Socioeconomic differences in participation and diagnostic yield within the Dutch national colorectal cancer screening programme with faecal immunochemical testing

Miriam P. van der Meulen, Esther Toes-Zoutendijk*, Manon C.W. Spaander, Evelien Dekker, Johannes M.G. Bonfrer, Anneke J. van Vuuren, Ernst J. Kuipers, Folkert J. van Kemenade, M. F. van Velthuysen, Maarten G.J. Thomeer, Harriët van Veldhuizen, Harry J. de Koning, Iris Lansdorp-Vogelaar, Monique E. van Leerdam

*Corresponding author for this work

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Abstract

Background CRC mortality rates are higher for individuals with a lower socioeconomic status (SES). Screening could influence health inequalities. We therefore aimed to investigate SES differences in participation and diagnostic yield of FIT screening. Methods All invitees in 2014 and 2015 in the Dutch national CRC screening programme were included in the analyses. We used area SES as a measure for SES and divided invitees into quintiles, with Quintile 1 being the highest SES. Logistic regression analysis was used to compare the participation rate, positivity rate, colonoscopy uptake, positive predictive value (PPV) and detection rate across the SES groups. Results Participation to FIT screening was significantly lower for Quintile 5 (67.0%) compared to the other Quintiles (73.0% to 75.1%; adjusted OR quintile 5 versus quintile 1: 0.73, 95%CI: 0.72–0.74), as well as colonoscopy uptake after a positive FIT (adjusted OR 0.73, 95%CI: 0.69–0.77). The detection rate per FIT participant for advanced neoplasia gradually increased from 3.3% in Quintile 1 to 4.0% in Quintile 5 (adjusted OR 1.20%, 95%CI 1.16–1.24). As a result of lower participation, the yield per invitee was similar for Quintile 5 (2.04%) and Quintile 1 (2.00%), both being lower than Quintiles 2 to 4 (2.20%-2.28%). Conclusions Screening has the potential to reduce health inequalities in CRC mortality, because of a higher detection in participants with a lower SES. However, in the Dutch screening programme, this is currently offset by the lower participation in this group.

Original languageEnglish
Article numbere0264067
JournalPLoS ONE
Volume17
Issue number2 February
DOIs
Publication statusPublished - 17 Feb 2022

Bibliographical note

Funding: This analysis was performed as part of
the national monitoring and evaluation of the Dutch
colorectal cancer screening programme, funded by
the National Institute of Public Health and
Environment (Rijksinstituut voor Volksgezondheid
en Milieu (RIVM)). The funders had no role in
study design, data collection and analysis, decision
to publish, or preparation of the manuscript.

Publisher Copyright: © 2022 van der Meulen et al.

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