PROSPECTIVE EVALUATION OF SCREENING COLONOSCOPY: EVIDENCE AGAINST UNIVERSAL ACCESS?

B Bressler MD¹, C Lo¹, K Pluta², M Vivian², R Woods², J Amar MD², S Whittaker MD², H Chaun MD², L Halparin MD², R Enns MD²

Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Ontario¹, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia²

Universal access to medical procedures is deemed to be an advantage of the Canadian health care system.
AIM: The purposes of this prospective study were to determine the degree to which the practice of colon cancer screening by colonoscopy differed among socioeconomic classes and to assess adherence to screening guidelines.
METHODS: Consecutive patients in a single center scheduled for colonoscopy between 08/00 and 08/02 completed a questionnaire identifying patient characteristics and indications for their procedure. The patients were divided into two groups; screening patients, defined as those individuals who indicated they were undergoing their procedure for screening purposes and were asymptomatic and a control group. Our control group was symptomatic patients undergoing colonoscopy. Statistical analysis was performed to determine if patients in the screening colonoscopy group had different characteristics, defining their socioeconomic class compared to the control group.
RESULTS: A total of 1088 patients completed the questionnaire. 707 (65%) of these individuals were having colonoscopies for symptoms compared to 381 (35%) having screening colonoscopies. The mean age (±SD) and marital status was similar in both groups. Of all colonoscopy procedures, there were a significantly greater proportion of men undergoing colonoscopy for screening purposes (199 (52.2%) screening group vs 294 (41.6%) symptomatic group, p=0.001). Based on the Cochran-Armitage test, patients in the screening group had both statistically significantly higher education levels (p=0.004) and higher household incomes (p=0.001).
CONCLUSIONS: A patient's income and education level, two indices of socioeconomic status, are statistically significantly higher in patients receiving screening colonoscopies compared to those having colonoscopies for any other reasons.