| Abstract:[Purpose] To analyze the factors influencing the endoscopic screening participation rate among high-risk populations for esophageal cancer in Huai’an City,to construct and validate a predictive nomogram model for screening willingness,and to provide evidence for improving screening participation.[Methods] A retrospective analysis was conducted on the screening data of 57,368 residents aged 40–69 years from the Huai’an Esophageal Cancer Early Diagnosis and Early Treatment Project in the Huaihe River Basin from 2013 to 2023.A total of 20,903 high-risk individuals for esophageal cancer were identified.Factors associated with participation in endoscopic screening were identified through univariate analysis and multivariate logistic regression.The dataset was randomly split into a training set (n=14,633) and a validation set (n=6,270) at a 7:3 ratio.A nomogram prediction model was constructed and validated using the area under the receiver operating characteristic curve (AUC),calibration curves,the Hosmer–Lemeshow test,and decision curve analysis (DCA).[Results] From 2013 to 2023,health factor surveys were completed among 57,368 targeted residents,and 20,903 high-risk subjects were identified,yielding an overall high-risk rate of 36.44%.Among them,8,570 individuals underwent endoscopic screening,with an overall participation rate of 41.00%.Multivariate logistic regression analysis revealed that being aged 40–49 years,female sex,drinking non-tap water,having an annual household income <30,000 CNY,having an education level of college or above,being a non-smoker, and having a family history of cancer were associated with higher willingness to participate in endoscopic screening. In contrast,those aged 50–59 and 60–69 years,those who were overweight or obese,and those without a family history of cancer exhibited lower adherence to endoscopy.A nomogram model for predicting endoscopic screening participation was constructed based on the identified factors.The model achieved an AUC of 0.675 (95%CI:0.666–0.684) in the training set and 0.682 (95%CI:0.668–0.695) in the validation set.The Hosmer–Lemeshow goodness-of-fit test showed χ²=3.217 (P=0.920 ) for the training set and χ²=12.936 (P=0.114) for the validation set, indicating satisfactory calibration.DCA confirmed favorable net clinical benefit.[Conclusion] The high-risk rate of esophageal cancer in the Huai’an City is relatively high, and efforts should be made to improve this situation through health promotion measures such as strengthening health education, disseminating cancer prevention knowledge, and advocating healthy lifestyles. The nomogram model established in this study exhibits good discrimination and calibration, and can be used for stratified assessment of willingness to participate in endoscopic screening among high-risk populations for esophageal cancer, providing a scientific basis for formulating targeted intervention strategies. |
