Social determinants of health: are colonoscopies always fit for duty?

OBJECTIVES

Colorectal cancer (CRC) screening rates continue to be low among safety-net populations. We sought to elucidate the impact of social determinants of health (SDOH) on the noncompletion of fecal immunochemical tests (FITs) and colonoscopies at the Providence Community Health Centers (PCHC).

STUDY

DESIGN

This was a retrospective cohort review of PCHC patients with associated SDOH profiles between December 1, 2018, and December 1, 2019.

METHODS

We analyzed fulfilled and unfulfilled CRC screening orders (FITs and colonoscopies) and examined associations and odds ratios between order noncompletion and the presence of SDOH variables. The study sample consisted of a total of 517 orders (fulfilled and unfulfilled; FIT, n = 348; colonoscopy, n = 169).

RESULTS

FITs were completed more often than colonoscopies (81.3% vs 65.7%, respectively; P < .001). Colonoscopy noncompletion was associated with patient-reported social determinants of "housing insecurity/homelessness" (P = .0083) and "living conditions" (P = .048) and staff-reported "behavioral health problem" (P = .048). The presence of housing insecurity/homelessness increased the likelihood of an unfulfilled colonoscopy order (odds ratio, 7.5; 95% CI, 1.3-75.0). Patients who reported any SDOH need had a statistically significant increase in colonoscopy noncompletion (P = .0022), whereas FIT noncompletion was not associated with the presence of SDOH needs (P = .81).

CONCLUSIONS

Providers should consider FITs as a strategic real-world modality for patients with SDOH needs.