Long-term benefits for lower socioeconomic groups by improving bowel screening participation in South Australia: A modelling study

Lal, Anita; Gao, Lan; Tan, Elise Chia-Hui; McCaffrey, Nikki; Roder, David; Buckley, Elizabeth

doi:10.1371/journal.pone.0279177

Cited by 1 publication

(3 citation statements)

References 25 publications

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“…Our findings are consistent with previous studies that reported lower bowel screening uptake among more disadvantaged or remote areas in Australia [6,14,31] and globally. [8,12,32] That these patterns were evident across three non-overlapping consecutive time-periods indicates the stability of these associations.…”

Section: Discussionsupporting

confidence: 93%

“…Commonly cited reasons for the generally lower screening participation among people from more disadvantaged areas include differences in knowledge and attitudes, reduced responsiveness to disease prevention and health promotion messages and a lower engagement in healthy behaviors in general [ 8 , 14 , 31 , 33 ]. However, our results found that NBCSP participation rate in some areas categorized as most disadvantaged is higher than the national average, demonstrating that area-level disadvantage lacks sufficient specificity for identifying areas with poorer participation.…”

Section: Discussionmentioning

confidence: 99%

“…Given the cost-effectiveness of non-invasive iFOBTs versus invasive colonoscopies and similar efficacy in average-risk populations, [ 56 ] if the full benefits of the NBCSP are to be realized it is vital that the current NBCSP uptake is increased [ 4 , 31 ]. A recent study suggested that the NBCSP could potentially save around 76,000 lives over the period 2015–40 if coverage rates were increased to 50% [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

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Geographical and spatial variations in bowel cancer screening participation, Australia, 2015–2020

et al. 2023

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Background Participation in bowel cancer screening programs remains poor in many countries. Knowledge of geographical variation in participation rates may help design targeted interventions to improve uptake. This study describes small-area and broad geographical patterns in bowel screening participation in Australia between 2015–2020. Methods Publicly available population-level participation data for Australia’s National Bowel Cancer Screening Program (NBCSP) were modelled using generalized linear models to quantify screening patterns by remoteness and area-level disadvantage. Bayesian spatial models were used to obtain smoothed estimates of participation across 2,247 small areas during 2019–2020 compared to the national average, and during 2015–2016 and 2017–2018 for comparison. Spatial heterogeneity was assessed using the maximized excess events test. Results Overall, screening participation rates was around 44% over the three time-periods. Participation was consistently lower in remote or disadvantaged areas, although heterogeneity was evident within these broad categories. There was strong evidence of spatial differences in participation over all three periods, with little change in patterns between time periods. If the spatial variation was reduced (so low participation areas were increased to the 80th centile), an extra 250,000 screens (4% of total) would have been conducted during 2019–2020. Conclusions Despite having a well-structured evidence-based government funded national bowel cancer screening program, the substantial spatial variation in participation rates highlights the importance of accounting for the unique characteristics of specific geographical regions and their inhabitants. Identifying the reasons for geographical disparities could inform interventions to achieve more equitable access and a higher overall bowel screening uptake.

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