B0163 - Effect of Healthcare Disparities and Socioeconomic Factors on Adenoma Detection Rates During COVID-19 Pandemic

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Rajat Garg, MD

Cleveland Clinic Foundation
Cleveland, Ohio

Vidhi Patel, MD¹, Rajat Garg, MD², Dushyant S. Dahiya, MD³, Priya Sasankan, MD, MBA², John McMichael, PhD², Prashanthi Thota, MD⁴, Madhusudhan Sanaka, MD⁵
¹Cleveland Clinic, Cleveland, OH; ²Cleveland Clinic Foundation, Cleveland, OH; ³Central Michigan University College of Medicine, Saginaw, MI; ⁴Cleveland Clinic, Cleveland, OH; ⁵Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH

Introduction: Health care disparities, which existed prior to the pandemic appear to have worsened with the onset of the pandemic. These are especially pronounced for health maintenance measures such as screening colonoscopy which is the cornerstone of colorectal cancer (CRC) prevention. In this study, we aimed to evaluate the impact of COVID-19 on healthcare disparities and the demographic and socio-economic factors associated with adenoma detection rates (ADR).

Methods: We identified all patients who underwent colonoscopy at all Ohio facilities of the Cleveland Clinic health system in 2019, 2020, and 2021 from July 1^st to December 31^st in each year. The timeline of July 1^st to December 31^st was selected based on lockdown which lasted till the end of June 2020 in Ohio. The patients were divided into two groups: patients with an adenoma or other precancerous polyps (cases) and patients without an adenoma (controls) detected on colonoscopy. We collected and compared various demographic and socioeconomic factors between both groups.

Results: A total of 23,316 screening colonoscopies were performed in Cleveland Clinic, Ohio during the study period. Among these 23,316 procedures, adenomas were detected on 5,259 (22.6%) procedures. The ADR significantly increased from 2019 (21.5%) to 2021 (23.7%) (p< 0.001) (Figure 1). As compared to controls, there was significantly higher number of elderly patients, males, and Caucasians among the cases. Patients with private insurance (58.3% vs. 62.6%) had significantly decreased ADR whereas patients with Medicare (27% vs. 22.3%) and Medicaid (6.8% vs 6.2%) had higher rates of ADR as compared to controls. There was a significantly higher proportion of patients in the lower quartile of education and median household income among cases than in controls (p< 0.05 for both). Patients with tobacco use also had significantly higher ADR whereas alcohol use, Illicit drug use, and preferred language was not significantly associated with higher ADR (p >0.05 for all). On multivariate analysis, age >65, male gender, Caucasian race, tobacco use, private insurance, and obesity were positive predictors of adenomas (p< 0.05 for all) (Table 1).

Discussion: There has been significant increase in ADR immediately after Covid lockdown which continue to persist in 2021. Male patients, Caucasians, obese patients, smokers, and elderly have higher ADR. These results will help design targeted CRC screening in this high-risk population.

Figure:
Figure 1 showing increasing trends of adenoma detection on screening colonoscopy from 2019 to 2021.

Table 1: Demographic, socioeconomic factors associated with adenoma detection on screening colonoscopy
	No Adenoma (N=18057)	Adenoma (N=5259)		Adjusted OR (95% CI)	p-value
Age (mean ± sd)	59.1 ± 8.9	60.6 ± 9.0	< 0.001	NA
Age >=65	4877 (27%)	1741 (33.1%)	< 0.001	1.7 (1.6 - 1.7)	< 0.001
Sex
Male =1	7873 (43.6%)	2896 (55.1%)	< 0.001	REF
Female	10184 (56.4%)	2363 (44.9%)		0.65 (0.62 - 0.67)	< 0.001
Race			0.003
Caucasians	13621 (75.4%)	4054 (77.1%)		REF
African Americans	3145 (17.4%)	810 (15.4%)		0.9 (0.85 - 0.96)	0.001
Others	1291 (7.1%)	395 (7.5%)		0.97 (0.89 - 1.05)	0.54
Insurance type			< 0.001
Medicare	4033 (22.3%)	1419 (27%)		1.04 (0.98 - 1.09)	0.15
Medicaid and other public	1111 (6.2%)	356 (6.8%)		0.87 (0.8 - 0.94)	0.001
Private	11297 (62.6%)	3067 (58.3%)		REF
No insurance	1616 (8.9%)	417 (7.9%)		0.76 (0.71 - 0.82)	< 0.001
Education level (% high school grads in zip code)			0.008
Q1< 88	3887 (22.6%)	1143 (22.7%)		REF
Q2 >=88 to < 92.5	3973 (23.1%)	1268 (25.1%)		1.01.(0.94 - 1.08)	0.79
Q3 >= 92.5 to < 94	3962 (23%)	1153 (22.9%)		0.99 (0.91 - 1.08)	0.82
Q4 >= 94	5380 (31.3%)	1478 (29.3%)		0.99 (0.9 - 1.09)	0.87
Median household income (Quartiles based on Zip code)			0.005
Q1 < 43449	3759 (21.9%)	1147 (22.7%)		REF
Q2 >=43449 to < 55969	4113 (23.9%)	1220 (24.2%)		0.96 (0.0.90-1.03)	0.37
Q3 >= 55969 to < 67917	4288 (24.9%)	1324 (26.3%)		1.08 (0.98 - 1.18)	0.09
Q4 >= 67917	5042 (29.3%)	1351 (26.8%)		1.0 (0.9 - 1.1)	0.99
Tobacco Use	1549 (8.6%)	613 (11.7%)	< 0.001	1.41 (1.32 - 1.51)	< 0.001
Alcohol use	11686 (64.7%)	3404 (64.7%)	0.99	NA
Illicit drug use	622 (3.4%)	208 (4%)	0.079	NA
Preferred language			0.3	NA
English	17690 (98%)	5144 (97.8%)
Spanish	176 (1%)	48 (0.9%)
Others	191 (1.1%)	67 (1.3%)
BMI	29.5 ± 6.5	30.3 ± 6.5	< 0.001
Obesity	7200 (40.3%)	2333 (44.8%)	< 0.001	1.28 (1.23-1.33)	< 0.001

Table: Table 1: Demographic, socioeconomic factors associated with adenoma detection on screening colonoscopy

Disclosures:

Vidhi Patel indicated no relevant financial relationships.

Rajat Garg indicated no relevant financial relationships.

Dushyant Dahiya indicated no relevant financial relationships.

Priya Sasankan indicated no relevant financial relationships.

John McMichael indicated no relevant financial relationships.

Prashanthi Thota indicated no relevant financial relationships.

Madhusudhan Sanaka indicated no relevant financial relationships.

Vidhi Patel, MD¹, Rajat Garg, MD², Dushyant S. Dahiya, MD³, Priya Sasankan, MD, MBA², John McMichael, PhD², Prashanthi Thota, MD⁴, Madhusudhan Sanaka, MD⁵. B0163 - Effect of Healthcare Disparities and Socioeconomic Factors on Adenoma Detection Rates During COVID-19 Pandemic, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.