Predictors of adherence to repeat fecal occult blood test in a population-based colorectal cancer screening program.

BACKGROUND: Socio-economic, environmental factors and general practitioner (GP) involvement may influence adherence to repeat faecal occult blood testing (FOBT) of organised colorectal cancer (CRC) screening. The aim of the study was to identify predictors of adherence to repeat testing. METHODS: The populationcomprised people eligible for the third round of a CRC screening programme in a French district (n=118,905). Multilevel logistic regression analysis was performed to identify individual and area-level characteristics associated with 'compliant participants' participating in the all three rounds vs 'occasional participants' participating in one or two rounds. RESULTS: Compared to 'occasional participants', 'compliant participants' were more likely to participate after receiving a FOBT kit from their GP (odds ratio (OR), 10.7; 95% CI, 10.01-11.5) vs FOBT received at home, and were less likely to live in socio-economically deprived areas (OR, 0.75; 0.70-0.80) and urban areas (OR, 0.94; 0.88-1.00). CONCLUSIONS: As for a screening round participation, strategies aimed at improving the participation to a screening programme should target GPs and people living in socially deprived areas.

Prevalence, screening and treatment of chronic kidney disease in people with type 2 diabetes in France: the ENTRED surveys (2001 and 2007).

AIMS: The study aimed to assess the prevalence, quality of screening and treatment of chronic kidney disease (CKD), and their trends between 2001 and 2007, in French adults with type 2 diabetes (T2D). METHODS: The 2007 ENTRED survey randomly selected, from French medical insurance fund databases, 8926 adults treated for diabetes who had been reimbursed at least three times over the previous 12 months for oral hypoglycaemic agents or insulin. Medical reimbursement data were extracted and two sets of questionnaires were mailed, one to all patients (48% response rate) and the other to their doctors (62%). Analyses were restricted to the 3894 responders with T2D (2232 with data from their doctors). Trends between the 2001 and 2007 ENTRED surveys were studied. RESULTS: Participants' mean age was 66 years. The prevalence of CKD was estimated to be at least 29%, based on doctors' data (missing data included). Overall, only 17% had no claims for serum creatinine measurements during the year, and 71% had no claims for albuminuria tests; nonetheless, both figures had decreased from 2001. Older people, those who lived alone and those who felt poorly informed about diabetes were more likely to have made no claims for CKD screening. Assessment of quality of care (prescribing antihypertensive treatment when indicated) was possible for 66% of responders, of whom 25% did not receive such treatment. CONCLUSION: CKD is frequently seen in patients with T2D and is likely to be underestimated because albuminuria screening remains inadequate, despite significant improvements since 2001. Further efforts are needed to improve CKD screening, patient and doctor awareness, and adequate use of antihypertensive/nephroprotective medications.

Influence of socioeconomic environment on survival in patients diagnosed with esophageal cancer: a population-based study.

The influence of social environment on survival in patients with cancer has been demonstrated in many studies, subjects living in the most deprived areas having a poorer prognosis. Geographic remoteness and limited access to specialized care centers are often associated with socioeconomic deprivation. The aim was to assess the influence of social environment and geographic remoteness on the relative survival of patients diagnosed with esophageal cancer between 1997 and 2004 in the department of Calvados in France. The study population, which was provided by the Calvados digestive cancer registry, included 629 patients. Relative survival was used to estimate the influence of social environment and geographic remoteness on patient survival. Five-year survival rates were 14.1%, 15.1%, 11.8%, 8.8%, and 11.4%, respectively, for patients living in the least to the most deprived areas (P= 0.39). The influence of social environment was significant after adjustment for clinical variables, patients living in the most deprived areas having the worst survival. These discrepancies cannot totally be explained by differences in access to care, cancer extension, or morphology at diagnosis. No association was observed between distance to the nearest cancer center and survival. Social environment appears to induce disparities among patients diagnosed with esophageal cancer, with a worse prognosis for patients living in the most deprived areas.

[Social inequalities in health from observational studies to intervention: can the patient navigator reduce social inequalities in cancer patients?]. / Inégalités sociales, de santé du constat à l'action - Intérêt de la mise en place d'un accompagnement personnalisé pour la réduction des inégalités sociales en cancérologie.

The impact of social factors on healthcare inequality is well-recognized in many industrialized countries and involves a wide range of pathological conditions (cardiovascular disease, cancer, etc.). In general, the poorest indicators of health are observed in socially disadvantaged populations. Beyond this observation is the question of actions taken to prevent the formation of social inequality in healthcare. The purpose of this work was to evaluate the potential contribution of an intervention tool called the "patient navigator", used in English-speaking countries and to determine its feasibility in France.

[Social and geographical determinants of cancer care management in France - colorectal cancer incidence in Calvados from 1997 to 2004]. / Déterminants socio-géographiques de la prise en charge des cancers en France - Exemple des cancers colorectaux incidents entre 1997 et 2004 dans le département du Calvados.

BACKGROUND: Numerous studies have underlined an important deprivation gap in survival in all industrialized countries, prognosis being constantly poorer for the most deprived patients. Beside clinical factors, the explanation of this gap in survival could be partly explained by the influence of socio-geographical environment on cancer care management. The aim of this retrospective population-based study was to investigate the influence of socio-geographical determinants on access to a reference care centre. METHODS: The study population included all colorectal cancer patients with surgical treatment diagnosed between 1/01/1997 and 31/12/2004 in Calvados (n=2318). Individual clinical data were supplied by the Calvados registry of the gastrointestinal tumors. Beside geographical variables (distance to nearest cancer center), aggregate socioeconomic data were derived from the last exhaustive census organized by the national statistics institute (INSEE) in 1999. The Townsend deprivation index was used for this study. Due to the hierarchical structure of such variables, a multilevel logistic model was used (Level 1: Patients; Level 2: IRIS2000). RESULTS: After adjustment on the individual variables, most remote patients were less frequently treated in a reference care center than those who were living near a reference care center (Odds Ratio adjust=0.20 [0.15-0.28], p-trend<0.001). Patients living in an IRIS2000 with high medical density were more likely to receive surgical treatment in a reference care centre (p-trend=0.05). Townsend Deprivation index was not associated with access to reference care center. CONCLUSION: Access to a reference care center was strongly determined by the distance to nearest care center. Dissemination of clinical guidelines and improvement in treatment in non-reference care centers are crucial in ensuring equality in health care.

Socioeconomic determinants for compliance to colorectal cancer screening. A multilevel analysis.

BACKGROUND: Compliance in cancer screening among socially disadvantaged persons is known to be lower than among more socially advantaged persons. However, most of the studies regarding compliance proceed via a questionnaire and are thus limited by self-reported measures of participation and by participation bias. This study aimed at investigating the influence of socioeconomic characteristics on compliance to an organised colorectal cancer screening programme on an unbiased sample based on data from the entire target population within a French geographical department, Calvados (n=180 045). METHODS: Individual data of participation and aggregate socioeconomic data, from the structure responsible for organising screening and the French census, respectively, were analysed simultaneously by a multilevel model. RESULTS: Uptake was significantly higher in women than in men (OR=1.33; 95% CI 1.21 to 1.45), and significantly lower in the youngest (50-59 years) and in the oldest (70-74 years) persons, compared with intermediate ages (60-69 years), with OR=0.70 (95% CI 0.63 to 0.77) and OR=0.82 (95% CI 0.72 to 0.93), respectively. Uptake fell with increasing level of deprivation. There was a significant difference of uptake probability between the least deprived and the most deprived areas (OR=0.68; 95% CI 0.59 to 0.79). No significant influence of the general practitioners density was found. CONCLUSION: Multilevel analysis allowed to detect areas of weak uptake linked to areas of strong deprivation. These results suggest that targeting populations with a risk of low compliance, as identified both socially and geographically in our study, could be adopted to minimise inequalities in screening.