adherence and lesion detection in colorectal cancer(CRC)screening.Methods A cross-sectional analysis was conducted within an opportunistic CRC screening program in Chongqing,which enrolled 43,797 adults aged 35–74 years between 2021 and 2022.A total of 42,279 participants were included in the final analysis,of whom 19,462(46.0%)had excess body weight(BMI>24.0 kg/m2).Colonoscopy adherence and detection were compared between normal and excess body weight group,and associated factors were examined.Results Of the 7,002 participants recommended for colonoscopy,3,808(54.4%)had excess body weight.Adherence was significantly lower in the excess weight group(6.6%)than in the normal weight group(10.7%,P<0.001),and this trend was consistent across sex and age groups.The detection rates of advanced neoplasms(3.6%vs.1.8%)and non-advanced adenomas(10.7%vs.6.7%)were higher in the excess weight cohort,with a significant difference for any neoplasm(14.2%vs.8.9%,P<0.05).Differences in adherence-and detection-related factors were also observed between the groups.Conclusion Excess body weight was associated with lower colonoscopy adherence but higher neoplasm detection.These findings support the integration of weight management with targeted screening promotion to improve CRC prevention in this high-risk population.展开更多
Objective To explore the health determinants of all-cancer mortality from a health-ecological perspective.Methods Using the health-ecological model,we identified 15 health determinants across five domains:personal inn...Objective To explore the health determinants of all-cancer mortality from a health-ecological perspective.Methods Using the health-ecological model,we identified 15 health determinants across five domains:personal innate,behavioral,interpersonal network,socioeconomic,and macroenvironmental characteristics.Data on cancer outcomes and health determinants from 185 countries,classified using the Human Development Index(HDI),were extracted from GLOBOCAN 2022,the World Health Organization Global Health Observatory,the Global Burden of Disease Study 2021,the United Nations,and the World Bank.A multivariate linear regression model was used to estimate the association between health determinants and cancer outcomes.Results A total of 153 countries with complete information on cancer outcomes and health determinants were enrolled in the study.A higher all-cancer age-standardized mortality rate(ASMR)was associated with current tobacco use,alcohol consumption,obesity,agricultural employment,and lag-distributed income.In women aged 15–49 years,being married or in a union was associated with a lower ASMR.Early-onset ASMR was positively associated with agricultural employment,lag-distributed income,and unsafe sanitation.Notable sex differences were observed,although tobacco use and obesity were identified as risk factors in both sexes.Conclusion We underscore the crucial need to incorporate cross-sectoral interventions within a resilient healthcare system to effectively mitigate the cancer mortality burden.展开更多
Introduction:Individuals with excess body weight have elevated colorectal cancer(CRC)risk.This study aimed to evaluate the long-term efficacy and costeffectiveness of CRC screening strategies in populations with exces...Introduction:Individuals with excess body weight have elevated colorectal cancer(CRC)risk.This study aimed to evaluate the long-term efficacy and costeffectiveness of CRC screening strategies in populations with excess weight.Methods:A multistate Markov model was used to evaluate the efficacy and cost-effectiveness of CRC screening.Three hypothetical cohorts were simulated based on body mass index(BMI)subgroups:normal,overweight,and obese.Screening strategies included colonoscopy(every 10 years)or an annual fecal immunochemical test,initiated at ages 45 and 50.Key outcomes included CRC cases,deaths,quality-adjusted life-year(QALY),lifetime costs,endoscopic resource use,and incremental cost-effectiveness ratios.Results:QALY gains increased from 0.097[95%confidence interval(CI):0.091–0.102]in individuals with normal weight to 0.104(0.101–0.107)in those who were overweight and 0.108(0.105–0.111)in those who were obese.Individuals who were overweight or obese demonstrated 6%–14%greater colonoscopy efficiency compared with those of normal weight.All screening strategies were cost-effective(incremental cost-effectiveness ratio=USD 671–USD 949 per QALY gained),with a marginal decrease in cost per QALY gained observed at higher BMI.Despite improved cost-effectiveness,lifetime healthcare expenditures were higher in individuals who were overweight($845.19–$955.00)and obese($1,358.00–$1,467.37)than in those with normal weight($119.62–$229.20).Conclusion:CRC screening in China demonstrated effectiveness and cost-effectiveness across BMI groups,with populations with excess weight showing high colonoscopy resource efficiency.Amid rising lifetime healthcare costs attributable to high BMI,integrating weight management with CRC screening is critical for optimizing health and economic benefits.展开更多
Background:There is significant heterogeneity in patterns of colorectal cancer burden,which is still not well understood.This study examines global trajectories in the colorectal cancer burden,explores associated fact...Background:There is significant heterogeneity in patterns of colorectal cancer burden,which is still not well understood.This study examines global trajectories in the colorectal cancer burden,explores associated factors,and predicts future trends.Methods:Data on the colorectal cancer burden for 204 countries and territories from 1990 to 2021 were sourced from the Global Burden of Disease Study.Growth mixture models identified subgroups of age-standardized incidence and mortality rates.Eleven modifiable risk factors and four socioeconomic determinants were analyzed across the subgroups.Trends to 2040 were predicted using a Bayesian age-period-cohort model.Results:Three trajectories of colorectal cancer burden were observed:slowly increasing,rapidly increasing,and slowly decreasing age-standardized incidence rate,corresponding to stable,increasing,and decreasing mortality rate.Most countries showed slowly increasing incidence rates(49.0%,n=100)and stable age-standardized mortality rates(51.0%,n=104).Latin America and the Caribbean predominantly have a rapidly increasing trend(age-standardized incidence:69.7%;mortality rates:63.6%),while high-income countries largely followed decreasing trajectories(incidence:58.3%;mortality:75.0%).Higher sociodemographic index,universal health coverage,health expenditure,and gross domestic product per capita were linked to decreasing trends(all p<0.05).Low consumption of whole grains and milk,and excessive red meat consumption,contributed significantly to colorectal cancer mortality.However,the impact of behavioral factors such as physical inactivity,smoking,and alcohol consumption was relatively small.Mortality attributable to high fasting blood sugar and body mass index is rising.Despite a slight global decline in mortality,disparities are projected to persist through 2040.Conclusion:Global disparities in colorectal cancer burden highlight the need for targeted interventions,particularly focusing on dietary factors and health inequities.展开更多
基金supported by the National Natural Science Foundation of China(grant number 82404340)the Fundamental Research Funds for the Central Universities,Peking Union Medical College(grant number 3332024216).
文摘Objective To examine the effect of excess body weight on adherence and lesion detection in colorectal cancer(CRC)screening.Methods A cross-sectional analysis was conducted within an opportunistic CRC screening program in Chongqing,which enrolled 43,797 adults aged 35–74 years between 2021 and 2022.A total of 42,279 participants were included in the final analysis,of whom 19,462(46.0%)had excess body weight(BMI>24.0 kg/m2).Colonoscopy adherence and detection were compared between normal and excess body weight group,and associated factors were examined.Results Of the 7,002 participants recommended for colonoscopy,3,808(54.4%)had excess body weight.Adherence was significantly lower in the excess weight group(6.6%)than in the normal weight group(10.7%,P<0.001),and this trend was consistent across sex and age groups.The detection rates of advanced neoplasms(3.6%vs.1.8%)and non-advanced adenomas(10.7%vs.6.7%)were higher in the excess weight cohort,with a significant difference for any neoplasm(14.2%vs.8.9%,P<0.05).Differences in adherence-and detection-related factors were also observed between the groups.Conclusion Excess body weight was associated with lower colonoscopy adherence but higher neoplasm detection.These findings support the integration of weight management with targeted screening promotion to improve CRC prevention in this high-risk population.
基金supported by the National Natural Science Foundation of China(No.82273722)Noncommunicable Chronic Diseases-National Science and Technology Major Project(2024ZD0520000)(2024ZD0520005)Central University Basic Research Fund of Peking Union Medical College(3332024216)。
文摘Objective To explore the health determinants of all-cancer mortality from a health-ecological perspective.Methods Using the health-ecological model,we identified 15 health determinants across five domains:personal innate,behavioral,interpersonal network,socioeconomic,and macroenvironmental characteristics.Data on cancer outcomes and health determinants from 185 countries,classified using the Human Development Index(HDI),were extracted from GLOBOCAN 2022,the World Health Organization Global Health Observatory,the Global Burden of Disease Study 2021,the United Nations,and the World Bank.A multivariate linear regression model was used to estimate the association between health determinants and cancer outcomes.Results A total of 153 countries with complete information on cancer outcomes and health determinants were enrolled in the study.A higher all-cancer age-standardized mortality rate(ASMR)was associated with current tobacco use,alcohol consumption,obesity,agricultural employment,and lag-distributed income.In women aged 15–49 years,being married or in a union was associated with a lower ASMR.Early-onset ASMR was positively associated with agricultural employment,lag-distributed income,and unsafe sanitation.Notable sex differences were observed,although tobacco use and obesity were identified as risk factors in both sexes.Conclusion We underscore the crucial need to incorporate cross-sectoral interventions within a resilient healthcare system to effectively mitigate the cancer mortality burden.
基金Supported by the National Natural Science Foundation of China(grant number:82404340)Peking Union Medical College Union Youth Research Fund(grant number:3332024216)CAMS Innovation Fund for Medical Science(grant numbers:2021-I2M-1-067 and 2021-I2M-1-011).
文摘Introduction:Individuals with excess body weight have elevated colorectal cancer(CRC)risk.This study aimed to evaluate the long-term efficacy and costeffectiveness of CRC screening strategies in populations with excess weight.Methods:A multistate Markov model was used to evaluate the efficacy and cost-effectiveness of CRC screening.Three hypothetical cohorts were simulated based on body mass index(BMI)subgroups:normal,overweight,and obese.Screening strategies included colonoscopy(every 10 years)or an annual fecal immunochemical test,initiated at ages 45 and 50.Key outcomes included CRC cases,deaths,quality-adjusted life-year(QALY),lifetime costs,endoscopic resource use,and incremental cost-effectiveness ratios.Results:QALY gains increased from 0.097[95%confidence interval(CI):0.091–0.102]in individuals with normal weight to 0.104(0.101–0.107)in those who were overweight and 0.108(0.105–0.111)in those who were obese.Individuals who were overweight or obese demonstrated 6%–14%greater colonoscopy efficiency compared with those of normal weight.All screening strategies were cost-effective(incremental cost-effectiveness ratio=USD 671–USD 949 per QALY gained),with a marginal decrease in cost per QALY gained observed at higher BMI.Despite improved cost-effectiveness,lifetime healthcare expenditures were higher in individuals who were overweight($845.19–$955.00)and obese($1,358.00–$1,467.37)than in those with normal weight($119.62–$229.20).Conclusion:CRC screening in China demonstrated effectiveness and cost-effectiveness across BMI groups,with populations with excess weight showing high colonoscopy resource efficiency.Amid rising lifetime healthcare costs attributable to high BMI,integrating weight management with CRC screening is critical for optimizing health and economic benefits.
基金supported by the Chinese Academy of Medical Sciences(CAMS)Innovation Fund for Medical Science(Grant number:2021-I2M-1-067).
文摘Background:There is significant heterogeneity in patterns of colorectal cancer burden,which is still not well understood.This study examines global trajectories in the colorectal cancer burden,explores associated factors,and predicts future trends.Methods:Data on the colorectal cancer burden for 204 countries and territories from 1990 to 2021 were sourced from the Global Burden of Disease Study.Growth mixture models identified subgroups of age-standardized incidence and mortality rates.Eleven modifiable risk factors and four socioeconomic determinants were analyzed across the subgroups.Trends to 2040 were predicted using a Bayesian age-period-cohort model.Results:Three trajectories of colorectal cancer burden were observed:slowly increasing,rapidly increasing,and slowly decreasing age-standardized incidence rate,corresponding to stable,increasing,and decreasing mortality rate.Most countries showed slowly increasing incidence rates(49.0%,n=100)and stable age-standardized mortality rates(51.0%,n=104).Latin America and the Caribbean predominantly have a rapidly increasing trend(age-standardized incidence:69.7%;mortality rates:63.6%),while high-income countries largely followed decreasing trajectories(incidence:58.3%;mortality:75.0%).Higher sociodemographic index,universal health coverage,health expenditure,and gross domestic product per capita were linked to decreasing trends(all p<0.05).Low consumption of whole grains and milk,and excessive red meat consumption,contributed significantly to colorectal cancer mortality.However,the impact of behavioral factors such as physical inactivity,smoking,and alcohol consumption was relatively small.Mortality attributable to high fasting blood sugar and body mass index is rising.Despite a slight global decline in mortality,disparities are projected to persist through 2040.Conclusion:Global disparities in colorectal cancer burden highlight the need for targeted interventions,particularly focusing on dietary factors and health inequities.
