QS143 - Socioecological Determinants of Health and the Quality of Colonoscopy in Rural Alabama

Sunday, June 2, 2024

4:31 PM – 4:34 PM ET, USA

Location: Room 327

Quick Shot Presenter(s)

NE

Nathan C. English, MBChB (he/him/his)

Resident
University of Cape Town, Department of General Surgery
University of Cape Town
Birmingham, AL, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.

Senior Author(s)

Daniel I. Chu, MD MSPH

Professor
University of Alabama at Birmingham
University of Alabama at Birmingham
Birmingham, Alabama, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.

Author(s)

BS

Burkely Smith, MD, MSPH

Resident
University of Alabama at Birmingham
Birmingham, Alabama, United States

Disclosure information not submitted.
Wendelyn M. Oslock, MD, MBA (she/her/hers)

General Surgery Resident
University of Alabama Birmingham Department of Surgery; Birmingham Veterans Affairs Medical Center
University of Alabama Birmingham
Birmingham, AL, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Bayley A. Jones, MD

Resident
University of Alabama at Birmingham Department of Surgery
Birmingham, AL, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Robert Hollis, MD MSPH

Assistant Professor
University of Alabama at Birmingham
University of Alabama at Birmingham
Birmingham, AL, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.
QG

Quince-Xhosa Gibson, MD, MBA

Assistant Professor
University of Alabama at Birmingham
Demopolis, Alabama, United States

Disclosure information not submitted.
MK

Manu Kaushik, MD

Assistant Professor
University of Alabama at Birmingham
Greenville, Alabama, United States

Disclosure information not submitted.
GK

Gregory D. Kennedy, MD, PhD (he/him/his)

Professor of Surgery
University of Alabama at Birmingham
University of Alabama at Birmingham
Vestavia, Alabama, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.
LW

Lauren Wood, MSPH

Data analyst
University of Alabama at Birmingham
Birmingham, Alabama, United States

Disclosure information not submitted.
AA

Abiha Abdullah, MBBS

Research Scholar
University of Pittsburgh, Trauma and Transfusion Medicine Research Center
Pittsburgh, Pennsylvania, United States

Disclosure information not submitted.
PG

Princy Gupta, MBBS

Research Scholar
Maulana Azad Medical College
New Delhi, Delhi, India

Disclosure information not submitted.

Purpose/Background: Rural patients have higher incidence and mortality of colorectal cancer (CRC). Ensuring high quality cancer screening is essential to address these disparities. We aimed to investigate whether various socioecological determinants of health (SEDOHs) are associated with the quality of CRC screening in rural Alabama.

Methods/Interventions: This is a retrospective review of prospectively collected data across three rural hospitals in Alabama: Demopolis, Alexander City and Greenville, from August 2021 to July 2023. We included adult patients (>18-years old) who underwent a colonoscopy and completed the SEDOH-88 (a previously validated 88-item survey that measures SEDOHs). After excluding patients with incomplete records (n=14), survey responses (n=84) were linked to standard quality metrics of colonoscopies including quality of bowel preparation (based upon the Aronchick scale: a composite of ‘excellent’, ‘good’, and ‘fair’ prep was considered “adequate”, while a composite of ‘poor’ and ‘inadequate’ prep was considered “inadequate”), successful cecal intubation, withdrawal time, and adenoma detection rate (ADR). Analyses were performed using the Chi-squared and Kruskal-Wallis Rank sum tests with a p< 0.05 considered statistically significant.

Results/Outcomes: Among 84 patients surveyed across all three sites, the median age was 64 (54.5-70) years, 65.6% (n=55) were male, and 50% (n=42) were Black. Adequate bowel prep was present in 88.1% (n=74), 89.3% (n=75) had successful cecal intubations, 50% (n=42) had a withdrawal time of >6 minutes, and the overall ADR was 45.8%. Among those with low quality metrics, patients with inadequate bowel prep had lower rates of internet access (60% vs. 87.4%, p=0.02), experienced more difficulty understanding written information (30% vs. 1.35%, p=0.002), more often required help reading hospital materials (30% vs. 2.7%, p=0.007) and lacked a sense of responsibility for their health (30% vs. 51.4%, p=0.01) when compared to those with adequate bowel prep. In addition, having an unsuccessful cecal intubation was associated with a lower employment rate (22.2% vs. 37.3%, p=0.035), fewer yearly-physician consults (88.9% vs. 100%, p=0.004), lower physician-trust (55.6% vs. 73.3%, p=0.04) and generally receiving poor customer service in their community (22.2% vs. 1.3%, p=0.01) when compared to those with successful cecal intubation. In contrast, patients with successful cecal intubation were more confident at preventing health related problems (53.3% vs. 33.3%, p=0.02) and had a more supportive social environment (72% vs. 66.7%, p=0.001) compared to those with unsuccessful cecal intubation. Similarly, we noted that patients with 0-polyps detected had better social support compared to those who had adenomas detected, as they were more likely to have someone available to talk to (80% vs. 57.9%, p=0.02), who understood their problems (77.8% vs. 52.6%, p=0.03) and had supportive neighbors in their community (64.4% vs. 42.1%, p=0.06).

Conclusion/Discussion: Several SEDOHs are associated with the quality of colonoscopies among rural patients in the Deep South. Lower health literacy, internet access, physician trust, and rates of employment were associated with low-quality colonoscopy, while having a supportive social environment and higher patient sense of responsibility was associated with higher-quality metrics. These findings provide novel targets for future equity focused interventions.