Patricia Ajayi-Fox, MD1, Gianina Flocco, MD1, Carlos Romero-Marrero, MD, MSc2
1Cleveland Clinic Foundation, Cleveland, OH; 2Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH
Introduction: Despite the overall increase in colorectal cancer screening (CRCS) rates, disparities are still observed in minority groups, such as Hispanics. Suggested reasons for this are poor health literacy, different cultural attitudes about health and language barriers. To determine the impact of eliminating language barriers among Hispanics in CRCS, we analyzed differences in CRCS rates between Hispanics served at a bilingual underserved clinic to African Americans and Hispanics served at other non-bilingual clinics.
Methods: A retrospective review of CRCS rates of selected minority patients seen at our institution between 1/1/13 and 12/31/18 was conducted. Three outpatient primary care clinics were included: a clinic located at our Main Campus (GC), one with predominantly African American patients (AC), and a Hispanic clinic (HC) at an alternate location. While GC and AC had only English-speaking providers, the Hispanic clinic (HC) had exclusively bilingual providers. For GC, only Hispanic patients were included. Variables analyzed included general demographics, CRCS rates, screening method, quality of bowel preparation and adenoma detection rates.
Results: A total of 3963 patients were included in the study. Sixty percent were female. Average age of screening was 58, 57 and 58 at HC, GC and AC respectively (p 0.093). Overall, the predominant method of CRCS was colonoscopy (45.1%), however AC had a high rate (13.6%) of FIT utilization. 65.7% of patients had good or excellent bowel preparation quality, and there was a 37.2% adenoma detection rate (ADR). When comparing clinics, there was a statistically significant difference in CRCS rates (43.4% HC, 58.7% GC and 59.5% AC, p < 0.001), good bowel preparation quality, (53.6% HC, 68.5% GC and 69.2% AC, p < 0.001) and adenoma detection rates (29.8% HC, 29.3% GC and 40.3% AC, p < 0.001).
Discussion: Our study shows that, despite the elimination of language barriers, disparities affecting underserved Hispanic patients remain in colorectal cancer screening rates, bowel preparation quality and adenoma detection rates. Language alone may not be all that is needed for improving CRCS in underserved Hispanic populations and a multifactorial approach is needed for this. The higher CRCS at AC could be attributable to their high number of FIT tests. One potential intervention would be increasing FIT at the HC as an initial screening method.
Citation: Patricia Ajayi-Fox, MD; Gianina Flocco, MD; Carlos Romero-Marrero, MD, MSc. P1124 - ELIMINATION OF LANGUAGE BARRIERS AS A STRATEGY TO DECREASE COLORECTAL CANCER SCREENING DISPARITIES IN UNDERSERVED HISPANICS: IS THIS ENOUGH?. Program No. P1124. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.