Uptake of colorectal cancer screening among Ontarians with intellectual and developmental disabilities.

Hélène Ouellette-Kuntz,Helen Coo,Andrew S Wilton,Virginie Cobigo,Hajo Zeeb

doi:10.1371/journal.pone.0118023

Abstract

Under-screening for cancer may contribute to a greater disease burden in individuals with intellectual and developmental disabilities (IDD) as their life expectancy increases. In 2008, the province of Ontario launched Canada’s first population-based colorectal cancer screening program. Our objectives were to compare the proportions of Ontarians with and without IDD who have undergone colorectal cancer screening and to examine factors associated with screening uptake among Ontarians with IDD. Records for Ontario residents 50–64 years of age were linked across various administrative health and social services datasets to identify individuals with IDD and to select a random sample of the age-equivalent Ontario population without IDD as a comparison group. Logistic regression models were fit to examine the odds of screening uptake among individuals with IDD while controlling for age, sex, urban or rural residence, neighbourhood income quintile, expected use of health care resources, and being enrolled with or seeing a physician in a patient enrolment model (any of several primary care practice models designed to improve patient access and quality of care in Ontario), and to examine the association between these variables and colorectal cancer screening in the IDD population. The odds of having had a fecal occult blood test in the previous two years and being up-to-date with colorectal tests were 32% and 46% lower, respectively, for Ontarians with IDD compared to those without IDD. Being older, female, having a greater expected use of health care resources, and being enrolled with or seeing a physician in a primary care patient enrolment model were all significantly associated with higher odds of having been screened for colorectal cancer in the IDD population. These findings underscore the need for targeted interventions aimed at making colorectal cancer screening more equitable.

Highlights

Colorectal cancer is the third most common cancer diagnosed in Canada and the second and third leading cause of cancer deaths among Canadian men and women, respectively [1]
With the exception of those who work in Community Health Centres and Health Services Organizations [13], physicians compensated through alternative payment plans are required to submit shadow billings to Ontario Health Insurance Plan (OHIP)
The absolute difference between the groups in the “up-to-date with colorectal tests” indicator was larger, at 15.2% (Table 2). While these absolute differences do not take into account the unequal distribution between the groups of characteristics that may be associated with screening participation, Ontarians with intellectual and developmental disabilities (IDD) were still significantly less likely to have participated in colorectal cancer screening after controlling for various sociodemographic and health care utilization characteristics (Table 2)

Summary

Introduction

Colorectal cancer is the third most common cancer diagnosed in Canada and the second and third leading cause of cancer deaths among Canadian men and women, respectively [1]. Removal of adenomatous polyps has been shown to reduce its incidence by 76% to 90% [2]; colorectal cancer presents an ideal target for early detection and prevention through screening [3]. In 2008, the province of Ontario instituted the first population-based colorectal cancer screening program in Canada. At the time of this writing, biennial screening using the guaiac fecal occult blood test (FOBT) is recommended for individuals 50 to 74 years of age at average risk of colorectal cancer, followed by colonoscopy for those with an abnormal FOBT. For persons at increased risk because of a family history of the disease, colonoscopy is recommended beginning at age 50, or 10 years earlier than the age at which a first-degree relative was diagnosed with colorectal cancer, whichever occurs first [4]

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Discussion

Conclusion