Highlights
- •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.
Abstract
Background
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.
Methods
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.
Results
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).
Conclusions
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.
Keywords
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Article info
Publication history
Published online: April 28, 2022
Accepted:
April 19,
2022
Received in revised form:
April 12,
2022
Received:
January 2,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
