Odds of Incomplete Colonoscopy in Colorectal Cancer Screening Based on Socioeconomic Status

Birgitte Skau,Gunnar Baatrup,Ulrik Deding,Lasse Kaalby,Issam Al-Najami,Morten Kobaek-Larsen

doi:10.3390/diagnostics12010171

Birgitte Skau, Gunnar Baatrup + Show 4 more

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https://doi.org/10.3390/diagnostics12010171

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Abstract

The aim of this study is to investigate the association between socioeconomic status (SES) and the risk of having an incomplete colonoscopy (IC) in the Danish Colorectal Cancer (CRC) Screening Program. In this register-based study we included 71,973 participants who underwent colonoscopy after a positive fecal immunochemical test in the Danish CRC Screening Program. The main exposure, SES, was defined by income and education, and the outcome by complete or incomplete colonoscopy. Among the participants, 5428 (7.5%) had an incomplete colonoscopy. The odds ratio (OR) for ICs due to inadequate bowel preparation was 1.67 (95% CI: 1.46; 1.91) for income in the 1 quartile compared to income in the 4th quartile. ORs for income in the 2nd quartile was 1.38 (95% CI: 1.21; 1.56) and 1.17 (95% CI: 1.03; 1.33) for income in the 3rd quartile. For the educational level, an association was seen for high school/vocational education with an OR of 0.87 (95% CI: 0.79; 0.97) compared to higher education. For ICs due to other reasons, the level of income was associated with the risk of having an IC with an OR of 1.19 (95% CI: 1.05; 1.35) in the 1st quartile and an OR of 1.19 (95% CI: 1.06; 1.34) in the 2nd quartile. For the educational level, there were no significant associations. Low income is associated with high risk of having an IC, whereas educational level does not show the same unambiguous association.

Highlights

Colorectal cancer screening (CRC) has been implemented in numerous countries worldwide and often consists of a fecal immunochemical test (FIT) followed by colonoscopy [1].In the Danish CRC Screening Program, a colonoscopy is considered incomplete when the caecum is not reached, or when the colonic mucosa is not sufficiently visible in all segments [2]
We excluded 5550 (6.4%) participants where no registration had been made on outcome of the colonoscopy, and 446 (0.5%) participants with no cause stated for the incomplete colonoscopy
Lower income quartiles were associated with increased odds of incomplete colonoscopies (IC) due to poor bowel preparation for first round participants in the Danish CRC Screening Program

Summary

Introduction

Colorectal cancer screening (CRC) has been implemented in numerous countries worldwide and often consists of a fecal immunochemical test (FIT) followed by colonoscopy [1]. In the Danish CRC Screening Program, a colonoscopy is considered incomplete when the caecum is not reached, or when the colonic mucosa is not sufficiently visible in all segments [2]. There are multiple known risk factors for incomplete colonoscopies (IC), such as gender [4,5,6,7] and low BMI [4,6,8]. Comorbidity and medication are commonly reported reasons for poor bowel preparation. Franco et al stated that patients suffering from diabetes, patients having undergone abdominal and especially pelvic surgery, or patients taking certain medications, such as opioids, tricyclic medicine and other antidepressants, have an increased risk of poor bowel preparation [4]

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