E0168 - Socioeconomic Status: An Important Determinant for Follow-Up for Surveillance Colonoscopy After Endoscopic Mucosal Resection

Tuesday, October 25, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Rebecca Sullivan, MD

University of Alabama Birmingham
Birmingham, AL

Rebecca Sullivan, MD¹, Yassmin Hegazy, MD², Ashutosh Tamhane, MD, PhD¹, Bijal Vashi, MS¹, Lonnie Hannon, PhD¹, Ariann Nassel, MA¹, Sergio A. Sánchez-Luna, MD¹, Ali M. Ahmed, MD², Kondal R. Kyanam Kabir Baig, MD², Shajan Peter, MD², Ramzi Mulki, MD²
¹University of Alabama Birmingham, Birmingham, AL; ²University of Alabama at Birmingham, Birmingham, AL

Introduction: Alabama had significantly higher incidence of colorectal cancer (CRC)at 43.5 compared to the US rate 39.5, and African Americans have higher rate of CRC compared to Caucasian individuals. There is compelling evidence that surveillance colonoscopy after high-risk adenoma polypectomy can reduce the risk of developing CRC.Our objective was to identify risk factors associated with poor follow up after undergoing colonoscopy with endoscopic mucosal resection (EMR).

Methods: We performed retrospective chart review of patients who had EMR at our facility between June 2016-March 2022.Patient demographics, referral, procedural and census data were collected. Census data obtained was used to evaluate income, median household income, and educational attainment. Patients were divided into two groups; poor and good follow up. Poor follow up was defined as those who failed to follow up and/or presented for surveillance colonoscopy >1 month after the recommended timeframe.

Results: Initial chart review included 520 eligible patients;73 were excluded due to lack of referral data, and 59 with recent EMR whose recommended surveillance colonoscopy has not passed. Of the included 388 patients, 293 (75.5%) had poor follow up and 95 (24.5%) had good follow up. Descriptive statistics of the various characteristics and comparisons of the of two groups is presented in Table 1. Compared to individuals with good follow up, there was a significant association of poor follow up with patients whose index colonoscopy was performed at an outside hospital (p=0.003) and if the index colonoscopy was their first colonoscopy (p=0.04). Additionally, census data revealed lower median home values were associated with poor follow up ($168,382) when compared to good follow up ($185,034). There was a trend to poor follow up in patients with obesity (80.5%), former alcohol use (88.9%), patients insured by Medicaid (88.9%), and minority populations including African American, and Hispanic/other ethnicities (77.1%,90.9%, respectively).

Discussion: Our study illustrates that social economic status has significant impact on surveillance colonoscopy after EMR, and outside hospital referral are more likely to have poor follow up compared to in house referrals. Given the potential impact this data has for reducing risk of developing CRC in lower social economic individuals, further studies are needed to validate this finding and stratify predictors of poor follow up.

	Overall	Follow-up
	N=388	Poor n=293 (75.5%)	Good n=95 (24.5%)	p value
Age (years), mean (SD)	63 (10.4)	64 (10.4)	62 (10.4)	0.23^c

Sex: Male	52.1%	75.3%	24.8%	0.89^d
Female	47.9%	75.8%	24.2%	0.89^d

Race/ Ethnicity: Caucasian	67.8%	73.8%	26.2%	0.38^d
African American	28.1%	77.1%	22.9%
Other	2.8%	90.9%	9.1%

Type of insurance: Private	45.9%	74.7%	25.3%	0.39^d
Medicare	47.4%	75.0%	25.0%
Medicaid	4.6%	88.9%	11.1%
Uninsured	2.1%	75.0%	25.0%

BMI: less than 24.9 – Underweight/ Normal	24.8%	72.8%	27.2%	0.11^d
between 25.0 and 29.9 – Overweight	32.4%	70.0%	30.0%
more than 30.0 – Obese	42.9%	80.5%	19.5%

ASA classification: 1	0.8%	66.7%	33.3%	0.84^d
2	60.2%	75.5%	24.5%
3	38.5%	75.8%	24.2%
4	0.5%	50.0%	50.0%

Smoking: Current	25.0%	76.3%	23.7%	0.79^d
Former	26.8%	73.1%	26.9%
Never	47.7%	76.2%	23.8%

Alcohol: Current	46.1%	72.6%	27.4%	0.25^d
Former	6.9%	88.9%	11.1%
Never	46.4%	76.1%	23.9%

Drugs: Current	3.4%	84.6%	15.4%	0.85^d
Former	4.4%	70.6%	29.4%
Never	87.9%	75.4%	24.6%

Employment: Employed	29.9%	74.1%	25.9%	0.99^d
Unemployed	6.9%	74.1%	25.9%
Retired	28.4%	75.5%	24.6%
Disabled	10.1%	76.9%	23.1%

First colonoscopy: Yes	17.0%	75.8%	24.2%	0.04^d*
No	44.6%	69.9%	30.1%	0.04^d*

Outside Hospital Referral: Yes	31.7%	86.2%	13.8%	0.003^d*
No	67.8%	70.7%	29.3%	0.003^d*

Time of procedure: Morning	57.9%	72.9%	27.1%	0.16^d
Afternoon	42.0%	79.1%	20.9%	0.16^d

Table: Descriptive characteristics and comparison of poora vs goodb follow up in patients who underwent EMR at UAB between June 2016-March 2022.
ASA=American Society of Anesthesiologists; BMI=body mass index; EMR= endoscopic mucosal resection; SD=standard deviation; UAB=University of Alabama at Birmingham.
*Statistically significant at 0.05 level (two-tailed test)
a-Poor follow up included patients that did not receive surveillance colonoscopy within recommended timeframe or patients who were lost to follow up.
b-Good follow up is defined as undergoing surveillance colonoscopy within the recommended timeframe.
c-Unpaired t-test.
d-Chi-square test.

Disclosures:

Rebecca Sullivan indicated no relevant financial relationships.

Yassmin Hegazy indicated no relevant financial relationships.

Ashutosh Tamhane indicated no relevant financial relationships.

Bijal Vashi indicated no relevant financial relationships.

Lonnie Hannon indicated no relevant financial relationships.

Ariann Nassel indicated no relevant financial relationships.

Sergio Sánchez-Luna indicated no relevant financial relationships.

Ali Ahmed indicated no relevant financial relationships.

Kondal Kyanam Kabir Baig: Ambu – Consultant. Ambu – Grant/Research Support. Olympus – Grant/Research Support.

Shajan Peter indicated no relevant financial relationships.

Ramzi Mulki indicated no relevant financial relationships.

Rebecca Sullivan, MD¹, Yassmin Hegazy, MD², Ashutosh Tamhane, MD, PhD¹, Bijal Vashi, MS¹, Lonnie Hannon, PhD¹, Ariann Nassel, MA¹, Sergio A. Sánchez-Luna, MD¹, Ali M. Ahmed, MD², Kondal R. Kyanam Kabir Baig, MD², Shajan Peter, MD², Ramzi Mulki, MD². E0168 - Socioeconomic Status: An Important Determinant for Follow-Up for Surveillance Colonoscopy After Endoscopic Mucosal Resection, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.