American Indian/Alaska native access to colorectal cancer screening: Does gastroenterologist density matter?

Abstract

BackgroundAmerican Indians/Alaska Natives (AI/AN) receive less colorectal cancer (CRC) screening than other populations. Using gastroenterologist (GI) locations as a measure of colonoscopy access, we correlate GI density and AI/AN CRC screening rates. MethodsWe identified GIs from the 2016 National Provider Identifier registry, and calculated GI density per 100,000 people. We identified screening, demographic, and socioeconomic variables from the 2016 Behavioral Risk Factor Surveillance System Survey. GI density and CRC screening rates were analyzed with Multivariable Poisson regression. ResultsIn states with GI Density greater than 3.98/100,000, odds of AI/AN CRC screening are 1.27–1.37 times higher than in states below this threshold (p < 0.036). ConclusionsGI density has a limited association on CRC screening, with decrease impact beyond threshold of 3.98 GI/100,000. Minimal access to GIs is important in improving AI/AN CRC screening; however, further research is required to elucidate the most critical factors contributing to CRC screening.