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首页> 外文期刊>Journal of Clinical Epidemiology >Comparisons of colorectal cancer mortality between screening participants and the general population are strongly biased unless an incidence-based mortality approach is used
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Comparisons of colorectal cancer mortality between screening participants and the general population are strongly biased unless an incidence-based mortality approach is used

机译：除非使用基于发病率的死亡率方法，否则筛查参与者与一般人群之间大肠癌死亡率的比较存在很大偏差。

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摘要

Objectives A common approach in the evaluation of screening for colorectal cancer (CRC) is comparing observed numbers of CRC deaths in screening participants with expected numbers derived from CRC mortality in the general population. We aimed to illustrate and quantify an often-overlooked bias that may occur in such studies if CRC mortality in the general population is not restricted by the date of diagnosis (whereas screening participants by definition do not have a prior CRC diagnosis). Study Design and Setting We illustrate and quantify the expected bias using cancer registry data from the United States. Results Unless an incidence-based mortality approach is used, expected numbers of CRC deaths in screening cohorts (and hence estimated screening effects) are substantially overestimated. Overestimation of expected CRC deaths is most severe (more than fivefold) during the first year of follow-up and rapidly decreases in the subsequent years. Nevertheless, overestimation of 5- and 10-year cumulative numbers of expected CRC deaths is still as high as 60-70% and 20-30%, respectively. Substantial bias even persists if the initial years of follow-up are excluded from the analyses. Conclusion Careful restriction of expected CRC deaths by an incidence-based mortality approach is indispensable for deriving valid screening effect estimates.
机译：目的评估大肠癌筛查（CRC）的一种常用方法是将筛查参与者的观察到的CRC死亡人数与普通人群中CRC死亡的预期人数进行比较。我们的目的是说明和量化如果普通人群中的CRC死亡率不受诊断日期的限制（而根据定义对筛查参与者没有事先进行CRC诊断）的话，在此类研究中可能会出现的一个经常被忽视的偏倚。研究设计和设置我们使用来自美国的癌症注册数据来说明和量化预期的偏倚。结果除非使用基于发病率的死亡率方法，否则筛查队列中预期的CRC死亡人数（以及由此估算的筛查效果）将被大大高估。在随访的第一年中，对CRC预期死亡的高估是最严重的（超过五倍），在随后的几年中迅速下降。尽管如此，对CRC预期死亡的5年和10年累计数字的高估仍然分别高达60-70％和20-30％。如果从分析中排除了最初的随访年数，则甚至存在很大的偏见。结论通过基于发病率的死亡率方法仔细限制预期的CRC死亡对于得出有效的筛查效果估计是必不可少的。

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