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

Autoři: Fabrizio Stracci aff001;  Alessio Gili aff002;  Giulia Naldini aff003;  Vincenza Gianfredi aff003;  Morena Malaspina aff004;  Basilio Passamonti aff004;  Fortunato Bianconi aff002
Působiště autorů: Department of Experimental Medicine, Public Health Section, University of Perugia, Perugia, Italy aff001;  Umbria Cancer Registry, Perugia, Italy aff002;  School of Specialization in Hygiene and Preventive Medicine, University of Perugia, Perugia, Italy aff003;  Azienda USL Umbria 1,Laboratorio Unico di Screening, Perugia, Italy aff004
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0222396



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.


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.


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.


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.


Most deprived individuals and foreigners represent relevant targets for interventions in public health aimed to improve CRC screening adherence.

Klíčová slova:

Age groups – Cancer screening – Census – Colorectal cancer – Geographic areas – Italian people – Public and occupational health – Socioeconomic aspects of health


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