Predictors of endoscopy use in medically underserved communities of north miami-dade county--- Florida, United States, 2009-2010

Background: The burden of colorectal cancer (CRC) remains high in the U.S. due to the underutilization of routine screening. This study identified significant predictors of endoscopy use among households in medically underserved communities of Miami-Dade County, Florida.

Methods: A cross-sectional analysis was conducted on data from the North Miami-Dade Benchmark Survey. The analysis was restricted to households containing at least one member ≥50 years old (n=1,175). Endoscopy use was specifically defined as previous use (or non-use) of sigmoidoscopy or colonoscopy by any household member. Univariate and multivariate analyses were conducted using logistic regression models.

Results: The majority of households identified as Hispanic (27.6%) or non-Hispanic African American (56.9%); had less than a college degree (80.0%); were retired (33.2%) or employed (49.8%); and were insured continuously during the previous year (66.0%). Nearly half of households (46.3%) reported no history of endoscopy. Multivariate analysis identified the following significant (p<0.05), independent risk factors for never having had an endoscopy: Hispanic ethnicity (adjusted odds ratio [AOR]=0.68), Spanish-speaking (AOR=0.81), less than a college degree (AOR=0.63), unemployment (AOR=0.49) or employment (AOR=0.58) (vs. retirement), single relationship status (AOR=0.57), discontinuous health insurance coverage (AOR=0.59), postponement of care (AOR=0.89), and underutilization of or never use of blood stool tests (AOR=0.57 and AOR=0.28, respectively). Significant, independent protective factors included coinciding health problems (AOR=1.15) and physical limitations (AOR=1.50).

Conclusion: This is the first study of predictors of endoscopy use within these Miami-Dade County communities. The findings provide a basis for community-based interventions aimed at increasing CRC screening within this specific population.