A retrospective analysis of the impact of socioeconomic deprivation on the uptake of colorectal cancer screening


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Nikhil Pawa1,Nikhil Lal1,Paul Sullivan2,Azeem Majeed3
1University of Liverpool,2Chelsea and Westminster Hospital,3Imperial College, London

Abstract

Background

Screening programmes based on the faecal occult blood test (FOB) have demonstrated a significant reduction in mortality for colorectal cancer (CRC). However, a significant variation exists in the uptake of the Bowel Cancer Screening Programme within the United Kingdom. Disproportionate uptake risks increasing socioeconomic inequality during staging at diagnosis and survival from CRC. This study aims to evaluate the impact of socioeconomic deprivation on the uptake of CRC screening (FOB) in an unselected population in London.

Method

A retrospective review of the “Vanguard RM Informatics” database was performed to identify eligible individuals for CRC screening across all general practices across London over 2.5 years (2014-2017). The postcodes of the general practices were used to obtain the deprivation data such as the index of multiple deprivation rank (IMDR), income rank (IR), employment rank (ER), education and skills rank (ESR), and health and disability rank (HDR), via the “Indices of Deprivation” database. A Spearman’s rho correlation was performed to quantify the impact of the deprivation variables on FOB uptake.

Results

Overall, 697020 individuals were eligible for screening across 1359 general practices, with a median number of eligible individuals 421 and 192 participating. From this total, 48.4%(range: 0%-74%) participated in CRC screening. The correlation results have been summarised in table 1.

Table 1- Spearman's rank correlation of deprivation indices against compliance

Spearman’s rho

Correlation Coefficient

P value

IMDR vs FOB Uptake

0.525

<0.001

IR vs FOB Uptake

0.457

<0.001

ER vs FOB Uptake

0.426

<0.001

ESR vs FOB Uptake

0.309

<0.001

HDR vs FOB Uptake

0.449

<0.001

Conclusion

This is the largest study to date demonstrating a significant correlation between deprivation indices and compliance with the Bowel Cancer Screening programme. Further collaborative studies are imperative to quantify the impact of deprivation, together with specific strategies to reduce socioeconomic inequalities in CRC screening.