EP503 - Disparities In Colonoscopy Screening Rates Among Patients With A Non-English Primary Language

Purpose/Background: Colon cancer is the third most common non-skin cancer and ranks second highest among cancer-related deaths. Colonoscopy is the gold standard for routine screening, yet adherence to established guidelines is still suboptimal. Adherence differs across communities in the United States, yet these disparities have not been completely elucidated. We hypothesized that colonoscopy screening rates would be lower among non-native English speakers compared to native English speakers.

Methods/Interventions: Data were gathered from the Center for Disease Control's (CDC) National Health Interview Survey (NHIS) for the years 2023, 2021, and 2019, years in which screening data were recorded. Data from the NHIS are gathered during face to face interviews with participants from United States civilian households. To evaluate screening colonoscopy rates, only participants between the ages of 40 and 85 who did not receive a colonoscopy for diagnostic purposes were included. Native English and non-native English speakers were defined by which language was spoken at home. Results from categorical variables were compared by Fischer's exact test, and continuous variables were compared by unpaired t-test. A p value < 0.05 was considered significant.

Results/Outcomes: After removing duplicate household data and participants outside the indicated age range, the sample included 10,969 native English speakers and 2,244 non-native English speakers. For native English speakers, 61.68% reported history of a screening colonoscopy compared to 40.12% of non-native English speakers (p < 0.0001). Furthermore, non-United States citizens had a screening rate of 21.09% compared to 58.4% of citizens (p < 0.0001). Non-native English speakers were less likely than native English speakers to be insured, to have reliable transportation, or to have seen a doctor within the past year (Table 1). Conversely, they were more likely to be worried about the ability to pay for medical bills. For both native English speakers and non-native English speakers, screening rates were correlated with insurance status, citizenship status, regular medical visits, and concern over the ability to pay for medical bills. Sex and access to reliable transportation were not significantly correlated with screening rate for non-native English speakers, although these variables were correlated with screening rate for native English speakers (Table 2).

Conclusion/Discussion: Patients who are either non-native English speakers or non-citizens have lower colonoscopy screening rates, making them vulnerable to delayed cancer diagnoses. While further work is needed to determine the specific needs of these populations, community outreach and financial resources are potential solutions.

Table 1
This table shows percent prevalence of the indicated variables among patients who speak English at home or speak another language at home, with colonoscopy indicating colonoscopy screening rate. Age is a continuous variable shown as average in years with standard deviation. Relative risk and p values (p < 0.05 is statistically significant) are also shown.
Table 2
This table shows colonoscopy screening rates by percent for the indicated variables, with relative risk and p values to indicate effect size and type 1 error rate (p < 0.05 is statistically significant), respectively.