S292 Socioeconomic Status: An Important Determinant for Follow-Up for Surveillance Colonoscopy After Endoscopic Mucosal Resection

Abstract

Introduction: Alabama had significantly higher incidence of colorectal cancer (CRC)at 43.5 compared to the US rate 39.5, and African Americans have higher rate of CRC compared to Caucasian individuals. There is compelling evidence that surveillance colonoscopy after high-risk adenoma polypectomy can reduce the risk of developing CRC.Our objective was to identify risk factors associated with poor follow up after undergoing colonoscopy with endoscopic mucosal resection (EMR). Methods: We performed retrospective chart review of patients who had EMR at our facility between June 2016-March 2022.Patient demographics, referral, procedural and census data were collected. Census data obtained was used to evaluate income, median household income, and educational attainment. Patients were divided into two groups; poor and good follow up. Poor follow up was defined as those who failed to follow up and/or presented for surveillance colonoscopy >1 month after the recommended timeframe. Results: Initial chart review included 520 eligible patients;73 were excluded due to lack of referral data, and 59 with recent EMR whose recommended surveillance colonoscopy has not passed. Of the included 388 patients, 293 (75.5%) had poor follow up and 95 (24.5%) had good follow up. Descriptive statistics of the various characteristics and comparisons of the of two groups is presented in Table. Compared to individuals with good follow up, there was a significant association of poor follow up with patients whose index colonoscopy was performed at an outside hospital (p=0.003) and if the index colonoscopy was their first colonoscopy (p=0.04). Additionally, census data revealed lower median home values were associated with poor follow up ($168,382) when compared to good follow up ($185,034). There was a trend to poor follow up in patients with obesity (80.5%), former alcohol use (88.9%), patients insured by Medicaid (88.9%), and minority populations including African American, and Hispanic/other ethnicities (77.1%,90.9%, respectively). Conclusion: Our study illustrates that social economic status has significant impact on surveillance colonoscopy after EMR, and outside hospital referral are more likely to have poor follow up compared to in house referrals. Given the potential impact this data has for reducing risk of developing CRC in lower social economic individuals, further studies are needed to validate this finding and stratify predictors of poor follow up. Table 1. - Descriptive characteristics and comparison of poora vs goodb follow up in patients who underwent EMR at UAB between June 2016-March 2022 Overall Follow-up p value N=388 Poor n=293 (75.5%) Good n=95 (24.5%) Age (years), mean (SD) 63 (10.4) 64 (10.4) 62 (10.4) 0.23c Sex Male 52.1% 75.3% 24.8% 0.89d Female 47.9% 75.8% 24.2% Race/Ethnicity Caucasian 67.8% 73.8% 26.2% 0.38d African American 28.1% 77.1% 22.9% Other 2.8% 90.9% 9.1% Type of insurance Private 45.9% 74.7% 25.3% 0.39d Medicare 47.4% 75.0% 25.0% Medicaid 4.6% 88.9% 11.1% Uninsured 2.1% 75.0% 25.0% BMI less than 24.9 – Underweight/ Normal 24.8% 72.8% 27.2% 0.11d between 25.0 and 29.9 – Overweight 32.4% 70.0% 30.0% more than 30.0 – Obese 42.9% 80.5% 19.5% ASA classification 1 0.8% 66.7% 33.3% 0.84d 2 60.2% 75.5% 24.5% 3 38.5% 75.8% 24.2% 4 0.5% 50.0% 50.0% Smoking Current 25.0% 76.3% 23.7% 0.79d Former 26.8% 73.1% 26.9% Never 47.7% 76.2% 23.8% Alcohol Current 46.1% 72.6% 27.4% 0.25d Former 6.9% 88.9% 11.1% Never 46.4% 76.1% 23.9% Drugs Current 3.4% 84.6% 15.4% 0.85d Former 4.4% 70.6% 29.4% Never 87.9% 75.4% 24.6% Employment Employed 29.9% 74.1% 25.9% 0.99d Unemployed 6.9% 74.1% 25.9% Retired 28.4% 75.5% 24.6% Disabled 10.1% 76.9% 23.1% First colonoscopy Yes 17.0% 75.8% 24.2% 0.04d* No 44.6% 69.9% 30.1% Outside Hospital Referral Yes 31.7% 86.2% 13.8% 0.003d* No 67.8% 70.7% 29.3% Time of procedure Morning 57.9% 72.9% 27.1% 0.16d Afternoon 42.0% 79.1% 20.9% ASA=American Society of Anesthesiologists; BMI=body mass index; EMR= endoscopic mucosal resection; SD=standard deviation; UAB=University of Alabama at Birmingham.*Statistically significant at 0.05 level (two-tailed test).aPoor follow up included patients that did not receive surveillance colonoscopy within recommended timeframe or patients who were lost to follow up.bGood follow up is defined as undergoing surveillance colonoscopy within the recommended timeframe.cUnpaired t-test.dChi-square test.