331 Predictors of Colonoscopy Use Among Asian Indians in New York City, 2003-2016

Abstract

INTRODUCTION: Asian Americans have the lowest colorectal cancer screening uptake of any racial/ethnic group in the United States. Among Asian Americans, Asian Indians appear to be particularly under-screened, although data for this population is limited. Our objective was to characterize temporal trends in predictors of up-to-date colonoscopy use among Asian Indians in New York City. METHODS: We analyzed data from Indian participants in the 2003-2016 New York City Community Health Survey (NYCCHS), an annual telephone-based health survey. A total of 496 participants aged 50 years or older were identified during the study period. We examined 4 consecutive time periods for factors associated with up-to-date colonoscopy use (defined as a colonoscopy within the last 10 years): 2003-2008, 2009-2012, 2013-2014, and 2015-2016. Age, sex, and any other variable with P < 0.10 on univariate analysis was entered into a multivariable model; stepwise backward selection was performed to create the final model. RESULTS: On univariate analysis, factors associated with up-to-date colonoscopy use in at least two time periods included greater time in the US, non-Manhattan borough of residence, having received a flu shot, and age older than 65 years. Home language other than English, foreign birthplace, and not having a primary care provider were associated with decreased colonoscopy uptake. On multivariable analysis, older age, non-Manhattan borough of residence, BMI 25-29.9, higher income, and having received a flu shot were positively associated with colonoscopy use while Indian language, unemployment, and being non-diabetic were negatively associated in at least one time period. Compared to English, Indian home language was the most consistent negative predictor of colonoscopy uptake (OR 0.12-0.32 from 2003-2014). CONCLUSION: In a large study of Asian Indians in NYC, home language—a measure of acculturation—was the most consistent predictor of up-to-date colonoscopy use. Well-characterized predictors of screening in the general population, including education and insurance status, were not significant factors in the Indian population. These findings suggest targeted intervention for less acculturated members of the Asian Indian community may be warranted, and further research in this under-screened population is needed.