338 Factors Associated With Colonoscopy No-Show Among African Americans in an Urban Safety-Net Hospital

Abstract

INTRODUCTION: Colorectal cancer (CRC) is the most common cancer diagnosed in the United States, and the second leading cause of cancer-related deaths. The incidence and mortality rates of CRC in the United States have steadily declined over the past 10 years however, reductions have been strikingly much slower among African Americans (AA) who continue to have the highest mortality rate and lowest survival. Counterintuitively, AA reportedly have the highest rate of colonoscopy no-show (missed appointments). This study aimed to identify patient level factors and other characteristics that predict colonoscopy no-show in an urban safety net hospital. METHODS: We carried out a retrospective review of 161 electronic medical records (EMR) of patients scheduled for colonoscopy over a 2-week period in January 2017. We identified AA patients’ factors associated with colonoscopy appointment status (completed or missed) by using hierarchical multimodal regression. Patient factors examined include age, sex, race, residence, insurance status, substance abuse, psychiatric illness, comorbidities, positive FIT test, previous endoscopy, personal or family history of cancer. Microsoft Excel and STATA software were used for data management and analyses. Two-sided P-value < 0.05 was considered statistically significant. RESULTS: Majority (88.4%) of the patients were African American, 5.5% Caucasians, 4.9% Hispanic, 1.2% are from “other” race. The mean age was 59 years (SD 8.3), AA no-show rate was 43%. 46.7% were male and 53.3% were female, 8.9% were less than 50 years while 91.1% were >/= 50 years. Most patients (81.1%) were either unemployed or retired. 40.7% are uninsured, 9% were active substance abusers and 20% had a psychiatric illness. Patients on Medicaid were less likely to no-show when compared to the uninsured (P < 0.05). Substance abusers were 5-times more likely to no-show (P < 0.05). A personal history of cancer though not statistically significant was associated with reduced likelihood of no-show (P = 0.095) (data extraction is ongoing to increase sample size). CONCLUSION: Among African American patients, social and behavioral determinants of health are known to result in healthcare disparities. Increasing Medicaid funding and the use of a patient navigator for patients at high risk for no-show could reduce no-show rates, improve patient outcomes and reduce waste of resources associated with high no-show rates; and contribute to eliminating healthcare disparities.