Original Research Article| Volume 224, ISSUE 3, P965-970, September 2022

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American Indian/Alaska native access to colorectal cancer screening: Does gastroenterologist density matter?


      • White Patients undergo more endoscopic screening compared to AI/AN (69% vs 54%) with wide regional variation across the US.
      • Factors associated with decreased endoscopic screening: Being divorced, separated, or never married, lower incomes, having Medicaid and Indian health Service.
      • Factors associated with increased screening rates: more educational attainment, employer-based insurance.
      • A minimum number of Gastroenterologist has an important correlation with increasing screening rates, the effect diminishes beyond a of 3.98 gastroenterogloists/100,000 people.



      American Indians/Alaska Natives (AI/AN) receive less colorectal cancer (CRC) screening than other populations. Using gastroenterologist (GI) locations as a measure of colonoscopy access, we correlate GI density and AI/AN CRC screening rates.


      We identified GIs from the 2016 National Provider Identifier registry, and calculated GI density per 100,000 people. We identified screening, demographic, and socioeconomic variables from the 2016 Behavioral Risk Factor Surveillance System Survey. GI density and CRC screening rates were analyzed with Multivariable Poisson regression.


      In states with GI Density greater than 3.98/100,000, odds of AI/AN CRC screening are 1.27–1.37 times higher than in states below this threshold (p < 0.036).


      GI density has a limited association on CRC screening, with decrease impact beyond threshold of 3.98 GI/100,000. Minimal access to GIs is important in improving AI/AN CRC screening; however, further research is required to elucidate the most critical factors contributing to CRC screening.


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