Increased Screening Colonoscopy Rates and Reduced Racial Disparities in the New York Citywide Campaign: An Urban Model

Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA.
The American Journal of Gastroenterology (Impact Factor: 9.21). 11/2011; 106(11):1880-6. DOI: 10.1038/ajg.2011.191
Source: PubMed

ABSTRACT In 2003, in response to low colonoscopy screening rates and significant sociodemographic disparities in colonoscopy screening in New York City (NYC), the NYC Department of Health and Mental Hygiene, together with the Citywide Colon Cancer Control Coalition, launched a multifaceted campaign to increase screening. We evaluated colonoscopy trends among adult New Yorkers aged 50 years and older between 2003 and 2007, the first five years of this campaign.
Data were analyzed from the NYC Community Health Survey, an annual, population-based surveillance of New Yorkers. Annual prevalence estimates of adults who reported a timely colonoscopy, one within the past 10 years, were calculated. Multivariate models were used to analyze changes over time in associations between colonoscopy screening and sociodemographic characteristics.
Overall, from 2003 to 2007 the proportion of New Yorkers aged 50 years and older who reported timely colonoscopy screening increased from 41.7% to 61.7%. Racial/ethnic and sex disparities observed in 2003 were eliminated by 2007: prevalence of timely colonoscopy was similar among non-Hispanic whites, non-Hispanic blacks, Hispanics, men, and women. However, Asians, the uninsured, and those with lower education and income continued to lag in receipt of timely colonoscopies.
The increased screening colonoscopy rate and reduction of racial/ethnic disparities observed in NYC suggest that multifaceted, coordinated urban campaigns can improve low utilization of clinical preventive health services and reduce public-health disparities.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Patient navigation (PN) effectively increases screening colonoscopy (SC) rates, a key to reducing deaths from colorectal cancer (CRC). Ethnic minority populations have disproportionately low SC rates and high CRC mortality rates and, therefore, especially stand to benefit from PN. Adapting the Health Belief Model as an explanatory model, the current analysis examined predictors of SC rates in two randomized studies that used PN to increase SC among 411 African American and 461 Latino/a patients at a large urban medical center. Speaking Spanish but not English (odds ratio (OR), 2.192; p<0.005), having a higher income (OR, 1.218; p<0.005), and scoring higher on the Pros of Colonoscopy scale (OR, 1.535; p=0.023) independently predicted colonoscopy completion. Health education and PN programs that increase awareness of the benefits of getting a colonoscopy may encourage colonoscopy completion. In the context of language-appropriate PN programs for African American and Latino/a individuals, those with lower incomes and English speakers may require additional education and counseling to support their decision-making around colonoscopy.
    03/2014; 2(1). DOI:10.1007/s40615-014-0053-z
  • [Show abstract] [Hide abstract]
    ABSTRACT: Colorectal cancer (CRC) is an important cause of mortality and morbidity in North America. Screening using a fecal occult blood test, flexible sigmoidoscopy, or colonoscopy reduces CRC mortality through the detection and treatment of precancerous polyps and early stage CRC. Although CRC screening participation has increased in recent years, large inequities still exist. Minorities, new immigrants, and those with lower levels of education or income are much less likely to be screened. This review provides an overview of the commonly used tests for CRC screening, disparities in CRC screening, and promising methods at the individual, provider, and system levels to reduce these disparities. Overall, to achieve high CRC participation rates and reduce the burden of CRC in the population, a multi-faceted approach that uses strategies at all levels to reduce CRC screening disparities is urgently required.
    Journal of Carcinogenesis 01/2014; 13:12. DOI:10.4103/1477-3163.144576
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Colorectal cancer (CRC) screening reduces CRC mortality; however, for many reasons, uninsured individuals are less likely to utilize CRC screening tests. Purpose: To compare CRC screening behaviors and outcomes with guaiac fecal occult blood testing (gFOBT) from 1998 to 2006 and fecal immunochemical testing (FIT) from 2006 to 2010 in a community-based program serving uninsured patients in northern Manhattan. Methods: In 2013, we conducted a retrospective record review of individuals aged >= 50 years who received fecal-based CRC screening at the Northern Manhattan Cancer Screening Partnership between. 1998 and 2010. Included were those with household income <= 250% of the federal poverty level, no medical insurance coverage, and who were not up to date with CRC screening. We assessed screening positivity rate, positive predictive value, differences in the use of diagnostic colonoscopy, colonoscopic findings, and adenoma detection rates for gFOBT versus FIT. Results: In total, 7,710 patients completed CRC screenings (4,951 gFOBT and 2,759 FIT). The majority were female, Hispanic, foreign born, and young at age of first screening. Compared to gFOBT, FIT detected twice as many positive tests (3.2% vs 1.5%, p <= 0.001) and had a higher adenoma detection rate (18.2 vs 11.8, p=0.002). Conclusions: The improved positivity and adenoma detection rates with greater number of screening tests over time favor the use of FIT over gFOBT for colorectal screening among uninsured populations in northern Manhattan. (C) 2014 American Journal of Preventive Medicine
    American Journal of Preventive Medicine 06/2014; 47(2). DOI:10.1016/j.amepre.2014.03.011 · 4.28 Impact Factor