Association between socioeconomic and demographic characteristics and utilization of colonoscopy in the EPIC–Heidelberg cohort

Abstract

We aimed to describe the utilization of colonoscopy and its association with sociodemographic characteristics within the European Prospective Investigation into Cancer and Nutrition (EPIC)-Heidelberg cohort study. We included 15 014 study participants (43% men) of the EPIC-Heidelberg cohort recruited between 1994 and 1998. At baseline recruitment, as well as in the 3-yearly follow-up surveys, study participants completed questionnaires on lifestyle, socioeconomic background variables, health status, and use of medications and medical services, including colonoscopy examinations. The present analyses focused on participants who completed the question on colonoscopy examination in all follow-up rounds. Our results show that by the end of the fourth follow-up round, more than half of all participants of the EPIC-Heidelberg cohort had had a colonoscopy. Colonoscopy was associated with some socioeconomic and demographic characteristics: a positive association with vocational training level as well as overall socioeconomic status level [International Standard Classification of Education (ISCED) classification]. A negative association was found for household size and employment status. Colonoscopy usage increased steeply within the subgroup of participants older than 55 years of age and decreased again within the subgroup of participants older than 75 years of age. Organized colorectal cancer screening should include a written invitation system, to overcome the problem of sociodemographic-related differential awareness of and attendance at colonoscopy examinations. Also, the high proportion of prescreened individuals should be taken into account to avoid unnecessary re-examinations. We aimed to describe the utilization of colonoscopy and its association with sociodemographic characteristics within the European Prospective Investigation into Cancer and Nutrition (EPIC)-Heidelberg cohort study. We included 15 014 study participants (43% men) of the EPIC-Heidelberg cohort recruited between 1994 and 1998. At baseline recruitment, as well as in the 3-yearly follow-up surveys, study participants completed questionnaires on lifestyle, socioeconomic background variables, health status, and use of medications and medical services, including colonoscopy examinations. The present analyses focused on participants who completed the question on colonoscopy examination in all follow-up rounds. Our results show that by the end of the fourth follow-up round, more than half of all participants of the EPIC-Heidelberg cohort had had a colonoscopy. Colonoscopy was associated with some socioeconomic and demographic characteristics: a positive association with vocational training level as well as overall socioeconomic status level [International Standard Classification of Education (ISCED) classification]. A negative association was found for household size and employment status. Colonoscopy usage increased steeply within the subgroup of participants older than 55 years of age and decreased again within the subgroup of participants...

10-year prevalence of diagnostic and screening colonoscopy use in Germany: a claims data analysis

“…In our study, there were no relevant differences in colonoscopy use according to estimates of SES defined by educational level. This is consistent with the results of the analyses by Hermann et al (2015 ) including 15 014 participants aged 35–60 years of the EPIC study in Germany where no association with educational but a weak positive association with vocational training was observed. In a study by Sieverding et al (2010 ), also no clear association was found between education and colonoscopy use in Germany in both sexes.…”

The association between educational status and colorectal neoplasia: results from a screening cohort

“…Further models included addi-tional covariates, the 10-year risk for cardiovascular disease, and the family history of CRC (model-2) and age, sex, presence of metabolic syndrome, smoking status, family history of CRC, red meat consumption, and physical activity (model-3). Odds ratios (OR) and respective 95% confidence intervals (CI) were calculated for the binary depend- [21,22]. In line with these preliminary studies, the average age of patients with low education status was also higher in our study, indicating that these patients came for screening later in their life.…”

“…Interestingly, in our study, the participants with lower education reported even less physical activity, whereas the amounts of red meat as main meal were different statistically, but this difference did not seem clinically relevant. There is also evidence that patients with lower education are less likely to participate in CRC screening [ 21 , 22 ]. In line with these preliminary studies, the average age of patients with low education status was also higher in our study, indicating that these patients came for screening later in their life.…”

To what extent is male excess risk of advanced colorectal neoplasms explained by known risk factors? Results from a large German screening population

“…Apart from observed AN risk among those who participate in screening colonoscopy, sex‐specific differences are also expected with respect to socioeconomic status (SES) and use of screening colonoscopy, with stronger associations between SES and colonoscopy screening participation among males than females 29 . If consideration of SES may increase the explainable proportion of male excess risk should be investigated in further studies.…”