Risk of colorectal adenomas and advanced neoplasia in Hispanic, black and white patients undergoing screening colonoscopy

Abstract

SUMMARY Background Racial and ethnic differences in the risk of premalignant colorectal neoplasia have not been extensively studied. Aim To measure adenoma prevalence among asymptomatic white, black and Hispanic patients undergoing screening colonoscopy. Methods In this cross sectional cohort study, data from individuals ≥50 years undergoing first-time colonoscopy since 2006 at a single tertiary-care medical centre were obtained from the electronic medical record. Adenoma prevalence among whites, blacks and Hispanics was calculated; multivariate Poisson and logistic regression were used to identify factors independently associated with adenoma rates and the presence of advanced adenomas. Results We identified 5075 eligible subjects: 3542 (70%) whites, 942 (18%) Hispanics and 591 (12%) blacks. The mean age was 62.2 years with 58% women. At least one adenoma was detected in 19%, 22% and 26% of whites, Hispanics and blacks respectively (Hispanics vs. whites P = 0.09; blacks vs. whites P = 0.0001). Isolated proximal adenomas were present in 9% of whites, 11% of Hispanics (P = 0.03) and 11% of blacks (P = 0.03). In multivariate analyses, a higher rate of adenomas was present in Hispanics (RR: 1.37, 95% CI: 1.20–1.57) and blacks (RR: 1.76, 95% CI: 1.52–2.04) than whites. Hispanics and blacks also had an increased risk of advanced adenomas compared to whites (ORHispanics: 2.25, 95% CI: 1.62–3.11; ORblacks: 1.91, 95% CI: 1.27–2.86). Conclusions Adenoma prevalence was higher in blacks and Hispanics than in whites. Both groups were at greater risk of having proximal adenomas in the absence of any distal pathology than whites, where these lesions would have only been detected by colonoscopy. Efforts to promote screening are necessary among diverse, under-represented populations.

The Prevalence of Colorectal Adenomas in Asymptomatic Korean Men and Women

“…The prevalence of advanced adenomas among participants in our study was 3.6%, 5.1%, and 7.4% for men 50 to 59, 60 to 69, and 70 to 79 years of age, respectively, and 1.9%, 2.7%, and 2.5% for women 50 to 59, 60 to 69, and 70 to 79 years of age, respectively. These estimates are similar to estimates from previous Korean studies of 2.5% to 4.1% in participants 50 years of age and older (6, 7), but are lower than estimates from Western studies of 4.4% to 10.5% (21)(22)(23). The reasons for the lower prevalence of advance adenomas among Koreans are unclear.…”

Disparities in prevalence, location, and shape characteristics of colorectal neoplasia between South Korean and U.S. patients

“…16,18 Previous studies have shown not only differences in prevalence, but also differences in anatomic distribution of polyps between various racial groups. Compared with white patients, black patients 12,14 and Hispanic patients 14 were found to be at greater risk of having proximal lesions, and Chinese patients 16 were at greater risk of having distal lesions.…”

“…[12][13][14][15][16][17] Studies have reported differences in the prevalence of colorectal neoplasia between white and black, [12][13][14] Hispanic and white, 15,17 and Chinese and white 16 patients. Until now, the prevalence of colorectal neoplasia in Asians has been thought to be lower than that in Western patients.…”

Prevalence of Advanced Colorectal Neoplasia in White and Black Patients Undergoing Screening Colonoscopy in a Safety-Net Hospital

“…Studies to date, however, have provided conflicting results, with some studies finding a higher prevalence among blacks and others finding no difference (14–17). Possible explanations include differences in the primary endpoint (e.g.…”