A 9-year follow-up study of participants and nonparticipants in sigmoidoscopy screening: Importance of self-selection
(2008) In Cancer Epidemiology Biomarkers & Prevention 17(5). p.1163-1168- Abstract
- Background: Self-selection may compromise cost-effectiveness of screening programs. We hypothesized that nonparticipants have generally higher morbidity and mortality than participants. Methods: A Swedish population-based random sample of 1,986 subjects ages 59 to 61 years was invited to sigmoidoscopy screening and followed up for 9 years by means of multiple record linkages to health and population registers. Gender-adjusted cancer incidence rate ratio (IRR) and overall and disease group-specific and mortality rate ratio (MRR) with 95% confidence intervals (95% CD were estimated for nonparticipants relative to participants. Cancer and mortality rates were also estimated relative to the age-matched, gender-matched, and calendar... (More)
- Background: Self-selection may compromise cost-effectiveness of screening programs. We hypothesized that nonparticipants have generally higher morbidity and mortality than participants. Methods: A Swedish population-based random sample of 1,986 subjects ages 59 to 61 years was invited to sigmoidoscopy screening and followed up for 9 years by means of multiple record linkages to health and population registers. Gender-adjusted cancer incidence rate ratio (IRR) and overall and disease group-specific and mortality rate ratio (MRR) with 95% confidence intervals (95% CD were estimated for nonparticipants relative to participants. Cancer and mortality rates were also estimated relative to the age-matched, gender-matched, and calendar period-matched Swedish population using standardized incidence ratios and standardized mortality ratios. Results: Thirty-nine percent participated. The incidence of colorectal cancer (IRR, 2.2; 95% CI, 0.8-5.9), other gastrointestinal cancer (IRR, 2.7; 95% CI, 0.6-12.8), lung cancer (IRR, 2.2; 95% CI, 0.8-5.9), and smoking-related cancer overall (IRR, 1.4; 95% CI, 0.7-2.5) tended to be increased among nonparticipants relative to participants. Standardized incidence ratios for most of the studied cancers tended to be >1.0 among nonparticipants and <1.0 among participants. Mortality from all causes (MRR, 2.4; 95% CI, 1.7-3.4), neoplastic diseases (MRR, 1.9; 95% CI, 1.1-3.5), gastrointestinal cancer (MRR, 4.7; 95% CI, 1.120.7), and circulatory diseases (MRR, 2.3; 95% CI, 1.2-4.2) was significantly higher among nonparticipants than among participants. Standardized mortality ratio for the studied outcomes tended to be increased among nonparticipants and was generally decreased among participants. Conclusion: Individuals who might benefit most from screening are overrepresented among nonparticipants. This self-selection may attenuate the cost-effectiveness of screening programs on a population level. (Less)
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https://lup.lub.lu.se/record/1203453
- author
- Blom, Johannes ; Yin, Li ; Liden, Annika ; Dolk, Anders ; Jeppsson, Bengt LU ; Pahlman, Lars ; Holmberg, Lars and Nyren, Olof
- organization
- publishing date
- 2008
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Cancer Epidemiology Biomarkers & Prevention
- volume
- 17
- issue
- 5
- pages
- 1163 - 1168
- publisher
- American Association for Cancer Research
- external identifiers
-
- wos:000256012800021
- scopus:52649100581
- pmid:18483338
- ISSN
- 1538-7755
- DOI
- 10.1158/1055-9965.EPI-07-2764
- language
- English
- LU publication?
- yes
- id
- 29b3c48c-b883-4a2e-8334-9fceb81c6402 (old id 1203453)
- date added to LUP
- 2016-04-01 13:33:24
- date last changed
- 2022-03-21 19:13:56
@article{29b3c48c-b883-4a2e-8334-9fceb81c6402,
abstract = {{Background: Self-selection may compromise cost-effectiveness of screening programs. We hypothesized that nonparticipants have generally higher morbidity and mortality than participants. Methods: A Swedish population-based random sample of 1,986 subjects ages 59 to 61 years was invited to sigmoidoscopy screening and followed up for 9 years by means of multiple record linkages to health and population registers. Gender-adjusted cancer incidence rate ratio (IRR) and overall and disease group-specific and mortality rate ratio (MRR) with 95% confidence intervals (95% CD were estimated for nonparticipants relative to participants. Cancer and mortality rates were also estimated relative to the age-matched, gender-matched, and calendar period-matched Swedish population using standardized incidence ratios and standardized mortality ratios. Results: Thirty-nine percent participated. The incidence of colorectal cancer (IRR, 2.2; 95% CI, 0.8-5.9), other gastrointestinal cancer (IRR, 2.7; 95% CI, 0.6-12.8), lung cancer (IRR, 2.2; 95% CI, 0.8-5.9), and smoking-related cancer overall (IRR, 1.4; 95% CI, 0.7-2.5) tended to be increased among nonparticipants relative to participants. Standardized incidence ratios for most of the studied cancers tended to be >1.0 among nonparticipants and <1.0 among participants. Mortality from all causes (MRR, 2.4; 95% CI, 1.7-3.4), neoplastic diseases (MRR, 1.9; 95% CI, 1.1-3.5), gastrointestinal cancer (MRR, 4.7; 95% CI, 1.120.7), and circulatory diseases (MRR, 2.3; 95% CI, 1.2-4.2) was significantly higher among nonparticipants than among participants. Standardized mortality ratio for the studied outcomes tended to be increased among nonparticipants and was generally decreased among participants. Conclusion: Individuals who might benefit most from screening are overrepresented among nonparticipants. This self-selection may attenuate the cost-effectiveness of screening programs on a population level.}},
author = {{Blom, Johannes and Yin, Li and Liden, Annika and Dolk, Anders and Jeppsson, Bengt and Pahlman, Lars and Holmberg, Lars and Nyren, Olof}},
issn = {{1538-7755}},
language = {{eng}},
number = {{5}},
pages = {{1163--1168}},
publisher = {{American Association for Cancer Research}},
series = {{Cancer Epidemiology Biomarkers & Prevention}},
title = {{A 9-year follow-up study of participants and nonparticipants in sigmoidoscopy screening: Importance of self-selection}},
url = {{http://dx.doi.org/10.1158/1055-9965.EPI-07-2764}},
doi = {{10.1158/1055-9965.EPI-07-2764}},
volume = {{17}},
year = {{2008}},
}