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Utilization of Census Tract-Based Neighborhood Poverty Rates to Predict Non-adherence to Screening Colonoscopy

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Abstract

Objectives

Efforts to improve colorectal cancer (CRC) screening rates include recognizing predictors of colonoscopy non-adherence and identifying these high-risk patient populations. Past studies have focused on individual-level factors but few have evaluated the influence of neighborhood-level predictors. We sought to assess the effect of census tract-based neighborhood poverty rates on scheduled screening colonoscopy non-adherence.

Methods

In this prospective observational cohort study, data from electronic medical records and appointment tracking software were collected in 599 patients scheduled to undergo outpatient CRC screening colonoscopy at two academic endoscopy centers between January 2011 and December 2012. Non-adherence was defined as failure to attend a colonoscopy appointment within 1 year of the date it was electronically scheduled. Neighborhood poverty rate was determined by matching patients’ self-reported home address with their corresponding US census tract. Individual factors including medical comorbidities and prior appointment adherence behavior were also collected.

Results

Overall, 17% (65/383) of patients were non-adherent to scheduled colonoscopy at 1-year follow-up. Neighborhood poverty rate was a significant predictor of non-adherence to scheduled screening colonoscopy in multivariate modeling (OR 1.53 per 10% increase in neighborhood poverty rate, 95% CI 1.21–1.95, p < 0.001). By incorporating the neighborhood poverty rate, screening colonoscopy non-adherence was 31% at the highest quartile compared to 14% at the lowest quartile of neighborhood poverty rates (p = 0.006).

Conclusions

Census tract-based neighborhood poverty rates can be used to predict non-adherence to scheduled screening colonoscopy. Targeted efforts to increase CRC screening efficiency and completion among patients living in high-poverty geographic regions could reduce screening disparities and improve utilization of endoscopy unit resources.

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Abbreviations

ACG:

American College of Gastroenterology

ACS:

American Community Survey

AUROC:

Area under the receiver operating curve

CRC:

Colorectal cancer

FIT:

Fecal immunochemical testing

SES:

Socioeconomic status

USPSTF:

US Preventative Services Task Force

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Funding

Some study support was provided by the American Cancer Society of Illinois (Grant No. 255086).

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Authors and Affiliations

  1. Division of Digestive Diseases, Department of Medicine, Rush University Medical Center, 1725 West Harrison Street, Suite 206, Chicago, IL, 60612, USA

    Philip Vutien, Rucha Shah, Karen Ma, Nasir Saleem & Joshua Melson

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  1. Philip Vutien
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Contributions

PV collected and interpreted the data, contributed to statistical analysis, and drafted the manuscript. RS collected and interpreted the data. KM interpreted the data and drafted the manuscript. NS collected and interpreted the data. JM planned and conducted the study, interpreted the data, and edited the manuscript. All authors approved the final draft of this manuscript.

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Correspondence to Joshua Melson.

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Conflict of interest

Philip Vutien, Rucha Mehta, Karen Ma, Nasir Saleem have no conflicts of interest. Joshua Melson has received research grants from the American Cancer Society of Illinois (Grant No. 255086).

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Vutien, P., Shah, R., Ma, K. et al. Utilization of Census Tract-Based Neighborhood Poverty Rates to Predict Non-adherence to Screening Colonoscopy. Dig Dis Sci 64, 2505–2513 (2019). https://doi.org/10.1007/s10620-019-05585-8

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  • DOI: https://doi.org/10.1007/s10620-019-05585-8

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