Sociogeographical factors associated with participation in colorectal cancer screening

Construction of an individual socioeconomic status index for analysing inequalities in colorectal cancer screening

OBJECTIVE

To construct an individual socioeconomic status index (ISESI) with information available in the Population Information System of the Region of Valencia, Spain, and use it to analyse inequalities in a colorectal cancer screening programme (CRCSP).

METHODS

Cross-sectional study of men and women aged between 50 and 75 at the time of the study (2020) that were selected from the target population of the Region of Valencia CRCSP. (study sample 1,150,684). First, a multiple correspondence analysis was performed to aggregate information from the Population Information System of the Region of Valencia into an ISESI. Second, data from the 2016 Region of Valencia Health Survey were used for validation, and finally the relationship between CRCSP participation and the ISESI was analysed by logistic regression models.

RESULTS

The variables included in the index were nationality, employment status, disability, healthcare coverage, risk of vulnerability and family size. The most important categories for determining the highest socioeconomic status were being employed and not being at risk of social vulnerability, and being unemployed and at risk of social vulnerability for determining the lowest socioeconomic status. Index validation demonstrated internal and external coherence for measuring socioeconomic status. The relationship between CRCSP participation and the ISESI categorised by quartile (Q) showed that Q4 (the lowest socioeconomic status) was less likely to participate OR = 0.769 (0.757-0.782) than Q1 (the highest socioeconomic status), and the opposite was found for Q2 OR = 1.368 (1.347-1.390) and Q3 OR = 1.156 (1.137-1.175).

CONCLUSIONS

An ISESI was constructed and validated using Population Information System data and made it possible to evaluate inequalities in colorectal cancer screening.

Colorectal cancer incidence and survival inequalities among labour immigrants in Belgium during 2004-2013

Colorectal cancer (CRC) is one of the leading causes of cancer-related morbidity and mortality. We aim to map out differences in CRC incidence and survival between first-generation traditional labour immigrants of Italian, Turkish and Moroccan descent and native Belgians; and assess the contribution of socioeconomic position (SEP) to these differences. Individually-linked data of the 2001 Belgian Census, the Crossroads Bank for Social Security and the Belgian Cancer Registry are used. Age-standardized incidence rates and incidence rate ratios are calculated by country of origin, with and without adjusting for SEP. For CRC patients, 5-year relative survival rates and the relative excess risk for dying within five years after diagnosis are calculated by migrant origin. Lower CRC incidence was observed among immigrants compared to native Belgians, in particular among non-Western immigrants, which could not be explained by SEP. Survival inequalities were less clear, yet, after adjusting for age and stage at diagnosis and educational attainment, we observed a survival advantage among Turkish and Italian immigrant men. Health gains can be made for the native population by adapting lifestyle. The later stage at diagnosis for immigrants is of concern. Barriers regarding screening as perceived by the vulnerable groups should be identified.

Health educational background as a predictor of non-participation in national colorectal cancer screening: A cross-sectional population study among 886,088 invited Danes

Health information knowledge may affect attitude toward colorectal cancer screening, but the participation of health educated citizens are unknown. Therefore, we investigated non-participation in a sample of 886,088 invited participants, based on educational length, type, and level. Logistic regression analyses were conducted to estimate the odds of non-participation in Danish men and women based on educational type and length. Models were adjusted for age, income, marital status and immigration status. Information was derived from National registers. Men with long educational length level had increased odds of non-participation if their education was within the field of medicine/medical science (OR 1.87) or belonged to other long health educations, but not in nursing and health care, compared to other long educations after full model adjustment. Women with long educational length level had increased odds of non-participation if they were educated in the field of medicine/medical science (OR 1.47), whereas they had decreased odds in the fields of nursing and health care and other long health educations, compared to other long educations after full model adjustment. Men within short educational length level did not have different odds of nonparticipation, after full model adjustments, whereas women within short health educations were at increased odds in the youngest age group and at decreased odds in the eldest age group. Having an education in the field of medicine/medical science is associated with non-participation in colorectal cancer screening in Denmark 2014-2015. Opposite, an educational background in nursing and health care increased participation in women, but not in men.

The effects of reminders for colorectal cancer screening: participation and inequality

PURPOSE

To investigate the effect of sending out reminders for colorectal cancer screening on socioeconomic and demographic inequalities in screening uptake.

METHODS

All citizens aged 50-74 in Denmark are invited every 2 years for colorectal cancer screening. Non-participants receive an electronically distributed reminder. Data for these analyses were derived from national registers. Socioeconomic status was measured by income and educational level. Demographic variables included age, gender and marital status, and the analyses were stratified by immigration status. Logistic regression analyses were conducted to estimate the odds of non-participation for invited citizens and for reminded citizens divided by socioeconomic and demographic predictors.

RESULTS

Of 763,511 native Danes invited for screening from 2014 to 2015, 387,116 (50.70%) participated after the initial invitation and 133,470 after receiving a reminder. Differences in participation were present in relation to all subgroups among both the invited citizens and reminded citizens. Differences persisted after full model adjustments with reductions for demographic variables. Odds ratio (OR) for non-participation in the eldest age group was 0.32 (95% CI, 0.32; 0.33) before and 1.11 (95% CI 1, 0.08; 1.14) after the reminder, compared to those under 55 years. OR for the 4th income quartile was 0.54 (95% CI, 0.53; 0.55) before and 0.44 (95% CI, 0.43; 0.45) after the reminder, compared to 1st quartile.

CONCLUSIONS

Reminders increased the overall participation, and the inequalities in participation in relation to demographic factors were reduced after the distribution of reminders. The age differences were especially reduced. The inequalities in participation related to socioeconomic status were, however, slightly increased after reminder distribution.

Sociodemographic predictors of participation in colorectal cancer screening

PURPOSE

Colorectal cancer screening by inviting citizens to complete a test for blood in faeces was initiated in Denmark in 2014. We have examined sociodemographic predictors that influence participation to identify factors that could be targeted to increase compliance.

METHODS

National registers were used to link data on invitations for colorectal cancer screening in Denmark from 2014 to 2015. Region of residence, age, gender, immigration status, income, educational level and marital status were identified. Logistic regression analysis was used to estimate the risk of non-participation for invited citizens while adjusting for all other sociodemographic variables.

RESULTS

A total of 854,237 individuals were included in the analysis. The national participation proportion was 65.33%, with significant differences between sociodemographic groups. Participation proportions were the lowest in non-Western immigrants (53.00%), individuals without a partner (54.05%) and those in the lowest income quartile (54.65%), with subgroup participation as low as 40.56%. The highest participation proportion was seen in individuals in the highest income quartile (71.56%). Region of residence, age, gender, educational level, income quartile, marital status and immigration status all had statistically significant independent differences in risk of non-participation after full model adjustment.

CONCLUSION

Participation in colorectal cancer screening was high in Denmark in 2014 and 2015. Large differences in participation were seen between sociodemographic subgroups, potentially resulting in social inequality in the benefits from screening. Future efforts to increase participation should focus on the low compliance subgroups, such as singles, non-Western immigrants and people from the lowest socioeconomic groups.

Patterns of participation over four rounds of annual fecal immunochemical test-based screening for colorectal cancer: what predicts rescreening?

BACKGROUND

Participation at the recommended intervals is critical for screening to be effective in reducing colorectal cancer (CRC) incidence. This study describes patterns of screening participation over four rounds of fecal immunochemical testing (FIT) to identify whether demographic variables and prior screening satisfaction are significantly associated with patterns of re-participation.

METHODS

Baseline surveys were mailed to 4000 South Australians randomly selected from the electoral-roll. Respondents (n = 1928/48.2%) were offered four annual FIT rounds. Screening participation and satisfaction at each round were recorded.

RESULTS

Study participation was 58.5, 66.9, 73.1 and 71.4% respectively over four rounds. Three participation patterns were described: consistent participation (43.1%), consistent non-participation (26.4%) and inconsistent participation (changeable; 30.5%), including intermittent and sustained change patterns. Sustained change described those who changed participatory behavior and then maintained for at least two rounds (n = 375/19.5%). Older people, and those not working were most likely to sustain participation. Younger invitees, especially men, were more likely to change participatory behavior and sustain the change. People with higher disadvantage, less education, not working and with no prior (pre-trial) screening experience were more likely to start participating and drop out. People dissatisfied with a prior screening test, including finding aspects embarrassing or unpleasant, were also more likely not to participate in annual screening or to drop out.

CONCLUSIONS

The findings identify those at risk of non- or inconsistent participation in rescreening. They should aid targeting of interventions for demographic groups at risk and ensuring screening experiences are not perceived as unpleasant or difficult.

Behavioural and demographic predictors of adherence to three consecutive faecal occult blood test screening opportunities: a population study

Background

Social cognitive variables are often examined for their association with initial participation in colorectal cancer screening. Few studies have examined the association of these variables with adherence to multiple screening offers i.e., rescreening. This study aimed to describe patterns of participatory behaviour after three rounds of screening using faecal immunochemical tests (FIT) and to determine social cognitive, demographic and background variables predictive of variations in adherence.

Methods

Participants were 1,540 men and women aged 50 to 75 living in South Australia who completed a behavioural survey measuring demographic (for example, age, gender) and social cognitive variables relevant to FIT screening (for example, perceived barriers, benefits, self-efficacy). The survey was followed by three, free FIT screening offers mailed on an annual basis from 2008 to 2010. Patterns of participation after three screening rounds were described as one of five screening behaviours; 1) consistent re-participation (adherent with all screening rounds), 2) consistent refusal (adherent with no screening rounds), 3) drop out (adherent with earlier but not later rounds), 4) intermittent re-participation (adherent with alternate rounds) and 5) delayed entry (adherent with later but not initial round(s)). Univariate (Chi Square and Analysis of Variance) and multivariate (Generalised Estimating Equations) analyses were conducted to determine variables predictive of each category of non-adherence (those that did not participate in every screening offer, groups 2, 3, 4 and 5) relative to consistent re-participation.

Results

Significant social cognitive predictors of non-adherence were; less self-efficacy (drop out and consistent refusal), greater perceived barriers (drop out) and lower levels of response efficacy (consistent refusal). Demographic predictors of non-adherence included; male gender (delayed entry), younger age (intermittent, delayed and consistent refusal), less frequent GP visits (intermittent re-participation) and 'ancillary only' private health insurance (drop out). Less satisfaction with screening at baseline predicted drop out, consistent refusal and delayed entry.

Conclusions

Different combinations of demographic and behavioural variables predicted different patterns of rescreening adherence. Rescreening interventions may benefit from a targeted approach that considers the different needs of the population subgroups. Satisfaction with past FOBT screening measured prior to the study screening offers was an important predictor of adherence.

Characteristics of French people using organised colorectal cancer screening. Analysis of the 2010 French Health, Healthcare and Insurance Survey

OBJECTIVE

To analyse relationships between socio-demographic characteristics, healthcare access, and behaviour with regard to participation in organised colorectal cancer (CRC) screening.

METHODS

We analysed a subset of 2,276 individuals from a cross-sectional population-based survey of French households in 2010. The outcome was participation in CRC screening using multiple logistic regression. The studied variables included socio-demographic characteristics, healthcare access-related variables, and health or perceived health.

RESULTS

Age, living in a pilot district for CRC screening, and having a private additional insurance were associated with participation in CRC screening for both genders. In men, other characteristics were associated: not having 100% coverage for medical fees for a long-term disease, having consulted a medical specialist in the last 12 months, and not smoking. In women, other cancer screening behaviours were associated with participation in CRC screening. Results also showed that 81.4% of individuals, who did not have a Hemoccult® test, consulted a GP in the last 12 months.

CONCLUSIONS

Despite efforts made, results confirmed that CRC screening differed among socioeconomic groups. GPs should be encouraged to systematically recommend CRC screening to their patients fitting the criteria of the organised CRC screening programme and further investigation is required to optimise information strategies targeting GPs.

Screening for colorectal cancer: how can we maximize uptake?

SUMMARY Screening for colorectal cancer is being introduced in a number of countries, yet uptake remains low. The rationalistic model of screening participation explains low uptake in terms of deficient knowledge and high cost. There is evidence to support this view and remedial actions produce anticipated effects up to a point. However, differential uptake among specific groups suggests that the individual decision to participate in screening is idiosyncratic, and understanding decisions requires interpretation in terms of message framing, reference points, the use of simplifying heuristics and affective or emotional reaction. As these aspects of decisions originate from fundamental personal characteristics, they may be difficult to combat. When decision determinants, such as fear and herding, are manipulated, consequences for uptake can be contradictory.

Socioeconomic factors affecting colorectal, breast and cervical cancer screening in an Asian urban low-income setting at baseline and post-intervention

BACKGROUND

Inequalities in cancer screening are little studied in Asian societies. We determined whether area and individual measures of socio-economic status (SES) affected cancer screening participation in Singapore and prospectively evaluated an access-enhancing community-based intervention.

METHODS

The study population involved all residents aged >40 years in two housing estates comprising of owner-occupied (high-SES area) and rental (low-SES area) flats. From 2009 to 2011, non-adherents to regular screening for colorectal/breast/cervical cancer were offered free convenient screening over six months. Pre- and post-intervention screening rates were compared with McNemar's test. Multi-level logistic regression identified factors of regular screening at baseline; Cox regression analysis identified predictors of screening post-intervention.

RESULTS

Participation was 78.2% (1081/1383). In the low-SES area, 7.7% (33/427), 20.4% (44/216), and 14.3% (46/321) had regular colorectal, cervical and breast cancer screening respectively. Post-intervention, screening rates in the low-SES area rose significantly to 19.0% (81/427), 25.4% (55/216), and 34.3% (74/216) respectively (p<0.001). Area SES was more consistently associated with screening than individual SES at baseline. Post-intervention, for colorectal cancer screening, those with higher education were more likely to attend (p=0.004); for female cancer screening, the higher-income were less likely to attend (p=0.032).

CONCLUSIONS

Access-enhancing community-based interventions improve participation among disadvantaged strata of Asian societies.