Abstract: Objective To investigate the status of high-risk populations for colorectal cancer among middle-aged and elderly residents in Xi'an region,to understand the early diagnosis awareness of high-risk populations and analyze its influencing factors,and to provide reference for the optimization of colorectal cancer screening strategy. Methods A cross-sectional investigation was carried out from June through December 2022,enrolling permanent residents of Xi'an for research purposes. A quantified risk assessment questionnaire coupled with fecal occult blood testing （FOBT） were implemented to identify populations at an elevated risk for colorectal cancer. Subsequently,a questionnaire pertaining to the early diagnosis awareness regarding cancer was conducted among those classified as high-risk. To further elucidate the determinants influencing early diagnosis awareness,a Logistic regression model was utilized for a comprehensive multivariate analysis. Results A cohort of 5 478 individuals,aged between 40 to 74 years,was included in the survey to assess the risk factors for colorectal cancer,with 2 690 males （49.11%） and 2 788 females （50.89%） participating. The survey identified 956 individuals as being at high risk,with an overall high-risk prevalence of 17.45%. The prevalence of high risk among females （19.19%） surpassed that of males （15.65%） （χ²=11.901）,and there was a positive correlation between increasing age and high-risk prevalence （χ²=113.178）,with the 60 to 69 years age group exhibiting the highest high-risk prevalence （24.18%） and the 40 to 49 years group the lowest （10.71%）. A significantly higher high-risk prevalence was observed among rural residents （20.93%） compared to urban residents （13.72%） （χ²=49.331）. Education level significantly affected the high-risk prevalence,with lower educational attainment linked to increased high-risk prevalence （χ²=162.742）,with all differences being statistically significant （all P<0.01）. Among the 956 individuals classified as high risk,289 （30.23%） possessed awareness for early cancer diagnosis. Multivariable Logistic regression analysis indicated that rural residency （OR=0.455）,higher educational attainment （OR=1.919）,higher annual family income （OR=1.358）,self-pay medical insurance （OR=1.260）,employment as a farmer or migrant worker （OR=0.495） and unemployment （OR=0.444）,routine health examinations （OR=3.121）,personal history of cancer or polyps （OR=2.438）,and a family history of colorectal cancer （OR=2.484） were all correlated with early diagnosis awareness in the high-risk population for colorectal cancer. Conclusions Residents in Xi'an have a high risk of colorectal cancer,and the early diagnosis awareness of high-risk populations needs to be further improved. Interventions should be given to the influencing factors of early diagnosis awareness among high-risk populations,to achieve early detection,diagnosis,and treatment of cancers,and reduce the burden of family and social diseases.

Key words: Colorectal cancer, High-risk population, Early diagnosis, Early treatment, Influencing factor