Gut Liver.  2015 Jul;9(4):502-508. 10.5009/gnl14039.

Screening Colonoscopy among Uninsured and Underinsured Urban Minorities

• Collazo TH
• Jandorf L
• Thelemaque L
• Lee K
• Itzkowitz

• KMID: 2160634
• DOI: http://doi.org/10.5009/gnl14039

Abstract

BACKGROUND/AIMS
Uninsured individuals have lower rates of screening colonoscopy (SC), and little is known regarding the pathology results obtained when they undergo colonoscopies. Since 2004, we have participated in a program that offers SC to uninsured New Yorkers; herein, we report our findings.
METHODS
Uninsured, average-risk patients who were at least 50 years of age underwent SC at our institution between April 2004 and June 2011. We analyzed polyp pathology, location, size, incidence of adenomas, and incidence of adenomas with advanced pathology (AAP) with respect to ethnicity, gender, and age.
RESULTS
Out of 493 referrals, 222 patients completed the colonoscopies. Polyps were identified in 21.2% of all patients; 14% had adenomas, and 4.5% had AAP. The rates of adenomas among African-Americans, Hispanics, and Whites were 24.3%, 12.1%, and 11.6%, respectively, and the corresponding rates of AAP were 10.8%, 3.5%, and 2.3%. Differences in the polyp type, location, and AAP did not reach statistical significance with respect to ethnicity or gender. Patients aged 60 and older were found to have a higher rate of advanced adenomas compared with younger patients (8.6% vs 2.6%, p=0.047).
CONCLUSIONS
Further efforts to fund screening colonoscopies for uninsured individuals will likely result in the identification of advanced lesions of the colon before they progress to colorectal cancer.

Keyword

Colonoscopy; Adenoma; Medically uninsured; Patient navigator; Minorities

MeSH Terms

Adenoma/diagnosis/epidemiology
African Americans/statistics & numerical data
Age Factors
Aged
Colon/pathology
Colonic Neoplasms/diagnosis/epidemiology
Colonic Polyps/diagnosis/epidemiology
Colonoscopy/*statistics & numerical data
European Continental Ancestry Group/statistics & numerical data
Female
Hispanic Americans/statistics & numerical data
Humans
Incidence
Male
Mass Screening/*statistics & numerical data
Medically Uninsured/*statistics & numerical data
Middle Aged
Minority Groups/*statistics & numerical data
New York City/epidemiology
Program Evaluation
*Urban Population