TY - JOUR
T1 - Hurdle Poisson Regression Model for Identifying Factors Related to Noncompliance and Waiting Time for Confirmatory Diagnosis in Colorectal Cancer Screening
AU - Jen, Hsiao Hsuan
AU - Wang, Tsung Hsi
AU - Chiu, Han Mo
AU - Peng, Szu Min
AU - Hsu, Chen Yang
AU - Chiu, Sherry Yueh Hsia
AU - Chen, Sam Li Sheng
AU - Yen, Amy Ming Fang
AU - Lee, Yi Chia
AU - Chen, Hsiu Hsi
AU - Fann, Jean Ching Yuan
N1 - Publisher Copyright:
Copyright © Cambridge University Press 2019.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - 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.
AB - 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.
KW - Colonoscopy
KW - Colorectal cancer screening
KW - Hurdle Poisson model
KW - Noncompliance
KW - Waiting time
UR - http://www.scopus.com/inward/record.url?scp=85062392064&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85062392064&partnerID=8YFLogxK
U2 - 10.1017/S0266462319000047
DO - 10.1017/S0266462319000047
M3 - Article
C2 - 30819270
AN - SCOPUS:85062392064
SN - 0266-4623
VL - 35
SP - 85
EP - 91
JO - International Journal of Technology Assessment in Health Care
JF - International Journal of Technology Assessment in Health Care
IS - 2
ER -