Comparison of the Yield of Colonoscopy among Uninsured Patients Who Benefitted from the Free DC Screen for Life Program and Privately Insured Patients

Abstract

Purpose: Background: Low socioeconomic status is associated with an increased burden of colorectal cancer in the United States. The District of Columbia Cancer Consortium provided funding for the DC Screen for Life Program to educate 1,000 DC residents and provide free colorectal cancer screening for 600 uninsured or underinsured DC residents. Aim: To compare the prevalence of colorectal neoplasia among patients who underwent free colonoscopy through this program with privately insured patients who underwent colonoscopy as part of their routine care. Methods: We abstracted the data from the colonoscopy reports of 262 uninsured or underinsured patients who underwent colonoscopy in Howard University Hospital. We also identified 331 patients with private insurance who underwent colonoscopy as part of their routine clinical care. We used chi square and ranksum tests to compare categorical and continuous variables and used Poisson regression models to evaluate the association of insurance status with the yield of colorectal neoplasia. Results: The proportion of black patients among Screen for Life Program participants was comparable to insured patients (88.6% versus 84.6%; P value = 0.163) as well as the mean age (55.8 versus 57.1 years; P value = 0.174). However, there was a higher percentage of females among insured patients (46.2% versus 69.8%; P value < 0.001). The polyp detection rate and adenoma detection rate were significantly higher among uninsured and underinsured patients after adjusting for age, sex, and race-ethnicity (Table). Similar results were obtained among men and women.Table: The risk of colorectal neoplasia by insurance statusConclusion: Uninsured patients have a higher yield of colorectal neoplasia detection when compared to insured patients. Improved access to colorectal screening such as the DC Screen for Life program will be essential if colorectal cancer disparities are to be eliminated.