ASPO Abstracts
Preventing recurrence: disparities in adherence to surveillance colonoscopy among colorectal cancer survivors in South Carolina
Category: Cancer Health Disparities, Survivorship & Health Outcomes/Comparative Effectiveness Research
Conference Year: 2018
Abstract Body:
Purpose: Surveillance colonoscopy is recommended the first year after a colorectal cancer (CRC) diagnosis, but uptake is suboptimal among minority populations. We examined whether racial disparities in adherence to surveillance to prevent recurrence are less pronounced in older CRC survivors (65+ vs. <65) due to improved access to health insurance. Methods: We used the population-based, all-payer, South Carolina (SC) Central Cancer Registry linked to the SC Outpatient Discharge Database. Records for 8,432 patients aged 25 — 85 diagnosed with a primary CRC between 2000 — 2011 were linked with colonoscopy records from 2000 — 2014. Descriptive statistics and multivariate logistic regression were employed to describe and model adherence to surveillance colonoscopy within one year (9 — 15 months) after date of CRC diagnosis. Persons with stage IV cancer, <65 years with Medicare, and death before the surveillance window were excluded. Covariates included sex, primary insurance, stage at diagnosis (I — III) and residential location (urban vs. rural). Results: Overall, 35% percent of black and 43% of white patients received a surveillance colonoscopy within the first year window. The interaction between age (<65 vs. 65+) and race was statistically significant, indicating that racial disparities in surveillance persisted, but were less pronounced, in the older patient cohort. In stratified models, the odds of adherence to surveillance were lower in younger [OR=0.67, 95% CI (0 .57, 0.77)] and older [OR=0.73, 95% CI (0.63, 0.86)] black patients compared to white patients within the same <64 and 65+ age groups, respectively. Conclusion: Although the 65+ population has more equitable access to care due to Medicare, we observed a persistent, although diminished, disparity in surveillance colonoscopy use in black patients even among this age group. Future cohort studies should investigate the reasons for lower adherence to surveillance colonoscopy in order to reduce or eliminate this disparity.
Keywords: surveillance adherence