Abstract
BackgroundColorectal cancer (CRC) screening rates remain suboptimal, particularly in low-income and underserved populations. Mailed fecal immunochemical testing (FIT) may overcome common barriers to screening; however, the effect of mailed FIT kits may differ across important subpopulations. The goal of the current study was to examine sociodemographic and health-related factors that moderate the effect of an intervention of automated direct mail of FIT kits at health clinics serving low-income populations.MethodsThis study is a secondary analysis of the Strategies and Opportunities to Stop Colon Cancer in Priority Populations (STOP CRC) study, a cluster-randomized pragmatic trial to increase uptake of CRC screening in patients seen at federally qualified health centers. The intervention involved tools embedded in the electronic medical records to enable participating clinics to mail FIT kits and related materials to eligible participants. We examined the rate of FIT completion by potential moderating characteristics using electronic health record data supplemented by the American Community Survey and the Centers for Medicare & Medicaid Services Geographic Variation datasets, linked via geocoding to patients’ addresses. All patients aged 50–75 seen in participating health clinics who were eligible for CRC screening were included.ResultsAlthough not always statistically significant, we saw a consistent pattern of increased FIT return rates among intervention participants compared to control participants across all subgroups studied, with incidence rate ratios (IRRs) generally ranging from 1.25 to 1.50. FIT completion in the intervention group ranged from 15 and 20% across subpopulations, typically three to six percentage points higher than the control group participants. The only moderator with a statistically significant interaction was race: persons of Asian descent showed a twofold response to the intervention (adjusted incidence rate ratio [aIRR] = 2.06, 95% confidence interval 1.41 to 3.00).ConclusionsResponse to a mailed FIT intervention was generally consistent across a wide range of individual and neighborhood-level patient characteristics, including typically underserved patients and those in low-resource communities.Trial registrationClinicalTrials.gov, NCT01742065. Registered on 5 December 2012.
Highlights
Colorectal cancer (CRC) screening rates remain suboptimal, in low-income and underserved populations
A microsimulation model estimated that annual fecal immunochemical testing (FIT) among adults aged 50 to 75 would result in 244 life-years gained per 1000 persons, and other CRC screening methods showed similar levels of benefit [5]
We explored individual characteristics, identified from the electronic health record (EHR) and related administrative data, including age, gender, race, Hispanic ancestry, primary language, federal poverty level category, insurance status, body mass index (BMI), smoking status, whether the participant had a flu shot in the year prior to randomization, whether the participant was current on Pap test and mammography screening, number of Charlson comorbidities [28], and whether they had a visit for diabetes, depression, or a chronic pulmonary condition in the year prior to their enrollment date
Summary
Colorectal cancer (CRC) screening rates remain suboptimal, in low-income and underserved populations. The goal of the current study was to examine sociodemographic and health-related factors that moderate the effect of an intervention of automated direct mail of FIT kits at health clinics serving low-income populations. A microsimulation model estimated that annual fecal immunochemical testing (FIT) among adults aged 50 to 75 would result in 244 life-years gained per 1000 persons, and other CRC screening methods (e.g., periodic sigmoidoscopy and colonoscopy) showed similar levels of benefit [5]. According to the National Health Interview Survey, CRC screening rates are lower for those with low income, lack of health insurance, low education levels, who lack a source of regular medical care, or who are recent immigrants [8]. CRC screening is associated with a number of health-related factors, such as the presence of medical conditions [10,11,12,13] and utilization of other preventive health services [10, 12]
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