Abstract
Objective
Canadian colorectal cancer screening rates differ across income strata. In the United States, disparities across income strata worsen in rural areas. In Canada, differences in screening across income strata have not been explored by levels of urbanization. This project aimed to estimate up-to-date colorectal cancer (UTD-CRC) screening across income strata by levels of urbanization.
Methods
Data from the Canadian Community Health Survey (2013/2014) were used to estimate the prevalence of UTD-CRC screening by income quintiles for Canadians aged 50–74 years. UTD-CRC screening was defined as fecal occult blood testing within 2 years or colonoscopy/sigmoidoscopy within 10 years before the survey. Levels of urbanization were defined per Statistics Canada Metropolitan Influenced Zone classifications. Weighted proportions of UTD-CRC screening were calculated and logistic regression was used to assess the effect of income by levels of urbanization.
Results
Self-reported UTD-CRC screening prevalence among Canadians was 52.0%. UTD-CRC screening rates by income ranged from 47.8% (Q1-low) to 54.0% (Q5-high). Across all levels of urbanization, higher income was associated with increased odds of UTD-CRC screening compared to the lowest income quintile (Urban-ORQ5 = 1.49, 95% CI 1.17–1.89; Rural-ORQ5 = 1.42, 95% CI 1.02–1.99; Remote-ORQ5 = 1.54, 95% CI 1.02–2.31). Higher education (ORpost-secondary = 1.30, 95% CI 1.14–1.49), increasing age (OR70–74 = 2.88, 95% CI 2.39–3.47), and not identifying as an immigrant (OR = 1.45, 95% CI 1.19–1.75) were associated with an increased odds of UTD-CRC screening.
Discussion
Half of Canadians report UTD-CRC screening but across levels of urbanization, higher income was associated with higher screening rates. Efforts are needed to understand and address inequities, particularly among low-income populations.
Résumé
Objectif
Les taux de dépistage canadiens du cancer colorectal diffèrent selon les tranches de revenu. Aux États-Unis, les disparités selon les tranches de revenu sont accentuées dans les régions rurales. Au Canada, les différences dans les taux de dépistage selon les tranches de revenu n’ont pas été explorées par niveaux d’urbanisation. Notre projet visait à estimer le dépistage récent du cancer colorectal (DR-CCR) selon les tranches de revenu et les niveaux d’urbanisation.
Méthode
Nous avons utilisé les données de l’Enquête sur la santé dans les collectivités canadiennes (2013–2014) pour estimer la prévalence du DR-CCR par quintile de revenu pour les Canadiennes et les Canadiens de 50 à 74 ans. Le DR-CCR a été défini comme étant la recherche de sang occulte dans les selles au cours des 2 années antérieures ou une coloscopie/sigmoïdoscopie au cours des 10 années antérieures à l’enquête. Les niveaux d’urbanisation ont été définis en fonction des « zones d’influence des régions métropolitaines » de Statistique Canada. Nous avons calculé les proportions pondérées de DR-CCR et évalué l’effet du revenu selon le niveau d’urbanisation au moyen d’analyses de régression logistique.
Résultats
La prévalence autodéclarée du DR-CCR dans la population canadienne était de 52%. Le DR-CCR selon le revenu allait de 47,8% (Q1-faible) à 54% (Q5-élevé). Pour l’ensemble des niveaux d’urbanisation, le revenu élevé était associé à une probabilité accrue de DR-CCR comparativement au quintile de revenu le plus faible (RCQ5-Zone urbaine = 1,49, IC de 95% 1,17-1,89; RCQ5-Zone rurale = 1,42, IC de 95% 1,02-1,99; RCQ5-Région éloignée = 1,54, IC de 95% 1,02-2,31). Les études supérieures (RCpostsecondaire = 1,30, IC de 95% 1,14-1,49), l’âge avancé (RC70–74 ans = 2,88, IC de 95% 2,39-3,47) et le fait de ne pas être immigrant (RC = 1,45, IC de 95% 1,19-1,75) étaient associés à une probabilité accrue de DR-CCR.
Discussion
La moitié des Canadiens et des Canadiennes déclarent avoir subi un dépistage récent du cancer colorectal, mais pour l’ensemble des niveaux d’urbanisation, le revenu élevé est associé à des taux de dépistage supérieurs. Il faudrait déployer des efforts pour comprendre et aborder les inégalités, en particulier dans les populations à faible revenu.
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Acknowledgements
The authors would like to thank Dr. Mieke Koehoorn and Jennifer Guthrie for their support in data analysis and earlier drafts of the manuscript.
Funding
This research was supported by funds to the Canadian Research Data Centre Network (CRDCN) from the Social Sciences and Humanities Research Council (SSHRC), the Canadian Institutes of Health Research (CIHR), the Canadian Foundation for Innovation (CFI), and Statistics Canada.
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Ethics approval was covered by the publicly available data clause (item 7.10.3) governing the use of publicly released data set under the University of British Columbia’s Policy #89: Research Involving Human Subjects (University of British Columbia Board of Governors 2012).
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The authors declare that they have no conflict of interest.
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Although the research and analysis are based on data from Statistics Canada, the opinions expressed do not represent the views of Statistics Canada.
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Simkin, J., Ogilvie, G., Hanley, B. et al. Differences in colorectal cancer screening rates across income strata by levels of urbanization: results from the Canadian Community Health Survey (2013/2014). Can J Public Health 110, 62–71 (2019). https://doi.org/10.17269/s41997-018-0143-5
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DOI: https://doi.org/10.17269/s41997-018-0143-5