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Neighborhood Socioeconomic Status and Use of Colonoscopy in an Insured Population – A Retrospective Cohort Study

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  • Chyke A Doubeni
  • Guruprasad D Jambaulikar
  • Hassan Fouayzi
  • Scott B Robinson
  • Margaret J Gunter
  • Terry S Field
  • Douglas W Roblin
  • Robert H Fletcher

Abstract

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.

Suggested Citation

  • Chyke A Doubeni & Guruprasad D Jambaulikar & Hassan Fouayzi & Scott B Robinson & Margaret J Gunter & Terry S Field & Douglas W Roblin & Robert H Fletcher, 2012. "Neighborhood Socioeconomic Status and Use of Colonoscopy in an Insured Population – A Retrospective Cohort Study," PLOS ONE, Public Library of Science, vol. 7(5), pages 1-7, May.
    • Handle: RePEc:plo:pone00:0036392
    DOI: 10.1371/journal.pone.0036392
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    References listed on IDEAS

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    1. Doubeni, C.A. & Schootman, M. & Major, J.M. & Torres Stone, R.A. & Laiyemo, A.O. & Park, Y. & Lian, M. & Messer, L. & Graubard, B.I. & Sinha, R. & Hollenbeck, A.R. & Schatzkin, A., 2012. "Health status, neighborhood socioeconomic context, and premature mortality in the United States: The national institutes of health-AARP diet and health study," American Journal of Public Health, American Public Health Association, vol. 102(4), pages 680-688.
    2. Johnson, R.L. & Roter, D. & Powe, N.R. & Cooper, L.A., 2004. "Patient race/ethnicity and quality of patient-physician communication during medical visits," American Journal of Public Health, American Public Health Association, vol. 94(12), pages 2084-2090.
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    1. David C Wheeler & Jenna Czarnota & Resa M Jones, 2017. "Estimating an area-level socioeconomic status index and its association with colonoscopy screening adherence," PLOS ONE, Public Library of Science, vol. 12(6), pages 1-14, June.

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