Social determinants of health influencing the adherence to post-endoscopic mucosal resection surveillance
•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-...
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Published in | Clinics and research in hepatology and gastroenterology Vol. 48; no. 4; p. 102301 |
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Main Authors | , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
France
Elsevier Masson SAS
01.04.2024
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Subjects | |
Online Access | Get full text |
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Summary: | •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. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 2210-7401 2210-741X |
DOI: | 10.1016/j.clinre.2024.102301 |