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.
