Odds of Incomplete Colonoscopy in Colorectal Cancer Screening Based on Socioeconomic Status

Abstract

The aim of this study is to investigate the association between socioeconomic status (SES) and the risk of having an incomplete colonoscopy (IC) in the Danish Colorectal Cancer (CRC) Screening Program. In this register-based study we included 71,973 participants who underwent colonoscopy after a positive fecal immunochemical test in the Danish CRC Screening Program. The main exposure, SES, was defined by income and education, and the outcome by complete or incomplete colonoscopy. Among the participants, 5428 (7.5%) had an incomplete colonoscopy. The odds ratio (OR) for ICs due to inadequate bowel preparation was 1.67 (95% CI: 1.46; 1.91) for income in the 1 quartile compared to income in the 4th quartile. ORs for income in the 2nd quartile was 1.38 (95% CI: 1.21; 1.56) and 1.17 (95% CI: 1.03; 1.33) for income in the 3rd quartile. For the educational level, an association was seen for high school/vocational education with an OR of 0.87 (95% CI: 0.79; 0.97) compared to higher education. For ICs due to other reasons, the level of income was associated with the risk of having an IC with an OR of 1.19 (95% CI: 1.05; 1.35) in the 1st quartile and an OR of 1.19 (95% CI: 1.06; 1.34) in the 2nd quartile. For the educational level, there were no significant associations. Low income is associated with high risk of having an IC, whereas educational level does not show the same unambiguous association.

The optimal use of colon capsule endoscopes in clinical practice

“…33 34 In another study in a Danish bowel cancer screening population, lower income quartiles were associated with increased odds of incomplete OC due to poor bowel preparation. 35 Higher BMI has also been reported as a risk factor for incomplete OC. 36,37 For smallbowel capsule endoscopy, gastric transit time longer than 45 min, previously small-bowel surgery, hospitalisation and poor bowel preparation have been identified as risk factors for an incomplete examination.…”

Socioeconomic inequalities in interval colorectal cancer are explained by differences in faecal haemoglobin concentration and age: a register-based cohort study

“…Nevertheless, social inequalities are evident in participation at both faecal immunochemical test (FIT) and colonoscopy 5 6. The proportion of positive FIT samples and the risk of a following incomplete colonoscopy is higher in lower socioeconomic subgroups 7 8. Why this is, has yet to be determined, but it has been established that lifestyle and health behaviour affects the risk of colorectal cancer 9.…”