The impact of socioeconomic deprivation on the uptake of colorectal cancer screening in London

Abstract

Objective Screening programmes based on the faecal occult blood test (FOBT) can reduce mortality from colorectal cancer (CRC). However, a significant variation exists in uptake of the test within the UK. Disproportionate uptake risks increasing inequity during staging at diagnosis and survival from CRC. This study aims to evaluate the impact of socioeconomic deprivation on the uptake of CRC screening (FOBT) in London. Methods A retrospective review of the “Vanguard RM Informatics” database was performed to identify eligible individuals for CRC screening across all general practices across London over 30 months (2014–2017). The postcodes of the general practices were used to obtain the deprivation data via the “Indices of Deprivation” database. A Spearman’s rho correlation was performed to quantify the impact of the deprivation variables on FOBT uptake. Results Overall, 697,402 individuals were eligible for screening across 1359 London general practices, within 5 Clinical Commissioning Groups (CCGs); 48.4% (range: 13%–74%) participated in CRC screening with the lowest participation rates in North West (46%) and North East (47%) London CCGs. All indices of deprivation had a significant correlation with the uptake of FOBT ( p < 0.01). Conclusion This is the largest study across London to date demonstrating a significant positive correlation between deprivation indices and FOBT uptake, highlighting areas of particular risk. Further studies are imperative to quantify the impact of deprivation on CRC morbidity and mortality, together with focused strategies to reduce socioeconomic inequalities in screening in these high risk areas.

Ethnic disparities in the uptake of colorectal cancer screening: An analysis of the West London population

“…This is particularly true for those of Bangladeshi and Pakistani heritage who have compliance rates of less than 35%. Previous work has shown that socioeconomic status in London, measured using the English indices of deprivation, is significantly associated with poor compliance [24]. The multivariate analysis here confirms the independent role of ethnicity, irrespective of socioeconomic status, on poor compliance in London.…”

“…The overall compliance rate in our West London population from 2012 to 2017 was low at 46.5%. This is lower than the compliance rate for England (52%) from 2010 to 2015 [8] and similar to, albeit slightly lower than, the compliance rate for London (48%) from 2014 to 2017 [24]. Our West London population is highly diverse, with 21.6% being ‘Asian’, 6.3% ‘Black’ and 19.4% ‘Other’ which may account for the lower than national average compliance rate seen.…”

“…London population too (Table 5) [24,26,34]. Studies and projects such as PEARL and ACE looked at interventions that might overcome barriers and improve uptake in the UK [35,36].…”

“…Patients from Black, Hispanic and Asian backgrounds report issues around embarrassment, not part of the culture, problems with psychosocial care, health information and their own ethnic remedies as being protective against cancer among reasons for poor compliance [32,33]. Analysis of factors such as age, gender and socioeconomic status or income are well‐studied independent prognostic factors determining screening uptake, which are observed in our West London population too (Table 5) [24,26,34]. Studies and projects such as PEARL and ACE looked at interventions that might overcome barriers and improve uptake in the UK [35,36].…”

Use of ColonFlag score for prioritisation of endoscopy in colorectal cancer

“… 19 This has multiple causes including cultural and health inequalities related to deprivation. 20 Optimal performance of ColonFlag requires prior engagement by the population to have had blood tests and serial results may be least accessible in those people who decline faecal testing. However, potentially the use of ColonFlag as a test in iron deficiency 12 or as part of routine hospital admissions in the CRC screening age group could assist both with early detection and reduction of the mortality associated with late presentation.…”