Spatial Insights for Understanding Colorectal Cancer Screening in Disproportionately Affected Populations, Central Texas, 2019

Abstract

Introduction Colorectal cancer (CRC) screening can reduce morbidity and mortality; however, important disparities exist in CRC uptake. Our study examines the associations of distance to care and frequency of using primary care and screening. Methods To examine the distribution of screening geographically and according to several demographic features, we used individual patient-level data, dated September 30, 2018, from a large urban safety-net health system in Central Texas. We used spatial cluster analysis and logistic regression adjusted for age, race, sex, socioeconomic status, and health insurance status. Results We obtained screening status data for 13,079 age-eligible patients from the health system’s electronic medical records. Of those eligible, 55.1% were female, and 55.9% identified as Hispanic. Mean age was 58.1 years. Patients residing more than 20 miles from one of the system’s primary care clinics was associated with lower screening rates (odds ratio [OR], 0.63; 95% CI, 0.43−0.93). Patients with higher screening rates included those who had a greater number of primary care–related (nonspecialty) visits within 1 year (OR, 6.90; 95% CI, 6.04−7.88) and those who were part of the county-level medical assistance program (OR, 1.61; 95% CI, 1.40−1.84). Spatial analysis identified an area where the level of CRC screening was particularly low. Conclusion Distance to primary care and use of primary care were associated with screening. Priorities in targeted interventions should include identifying and inviting patients with limited care engagements.

The impact of driving time on participation in colorectal cancer screening with sigmoidoscopy and faecal immunochemical blood test

“…However, no linear trend emerged [20]. In Texas, lower CRC screening uptake was observed at driving distance of more than 20 miles to the nearest primary care unit [25]. In Utah and Oregon, rural vs. urban residence was more determining for participation than a long vs. short travel distance to the closest endoscopic facility [6,19].…”

Area-Level Determinants in Colorectal Cancer Spatial Clustering Studies: A Systematic Review

“…Other social aspects such as adherence to the existing CRC screening program may provide insight to explain the existence of a local cluster pattern [ 66 , 67 ]. A high-incidence area for CRC can be due to large uptake of CRC screening by the people, indicating good health awareness [ 68 ].…”

Disparities in Treatment Satisfaction and Supportive Care Receipt for Young Adult Oncology Patients on the Basis of Residential Location

“…38 RUCC classification was used over Rural-Urban Commuting Areas and Index of Relative Rurality on the basis of its equitable distribution of patients across the rural-urban interface and consistently defined rural boundaries. 39 Using cutoffs defined in previous literature, [40][41][42][43][44] we identified YAs living 0-20 miles from UWCCC as local and those living . 20 miles from UWCCC as distant.…”