TOPLINE

Following the implementation of an organized colorectal cancer (CRC) screening program in Hong Kong, participation in fecal testing increased by more than 36% and colonoscopy uptake rose by more than 54% from 2014 to 2022. Socioeconomic disparities narrowed considerably, with a decline in the concentration index for fecal test participation.

METHODOLOGY

• Many countries have adopted organized CRC screening initiatives to boost participation and reduce socioeconomic disparities. However, significant inequalities persist, showing the potential of these efforts to improve access while highlighting the ongoing challenge of achieving equitable coverage.
• Researchers used a repeated cross-sectional survey design to evaluate equity in the utilization of CRC screening program services across different socioeconomic groups in Hong Kong, China, before and during the implementation of an organized CRC screening program, which was piloted in 2016 and fully implemented in 2020.
• They analyzed data from 14,602 adults aged 50-75 years (52.84% women) without symptoms suggestive of CRC, high-risk conditions, or recent screening who participated in three repeated population surveys conducted between 2014 and 2022.
• The primary screening test was the fecal immunochemical test, with government subsidies covering the first consultation with an enrolled primary care physician, a participant pack containing two tubes, and a second consultation if fecal immunochemical test results were positive; positive results triggered referral to a colonoscopy specialist.
• Disparities in screening uptake by socioeconomic status (SES) were assessed using concentration curves and indices, with the SES index incorporating education level, housing type, and income domains.

TAKEAWAY

• Participation in fecal testing increased from 19.88% (95% CI, 18.70%-21.05%) during 2014-2015 to 27.15% (95% CI, 26.12%-28.18%) during 2020-2022, and colonoscopy uptake rose from 17.65% (95% CI, 16.53%-18.77%) to 27.28% (95% CI, 26.24%-28.31%) over the corresponding periods.
• Individuals aged 70-75 years had the highest odds of participating in screening during 2020-2022 (fecal testing: odds ratio [OR], 2.16; 95% CI, 1.76-2.64; colonoscopy: OR, 2.04; 95% CI, 1.67-2.50), with those aged 50-54 years considered the reference group.
• During 2020-2022, individuals with tertiary education were more likely to participate in screening (fecal test: OR, 2.06; 95% CI, 1.70-2.50; colonoscopy: OR, 1.80; 95% CI, 1.48-2.18) than those with primary education.
• Groups with higher SES had substantially elevated odds of fecal test screening before program implementation (2014-2015; OR, 3.52; 95% CI, 2.80-4.43), but this disparity narrowed after program implementation (2020-2022; OR, 2.34; 95% CI, 1.97-2.77), with the concentration index for fecal test participation declining from 0.11 to 0.02.

IN PRACTICE

“Socioeconomic disparities narrowed following the introduction of an organized, population-wide colorectal screening program, although some gaps remained for those who are younger, have lower educational attainment or lower income, are single, employed, or reside in public housing,” the authors wrote.

“Improvement strategies could include greater integration of cancer screening into primary care and expanding community outreach. Continued monitoring will be essential to ensure that all groups receive greater and more equitable benefits from cancer prevention efforts,” they added.

SOURCE

The study was led by Xuechen Xiong, PhD, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China. It was published online in JAMA Health Forum.

LIMITATIONS

The analysis used repeated cross-sectional data, which meant that the results showed trends over time rather than causal effects of the CRC screening program. The “ever screened” measure showed if someone had participated in screening at any point in their life, but it did not specify when the screening happened or if it was part of the CRC screening program or done privately; this limited the ability to understand recent screening habits or program-specific uptake.

DISCLOSURES

This study received funding from the Health and Medical Research Fund, Health Bureau, and the government of Hong Kong. One author disclosed receiving grants from the Health and Medical Research Fund and Hong Kong during the conduct of the study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.