THE ASSOCIATION BETWEEN HAVING A LONG-TERM CONDITION AND UPTAKE OF POPULATION-BASED SCREENING FOR COLORECTAL CANCER

Purpose:    To examine the association between having a long-term condition (LTC) and uptake of population-based screening for colorectal cancer.

Method(s):    Within England, invitations for colorectal cancer (CRC) screening are sent once every two years to men and women aged 60 to 74 by the national screening programme. This programme contains data on the uptake of CRC screening. This data was linked to the Yorkshire Health Study (YHS), a longitudinal observational regional health study. The YHS holds self-report data on 11 named LTCs (depression, anxiety, fatigue, pain, insomnia, diabetes, breathing problems, high blood pressure, heart disease, osteoarthritis, and stroke. Data for cancer were also available, but not considered for this study). Participants may also report additional LTCs as free-text. In addition, the YHS includes data on participant’s demographics (age, sex and ethnicity) and broader determinants of health (deprivation, education, smoking status, alcohol consumption, amount of physical activities). The association between having an LTC and uptake of CRC screening was modelled according to a pre-specified statistical analysis plan. Separate logistic regression models were built which controlled for (i) just patient demographics, and (ii) both patient demographics and broader determinants of health. The outcome of interest was the uptake of CRC screening, which was taken to be if the participant had ever received an adequate screen following an invitation for screening. 

Result(s):    After adjusting for patient demographics, the occurrence of a stroke, diabetes, depression or breathing problems was associated with increased odds of non-attendance, whilst the occurrence of osteoarthritis or a free-text LTC was associated with increased odds of attendance. After adjustment for broader determinants these associations were no longer significant for depression and breathing problems, but they remained for the other LTCs. Other variables associated with non-attendance were younger age, increasing levels of deprivation, male gender, currently smoking, low levels of walking or physical exercise, and no alcohol consumption in the last week.

Conclusion(s):   Evidence from this study suggests an association between the presence of stroke or diabetes and reduced uptake of CRC screening following an invitation. Future research should target these groups to identify potential barriers to and facilitators for uptake. Depression and breathing problems were also associated with reduced uptake, although some of this association may be due to the effect of broader health determinants.