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Hurdle Poisson Regression Model for Identifying Factors Related to Noncompliance and Waiting Time for Confirmatory Diagnosis in Colorectal Cancer Screening

Published online by Cambridge University Press:  01 March 2019

Hsiao-Hsuan Jen
Affiliation:
Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
Tsung-Hsi Wang
Affiliation:
Ministry of Health and Welfare, Taiwan Department of Public Health & Medical Humanities, Institute of Public Health, National Yangming University, Taipei, Taiwan
Han-Mo Chiu
Affiliation:
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
Szu-Min Peng
Affiliation:
Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
Chen-Yang Hsu
Affiliation:
Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
Sherry Yueh-Hsia Chiu
Affiliation:
Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
Sam Li-Sheng Chen
Affiliation:
School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
Amy Ming-Fang Yen
Affiliation:
School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
Yi-Chia Lee
Affiliation:
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
Hsiu-Hsi Chen
Affiliation:
Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
Jean Ching-Yuan Fann*
Affiliation:
Department of Health Industry Management, Kainan University, Taoyuan, Taiwan
*
Author for correspondence: Jean Ching-Yuan Fann, E-mail: jeanfann@mail.knu.edu.tw

Abstract

Objectives

Population-based colorectal cancer (CRC) screening programs that use a fecal immunochemical test (FIT) are often faced with a noncompliance issue and its subsequent waiting time (WT) for those FIT positives complying with confirmatory diagnosis. We aimed to identify factors associated with both of the correlated problems in the same model.

Methods

A total of 294,469 subjects, either with positive FIT test results or having a family history, collected from 2004 to 2013 were enrolled for analysis. We applied a hurdle Poisson regression model to accommodate the hurdle of compliance and also its related WT for undergoing colonoscopy while assessing factors responsible for the mixture of the two outcomes.

Results

The effect on compliance and WT varied with contextual factors, such as geographic areas, type of screening units, and level of urbanization. The hurdle score, representing the risk score in association with noncompliance, and the WT score, reflecting the rate of taking colonoscopy, were used to classify subjects into each of three groups representing the degree of compliance and the level of health awareness.

Conclusion

Our model was not only successfully applied to evaluating factors associated with the compliance and the WT distribution, but also developed into a useful assessment model for stratifying the risk and predicting whether and when screenees comply with the procedure of receiving confirmatory diagnosis given contextual factors and individual characteristics.

Type
Method
Copyright
Copyright © Cambridge University Press 2019 

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Footnotes

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Hsiao-Hsuan Jen and Tsung-Hsi Wang are equal contributors.

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