Characterizing racial disparities in follow-up care after open-access colonoscopy

Open-access (OA) colonoscopy expands colorectal cancer (CRC) screening services. Although CRC screening disparities have been established, disparities in the completion of follow-up care after an OA colonoscopy are unknown.

A retrospective cohort study included patients who had an OA colonoscopy in 2019 at a large nonprofit academic hospital in St Louis, Missouri, United States. Sociodemographic and clinical data were collected for patients who were given a short follow-up interval (<3 years) after the initial OA colonoscopy. The primary outcome was the odds of receiving follow-up care on the basis of sociodemographic factors. Multivariable logistic regressions were used to estimate adjusted odds ratios and 95% confidence intervals (CIs).

Of 2627 patients, 542 (20.6%) received a short-interval follow-up recommendation (mean age 59.8 [standard deviation 8.6 years]; 46.5% female). Most (57.0%) patients identified as a racial minority, with 93.9% (290 of 309) identifying as Black. Only 45.6% (247 of 542) of patients received their recommended short-interval follow-up care. White patients were more likely to receive follow-up care than patients identifying as a racial minority (52.8% vs 40.1%; P = .007). After adjustment for confounders, Black patients were 39% less likely to receive the appropriate follow-up for any recommendation that was <3 years (odds ratio, 0.61; 95% CI, 0.41-0.90).

Minority patients undergoing OA colonoscopy were less likely to receive the recommended short-interval (<3 years) follow-up. Our study suggests that implementing follow-up strategies after OA colonoscopy may be imperative to address disparities in CRC screening and surveillance.