Social determinants of health influencing the adherence to post-endoscopic mucosal resection surveillance

• Published in: Clinics and research in hepatology and gastroenterology Vol. 48; no. 4; p. 102301
• Main Authors: Vashi, Bijal, Norwood, Dalton A., Sullivan, Rebecca, Hegazy, Yassmin, Sánchez-Luna, Sergio A., Ajayi-Fox, Patricia, Ahmed, Ali M., Baig, Kondal R. Kyanam Kabir, Peter, Shajan, Mulki, Ramzi
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01.04.2024
• Subjects: Colorectal cancer; EMR; Social Determinants of Health; Surveillance; ACS; Social Determinants of Health; EGD; CDC; Surveillance; CRC; Colorectal cancer; EMR; IQR; None
• ISSN: 2210-7401; 2210-741X
• DOI: 10.1016/j.clinre.2024.102301

•Only 36.6 % of patients achieved adequate follow-up post-EMR, underscoring a major care gap.•Adherence to follow-ups increases with travel distance; over 80 miles travel lowers inadequate follow-up odds by 76 %.•Areas with 30–40 % high school education level see 3x higher odds of inadequate follow-up.•The truly highlights the crucial role of socioeconomic factors in CRC surveillance adherence.•Calls for actionable strategies, considering 41.6 % of patients were lost to follow-up, to enhance CRC management. : Colorectal cancer (CRC) is a global health challenge, particularly in Alabama, where the incidence rates exceed national averages. This study investigated the factors influencing adherence to post-endoscopic mucosal resection (EMR) colonoscopies, focusing on travel distance and socioeconomic status. This study aimed to provide evidence-based insights to improve patient care in CRC management. This retrospective study in a tertiary care referral center analyzed 465 patients who underwent EMR. The data included demographics, clinical details, and travel-related variables. Descriptive statistics, logistic regression, and spatial analysis were used to assess the factors affecting adherence. Of 465 patients, 36.6 % had adequate follow-up, 21.8 % had inadequate follow-up, and 41.6 % were lost to follow-up. Noteworthy demographic variations were observed, with median ages differing across adherence groups. Traveled distances showcased compelling insights, indicating a median distance of 22.2 miles for adequate follow-up, 15.7 miles for inadequate follow-up, and 31.6 miles for the lost-to-follow-up group (p<0.001). Longer travel distances were associated with better adherence. Longer travel distances from the hospital were associated with significantly lower odds of inadequate follow-up: 10–25 miles OR:0.29, 25–85 miles OR:0.35, and >80 miles OR:0.24 compared to the first quartile (<10 miles). Socioeconomic factors, particularly educational attainment, significantly influenced the follow-up rates. This study revealed suboptimal post-EMR follow-up rates and underscored the impact of travel distance and socioeconomic factors. Targeted interventions addressing distance-related barriers can enhance treatment adherence and ensure timely CRC surveillance after EMR. Further research is needed in diverse healthcare settings.