BACKGROUND Health status and life expectancy are important considerations for assessing potential benefits and harms of colorectal cancer (CRC) screening programs, particularly among older adults. METHODS We examined receipt of past-year CRC screening according to predicted 10-year mortality risk among 25,888 community-dwelling adults aged 65-84 years who were not up-to-date with screening in the nationwide National Health Interview Survey. Ten-year mortality risk was estimated using a validated index; from the lowest to highest quintiles of the index, risk was 12%, 24%, 39%, 58%, and 79%, respectively. We also examined the proportion of screening performed among adults with life expectancy <10 years. RESULTS The prevalence of past-year CRC screening was 39.5%, 40.6%, 38.7%, 36.4%, and 35.4%, from the lowest to highest quintile of 10-year mortality risk. Odds of CRC screening did not differ between adults in the lowest vs highest quintile (adjusted odds ratio 1.05, 95% confidence interval: 0.93-1.20). One-quarter (27.9%) of past-year CRC screening occurred in adults with life expectancy <10 years, and more than half (50.7%) of adults aged 75-84 years had 10-year mortality risk ≥50% at the time of screening. In an exploratory analysis, invasive but not noninvasive screening increased as 10-year mortality risk increased ( P < 0.05) among adults aged 70-79 years. DISCUSSION Past-year CRC screening does not differ by predicted 10-year mortality risk. An age-based approach to CRC screening results in underscreening of older, healthier adults and overscreening of younger adults with chronic conditions. Personalized screening with incorporation of individual life expectancy may increase the value of CRC screening programs.

中文翻译：

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老年人 10 年死亡风险对结直肠癌筛查结果没有影响。

背景技术健康状况和预期寿命是评估结直肠癌（CRC）筛查计划的潜在益处和危害的重要考虑因素，特别是在老年人中。方法 我们根据 25,888 名年龄在 65-84 岁之间、未在全国健康访谈调查中及时进行筛查的社区居民的 10 年死亡风险预测，检查了过去一年的 CRC 筛查情况。使用经过验证的指数估算十年死亡风险；从该指数最低到最高的五分位数，风险分别为 12%、24%、39%、58% 和 79%。我们还调查了预期寿命<10岁的成年人中进行筛查的比例。结果 过去一年的 CRC 筛查率为 39.5%、40.6%、38.7%、36.4% 和 35.4%，从 10 年死亡率风险最低到最高五分之一。最低和最高五分位数的成年人之间 CRC 筛查的几率没有差异（调整后的比值比 1.05，95% 置信区间：0.93-1.20）。过去一年的 CRC 筛查中有四分之一 (27.9%) 发生在预期寿命 <10 岁的成年人中，超过一半 (50.7%) 75-84 岁的成年人当时 10 年死亡风险≥50%的筛选。在一项探索性分析中，随着 70-79 岁成年人 10 年死亡风险的增加 (P < 0.05)，侵入性筛查增加，但非侵入性筛查增加。讨论 过去一年的 CRC 筛查并不会因为预测的 10 年死亡风险而有所不同。基于年龄的结直肠癌筛查方法会导致对年长、健康成年人的筛查不足，而对患有慢性病的年轻人进行过度筛查。结合个人预期寿命的个性化筛查可能会增加 CRC 筛查计划的价值。