E0177 - Evaluation of Gender, Racial, and Socio-Economic Factors Underlying Disparities in Colorectal Cancer Screening

Tuesday, October 25, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

AS

Achintya Singh, MD

Cleveland Clinic Foundation
Cleveland, Ohio

Achintya Singh, MD¹, Aakash Desai, MD², Muhammad Zarrar Khan, MD, MBBS³, Vardhmaan Jain, MD¹, Prabhat Kumar, MD¹, Andrew Ford, MD¹, Deepak Madhu, DM⁴, Babu P. Mohan, MD, MS⁵
¹Cleveland Clinic Foundation, Cleveland, OH; ²MetroHealth Medical Center/Case Western Reserve University, Cleveland, OH; ³Cleveland Clinic, Cleveland, OH; ⁴Caritas Hospital, Kottayam, Kerala, India; ⁵University of Utah School of Medicine, Salt Lake City, UT

Introduction: Screening colonoscopy is the best available means of preventing mortality and/ or morbidity from colorectal cancer (CRC). The present recommendations for CRC screening in average-risk asymptomatic individuals start at the age of 45 years. This has tremendously increased the population size eligible for screening colonoscopy. However, there are numerous unaccounted disparities in healthcare access and delivery that are not well understood. We conducted a cross-sectional analysis of non-institutionalized US adults to evaluate the impact of social, economic and literacy-based factors on the utilization of colonoscopy for CRC screening.

Methods: Individual-level data from the Center for Disease Control and Prevention’s Behavioral Risk Factors Surveillance System (BRFSS) from 2016 and 2018 was accessed to identify respondents that underwent colonoscopy. BRFSS is a telephone-based survey which provides prevalence data on behavioral risk factors related to common health conditions and preventive services from all US states and three US territories. Patient ethnicity, gender, literacy, annual income, and employment status associated with and without the use of colonoscopy for average-risk CRC screening was accessed. A logistic regression analysis of these factors was conducted utilizing the BRFSS web enabled analysis tool and reported as Odds Ratios (ORs) with corresponding 95% confidence intervals (CIs).

Results: A total of 923,739 patients were surveyed, of which 461,433 (50%) patients had undergone a colonoscopy or sigmoidoscopy at least once in their lifetime. Most patients were above 55 years of age (86.5%), female (57.9%), non-Hispanic Caucasians (82.4%), and had health care coverage (95.7%).

The factors associated with decreased odds of getting a screening colonoscopy were: Hispanic race (OR 0.79, 95% CI 0.75-0.85), lack of healthcare coverage (OR 0.43 95% CI 0.40-0.46), physical inactivity (OR 0.88, 95% CI 0.86-0.92), and financial concerns affecting doctor visits (OR 0.88, 95% CI 0.83-0.92). Female gender, patients with higher education, higher annual household income, and retired status had increased odds of getting a screening colonoscopy (Table 1).

Discussion: Survey of BRFSS demonstrates multiple factors that significantly impact the utilization of average-risk screening colonoscopy. This study helps shed light on racial and socioeconomic determinants of health that should be addressed to improve patient accessibility to screening colonoscopy.

Characteristic	Odds Ratio	95% CI	p-value
Demographics
Females	1.18	(1.15 - 1.22)	< 0.01
Caucasian race	1	(1.00 - 1.00)	.
African Americans	1.08	(1.03 - 1.15)	0.002
Hispanics	0.79	(0.75 - 0.85)	< 0.01
Annual household income
< $10,000	1	(1.00 - 1.00)	.
$10,000 < = < $15,000	1.20	(1.10 - 1.32)	< 0.01
$15,000 < = < $20,000	1.23	(1.13 - 1.34)	< 0.01
$20,000 < = < $25,000	1.39	(1.28 - 1.52)	< 0.01
$25,000 < = < $35,000	1.60	(1.47 - 1.75)	< 0.01
$35,000 < = < $50,000	1.87	(1.72 - 2.04)	< 0.01
$50,000 < = < $75,000	2.44	(2.24 - 2.66)	< 0.01
>= $75,000	2.91	(2.68 - 3.17)	< 0.01
Education
Did not graduate high school	1	(1.00 - 1.00)	.
High school graduate	1.24	(1.17 - 1.32)	< 0.01
Attended college or technical school	1.46	(1.38 - 1.56)	< 0.01
College or technical school graduate	1.74	(1.63 - 1.86)	< 0.01
Employment Status
Employed for wages	1	(1.00 - 1.00)	.
Self-employed	0.85	(0.81 - 0.90)	< 0.01
A homemaker	1.05	(0.97 - 1.14)	0.22
Retired	1.62	(1.55 - 1.70)	< 0.01
Unable to work	1.72	(1.62 - 1.84)	< 0.001
No exercise in the last one month	0.88	(0.85 - 0.92)	< 0.01
Could not see a doctor due to financial concerns	0.88	(0.84-0.93)	< 0.01
No healthcare coverage	0.43	(0.40 - 0.46)	< 0.01

Disclosures:

Achintya Singh indicated no relevant financial relationships.

Aakash Desai indicated no relevant financial relationships.

Muhammad Zarrar Khan indicated no relevant financial relationships.

Vardhmaan Jain indicated no relevant financial relationships.

Prabhat Kumar indicated no relevant financial relationships.

Andrew Ford indicated no relevant financial relationships.

Deepak Madhu indicated no relevant financial relationships.

Babu Mohan indicated no relevant financial relationships.

Achintya Singh, MD¹, Aakash Desai, MD², Muhammad Zarrar Khan, MD, MBBS³, Vardhmaan Jain, MD¹, Prabhat Kumar, MD¹, Andrew Ford, MD¹, Deepak Madhu, DM⁴, Babu P. Mohan, MD, MS⁵. E0177 - Evaluation of Gender, Racial, and Socio-Economic Factors Underlying Disparities in Colorectal Cancer Screening, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.