D0173 - The Impact of Social Determinants of Health on Colorectal Cancer Screening in Transgender People

Shabari M. Shenoy, MBBS¹, Gres Karim, MD², Shanique W. Noack, MD³, Joshua Safer, MD⁴, Ilan Weisberg, MD, MSc⁵, Amreen Dinani, MD^6
1Icahn School of Medicine at Mount Sinai Morningside-West, New York, NY; ²Mount Sinai Beth Israel, New York, NY; ³Mount Sinai Morningside-West-Beth Israel Hospitals, New York, NY; ⁴Center for Transgender Medicine and Surgery, Icahn School of Medicine at Mount Sinai, New York, NY; ⁵New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY; ⁶Duke University, Durham, NC

Introduction: Colon cancer screening (CRC) rates are lower in transgender (TGD) people compared to cis-gender people. Studies have identified several barriers to screening. TGD people experience discrimination such as unemployment, lack of education, access to health care, housing insecurity. The aim of our study is to identify the impact of barriers related to Social Determinants of Health (SDH), as identified by the United States Department of Health and Human Services (US DHHS), on CRC screening rates in TGD people.

Methods: A retrospective chart analysis using the electronic medical record was performed, including TGD people > 45 years of age between January 2017 to January 2022 at a large academic medical center in New York City with expertise in transgender medicine. Patients who had a concern for SDH during a healthcare visit were included in the analysis. Demographic data was collected. Patients’ CRC screening rates were noted. Specific barriers related to SDH were studied by categorising them into 5 main domains as described by the US DHHS: 1. Economic stability; 2. Access to quality education; 3. Access to quality health care; 4. Housing and neighbourhoods; 5. Social and community related concerns. A descriptive and co-variate analysis was performed.

Results: We identified 1046 TGD people > 45 years of age seen between January 2017 to January 2022, with complete data and colon cancer screening offered to 143 people. Of those offered screening,104/143 (72.7%) completed screening. Two or more barriers were identified in 78 people. Social and community related concerns (including food insecurity, mental health, disabilities, substance, domestic and child abuse) was the most common barrier (182 people, 59.3%), followed by economic instability (105 people, 32.4%). Fifty six people (18.2%) had a lack of access to healthcare. 43 people (14%) had housing insecurities while deficiency in access to quality education was perceived in 22 people (7.1%). The presence of at least one barrier to SDH negatively impacted CRC screening completion (p< 0.01).

Discussion: Thirty percent of people within our study were found to have at least one barrier related to SDH which was negatively associated with CRC screening. These barriers identified reaffirm the need to develop comprehensive initiatives aimed at mitigating obstacles to CRC screening, and raise awareness of CRC in TGD people. Future studies should focus on implementing assessment tools for early identification of these barriers.




Disclosures:


Shabari M. Shenoy, MBBS¹, Gres Karim, MD², Shanique W. Noack, MD³, Joshua Safer, MD⁴, Ilan Weisberg, MD, MSc⁵, Amreen Dinani, MD⁶. D0173 - The Impact of Social Determinants of Health on Colorectal Cancer Screening in Transgender People, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.