Faculty Bibliography

INTRODUCTION: Screening for colorectal cancer (CRC) reduces incidence and mortality. Latinos are more likely to be diagnosed with late-stage CRC than non-Latino whites, a disparity that may be partially attributed to lower rates of screening among Latinos. New York City (NYC) has the fourth largest Latino population in the U.S., with Dominicans comprising the largest subgroup (41%). The current study examines predictors of up-to-date colonoscopy use among Dominicans using the NYC Community Health Survey (NYCCHS).
METHOD(S): The NYCCHS is an annual population-based telephone survey of New Yorkers aged 18 and older. We included all Dominicans aged 50 and older who participated in the survey from 2003-2016. The outcome of interest was up-to-date colonoscopy use, defined as having completed a colonoscopy within the past 10 years. To evaluate sociodemographic and medical predictors of colonoscopy uptake, we entered age, sex, and all factors with P< 0.10 on univariate analysis into multivariable models for each of four consecutive time periods: 2003-2008, T1; 2009-2012, T2; 2013-2014, T3; and 2015-2016, T4. The final models were determined using stepwise backward selection.
RESULT(S): Results for 3,237 Dominican participants are shown in Table 1. On multivariable analysis, two variables were significantly associated with colonoscopy use in three of the time periods: age >=65 (T1, T2, T4) and having received a flu vaccine in the prior year (T1, T3, T4). Two variables were significantly associated with colonoscopy uptake in two time periods: foreign birth (T1, T4) and longer duration of residence in the US (T2, T3). Variables associated with up-to-date colonoscopy use in only one time period included having a primary care provider (T2), being unemployed (T2), self-rated poor health status (T2), residence in Queens (T3), and not drinking sugar-sweetened beverages (T3).
CONCLUSION(S): Among Dominicans living in NYC, older age, foreign birthplace, longer duration of residence in the US, and receiving the flu vaccine were the most consistent factors associated with upto- date colonoscopy use. (Table Presented)

INTRODUCTION: Colorectal cancer (CRC) is a leading cause of cancer death among Hispanic Americans. Puerto Ricans are the second largest Hispanic subgroup in the United States and the largest in New York City, but little is known about predictors of CRC screening uptake in this population. We used the New York City Community Health Survey (NYCCHS), a population-based telephone survey, to investigate predictors of up-to-date colonoscopy use over time among Puerto Ricans aged >=50 in NYC.
METHOD(S): We assessed the association between sociodemographic and medical factors and up-to-date colonoscopy use (defined as colonoscopy in the last 10 years) over four time periods: 2003-2008, 2009-2012, 2013-2014, and 2015-2016.We entered age, sex, and any additional factors with P<0.10 on univariate analysis into a multivariable model and reached the final model for each period using stepwise backward selection.
RESULT(S): On univariate analysis, factors including age >=65, having a primary care provider, and receiving the flu shot were associated with colonoscopy use in the last 10 years. After adjusting for multiple sociodemographic and medical factors (Table 1), age >=65 [OR 1.41 (2003-2008), OR 1.76 (2013-2014), OR 1.82 (2015-2016)] and receiving the flu shot [OR 2.14 (2003-2008), OR 1.52 (2009- 2012), OR 1.95 (2013-2014), OR 1.62 (2015-2016)] were two factors positively associated with up-todate colonoscopy use over most time periods. Those without a primary care provider [OR 0.53 (2003- 2008), OR 0.38 (2013-2014)] were significantly less likely to have an up-to-date colonoscopy.
CONCLUSION(S): Older age, having a primary care provider, and receiving the flu shot are independent predictors of up-to-date colonoscopy use among Puerto Ricans in NYC. Targeted interventions to improve CRC screening should be considered for Puerto Ricans aged 50-64 and those who do not have a primary care provider. (Figure Presented)

INTRODUCTION: Screening decreases colorectal cancer (CRC) incidence and mortality, but uptake in the United States remains suboptimal at 62%. Prior studies have investigated the effect of various interventions on overall CRC screening and stool-based testing, but the effect on colonoscopy-the predominant screening test in the US-has not been fully examined. We performed a systematic review and meta-analysis to assess the effect of behavioral interventions on screening colonoscopy uptake.
METHOD(S): We searched PubMed, EMBASE, and Cochrane databases through June 2018 for controlled trials that assessed the effect of behavioral interventions on screening colonoscopy rates. Our search yielded a total of 6,952 titles. All abstracts and articles were screened by at least two independent reviewers and 54 manuscripts were selected for review. Relative risk estimates were extracted from the original article or calculated from the raw data. The primary outcome was the relative increase in screening colonoscopy completion with any behavioral intervention. Subgroup analysis by type of intervention was also performed. Random effects meta-analysis was performed using Stata.
RESULT(S): A total of 21 studies with 24 behavioral interventions were analyzed. The most common interventions were patient navigation (n=8), a combination of multiple interventions (n=7), and educational interventions (n=4). Overall, behavioral interventions increased colonoscopy completion by 58% compared to controls (OR 1.58, 95% CI 1.33-1.88, Figure). Patient navigation (OR 1.80, 95% CI 1.22-2.67) and multiple interventions (OR 1.70, 95% CI 1.15- 2.50) had the strongest effect on colonoscopy completion. Significant heterogeneity was observed both overall and by intervention type, which may be attributed to differences in study setting and control group selection.
CONCLUSION(S): Behavioral interventions increase screening colonoscopy completion and should be considered in clinical practice. In particular, patient navigation and multiple interventions are the best-studied and most effective interventions. (Figure Presented)

BACKGROUND & AIMS/OBJECTIVE:Disparities in colorectal cancer (CRC) screening uptake by race/ethnicity, socioeconomic status, and geography are well documented. We sought to further characterize the relationship between sociodemographic factors and up-to-date colonoscopy use in a diverse urban center using the 2014 New York City Community Health Survey (NYCCHS). METHODS:We examined overall colonoscopy uptake by race/ethnicity-with a particular interest in Asian and Hispanic subgroups-and used weighting to represent the entire 2014 NYC adult population. We also evaluated the association between 10 sociodemographic variables (age, sex, race/ethnicity, birthplace, home language, time living in the US, education, employment, income, and borough of residence) and colonoscopy use using univariable and multivariable logistic regression models. RESULTS:Up-to-date colonoscopy uptake was 69% overall with reported differences by racial/ethnic group, ranging from 44%-45% for Mexicans and Asian Indians to 75% for Dominicans. In the multivariable regression model, colonoscopy use was associated with age greater than 65 years, Chinese language spoken at home, and not being in the labor force. Lower colonoscopy use was associated with living in the US for less than 5 years, Asian Indian language spoken at home, lower income, and residing outside of Manhattan. CONCLUSIONS:Among New Yorkers older than age 50, up-to-date colonoscopy use varied significantly by race/ethnicity, especially in Asian and Hispanic subgroups. Recent immigrants, low-income groups, and those living outside of Manhattan were significantly less likely to receive CRC screening. Targeted interventions to promote CRC screening in these underserved groups may improve overall screening uptake.

Colorectal cancer is the second leading cause of cancer death in the United States. Prospective studies demonstrate that colorectal cancer screening reduces incidence and mortality, but uptake remains suboptimal. More than a third of age-eligible Americans are not up to date on screening. There are several available screening tests, which may cause primary care providers to ponder which is the best test. This article provides an overview of the available test options and the evidence for each; a summary of major guidelines; and a comparison of the two most widely used tests, colonoscopy and fecal immunochemical testing.