eP592 - Unveiling the Urban Divide: A Single Institution Analysis of Colorectal Cancer Screening and Stage at Presentation Using Area Deprivation Index

Purpose/Background: In Massachusetts, the majority of colorectal cancers are diagnosed at advanced stages. Widespread screening is essential for prevention and early diagnosis, but disparities exist. Area deprivation index (ADI) is a validated comprehensive assessment of the social determinants of health using indicators from the US Census block group data reported as a composite score. The higher the ADI the more underserved the area. This study examines whether subpopulation differences in colorectal cancer screening and stage at presentation exist in relation to ADI scoring for patients receiving surgical intervention at a single institution.Methods/Interventions: Targeted National Surgical Quality Improvement Program (NSQIP) database was used to extract data from January 2015 to December 2019. This retrospective study focused on patients who underwent surgical intervention following a first-time diagnosis of primary colorectal cancer. Exclusions were made for non-primary cancer, benign conditions, metachronous lesions, and patients for whom ADI calculations were not feasible. Electronic health records were accessed to determine screening status and the stage of presentation. Subsequently, patients were categorized into quintiles based on their ADI scores. The primary objective of the study was to investigate whether a higher ADI score correlated with lower colonoscopy screening rates at the time of diagnosis and a higher stage at presentation.Results/Outcomes: Of the 483 patients included who underwent an elective resection for colorectal cancer, there were no significant differences between the low ADI quintiles (1-3) and high ADI quintiles (4-5) in baseline demographics including sex, age at diagnosis, race, and insurance payor status. The majority of patients (n=248, 51.3%) received a prior screening colonoscopy, 198 (41.0%) did not receive a colonoscopy, and 37 (7.7%) were of unknown status. Of those who received a screening exam 32.7% were from low ADI quintiles and 67.3% were from high ADI quintiles. Of those with no prior screening at the time of diagnosis, 28% were from low ADI quintiles and 71.7% from high ADI quintiles. The majority of patients presented with Stage 3 disease (n=177, 36.6%) as compared to other stages ( Stage 1: n= 136, 28.2%; Stage 2: n=136, 28.2%; Stage 4: n=34, 7%). Of those with Stage 1 or 2 disease, 30.9% were from low ADI quintiles and 69.1% were from high ADI quintiles. Of those with stage 3, 30.5% were from low ADI and 69.5% from high ADI. Of those with stage 4, 29.4% were from low ADI and 70.6% from high ADI. There were no significant differences between low vs high ADI quintiles and colorectal cancer screening or stage at diagnosis. However, the trend for both cancer screening and stage at diagnosis showed that higher ADI is correlated with lower screening rates and a later stage at diagnosis.Conclusion/

Discussion: In this single institution study, the majority of patients came from disadvantaged areas. Despite this, over half of patients had received prior colonoscopy screening and there were no significant differences in screening status or stage of presentation.The study had sufficient statistical power to detect large differences, but it lacked the power to detect minor variations. Although we cannot reliably state that ADI is a strong predictor of colorectal cancer screening status or stage at presentation, the trends may inform targeted interventions aimed to improve care and narrow the gap in access and presentation. Table 1: Descriptive Statistics of Cohort Variables According to Low and High Quintiles of Area Deprivation Index