American Indian/Alaska native access to colorectal cancer screening: Does gastroenterologist density matter?

Lily Gutnik; Josh Bleicher; Andrea Davis; M Chandler McLeod; Marta McCrum; Courtney Scaife

doi:10.1016/j.amjsurg.2022.04.023

American Indian/Alaska native access to colorectal cancer screening: Does gastroenterologist density matter?

Am J Surg. 2022 Sep;224(3):965-970. doi: 10.1016/j.amjsurg.2022.04.023. Epub 2022 Apr 28.

Authors

Lily Gutnik¹, Josh Bleicher², Andrea Davis³, M Chandler McLeod⁴, Marta McCrum⁵, Courtney Scaife⁶

Affiliations

¹ University of Alabama at Birmingham, Department of Surgery, 1807 Seventh Ave South, BDB 515, Birmingham, AL, 35233, USA; University of Utah, Department of Surgery, 30 N 1900 E, Salt Lake City, UT, 84132, USA. Electronic address: lgutnik@uabmc.edu.
² University of Utah, Department of Surgery, 30 N 1900 E, Salt Lake City, UT, 84132, USA. Electronic address: Josh.bleicher@hsc.utah.edu.
³ University of Utah, Department of Geography, 260 Central Campus Dr #4625, Salt Lake City, UT, 84112, USA. Electronic address: Rounkles22@hotmail.com.
⁴ University of Alabama at Birmingham, Department of Surgery, 1807 Seventh Ave South, BDB 515, Birmingham, AL, 35233, USA. Electronic address: marshallcmcleod@uabmc.edu.
⁵ University of Utah, Department of Surgery, 30 N 1900 E, Salt Lake City, UT, 84132, USA. Electronic address: Marta.mccrum@hsc.utah.edu.
⁶ University of Utah, Department of Surgery, 30 N 1900 E, Salt Lake City, UT, 84132, USA; Huntsman Cancer Institute at the University of Utah, Division of Surgical Oncology, 2000 Cir of Hope Dr #1950, Salt Lake City, UT, 84112, USA. Electronic address: Courtney.scaife@hci.utah.edu.

PMID: 35513914
DOI: 10.1016/j.amjsurg.2022.04.023

Abstract

Background: American Indians/Alaska Natives (AI/AN) receive less colorectal cancer (CRC) screening than other populations. Using gastroenterologist (GI) locations as a measure of colonoscopy access, we correlate GI density and AI/AN CRC screening rates.

Methods: We identified GIs from the 2016 National Provider Identifier registry, and calculated GI density per 100,000 people. We identified screening, demographic, and socioeconomic variables from the 2016 Behavioral Risk Factor Surveillance System Survey. GI density and CRC screening rates were analyzed with Multivariable Poisson regression.

Results: In states with GI Density greater than 3.98/100,000, odds of AI/AN CRC screening are 1.27-1.37 times higher than in states below this threshold (p < 0.036).

Conclusions: GI density has a limited association on CRC screening, with decrease impact beyond threshold of 3.98 GI/100,000. Minimal access to GIs is important in improving AI/AN CRC screening; however, further research is required to elucidate the most critical factors contributing to CRC screening.

Keywords: American Indian; Cancer screening; Colorectal cancer; Endoscopy; Gastroenterologist.

MeSH terms

Alaska Natives*
Colorectal Neoplasms*
Early Detection of Cancer
Gastroenterologists*
Humans
Indians, North American*
United States