Department of Medicine, Division of Geriatric Medicine; Department of Family Medicine and Community Health; Meyers Primary Care Institute
Colonoscopy; Socioeconomic Factors
Health Services Research | Primary Care
BACKGROUND: Low-socioeconomic status (SES) is associated with a higher colorectal cancer (CRC) incidence and mortality. Screening with colonoscopy, the most commonly used test in the US, has been shown to reduce the risk of death from CRC. This study examined if, among insured persons receiving care in integrated healthcare delivery systems, differences exist in colonoscopy use according to neighborhood SES.
METHODS: We assembled a retrospective cohort of 100,566 men and women, 50-74 years old, who had been enrolled in one of three US health plans for >/=1 year on January 1, 2000. Subjects were followed until the date of first colonoscopy, date of disenrollment from the health plan, or December 31, 2007, whichever occurred first. We obtained data on colonoscopy use from administrative records. We defined screening colonoscopy as an examination that was not preceded by gastrointestinal conditions in the prior 6-month period. Neighborhood SES was measured using the percentage of households in each subject's census-tract with an income below 1999 federal poverty levels based on 2000 US census data. Analyses, adjusted for demographics and comorbidity index, were performed using Weibull regression models.
RESULTS: The average age of the cohort was 60 years and 52.7% were female. During 449,738 person-years of follow-up, fewer subjects in the lowest SES quartile (Q1) compared to the highest quartile (Q4) had any colonoscopy (26.7% vs. 37.1%) or a screening colonoscopy (7.6% vs. 13.3%). In regression analyses, compared to Q4, subjects in Q1 were 16% (adjusted HR = 0.84, 95% CI: 0.80-0.88) less likely to undergo any colonoscopy and 30%(adjusted HR = 0.70, CI: 0.65-0.75) less likely to undergo a screening colonoscopy.
CONCLUSION: People in lower-SES neighborhoods are less likely to undergo a colonoscopy, even among insured subjects receiving care in integrated healthcare systems. Removing health insurance barriers alone is unlikely to eliminate disparities in colonoscopy use.
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Copyright: © 2012 Doubeni et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
DOI of Published Version
Doubeni CA, Jambaulikar GD, Fouayzi H, Robinson SB, Gunter MJ, et al. (2012) Neighborhood Socioeconomic Status and Use of Colonoscopy in an Insured Population – A Retrospective Cohort Study. PLoS ONE 7(5): e36392. doi:10.1371/journal.pone.0036392. Link to article on publisher's site
Doubeni CA, Jambaulikar GD, Fouayzi H, Robinson SB, Gunter MJ, Field TS, Roblin DW, Fletcher RH. (2012). Neighborhood socioeconomic status and use of colonoscopy in an insured population--a retrospective cohort study. Meyers Primary Care Institute Publications. https://doi.org/10.1371/journal.pone.0036392. Retrieved from https://escholarship.umassmed.edu/meyers_pp/544