Racial/ethnic and socioeconomic disparities in colorectal cancer screening in a large organization with universal insurance before and during the coronavirus disease 2019 pandemic

Zohar Levi, Naim Abu-Frecha, Doron Comanesther, Tania Backenstein, Arnon D. Cohen, Sapir Eizenstein, Anath Flugelman, Orly Weinstein

    Research output: Contribution to journalArticlepeer-review

    Abstract

    Objectives: Israel is regarded as a country with a developed economy and a moderate income inequality index. In this population-based study, we aimed to measure the inequalities in colorectal cancer screening within Clalit Health, an organization with universal insurance, before and during the coronavirus disease 2019 pandemic. Setting: Retrospective analysis within Clalit Health Services, Israel. Methods: We evaluated the rate of being up to date with screening (having a colonoscopy within 10 years or a fecal occult blood test within 1 year) and the colonoscopy completion rate (having a colonoscopy within 6 months of a positive fecal occult blood test) among subjects aged 50–75 in 2019–2021. Results: In 2019, out of 918,135 subjects, 61.3% were up to date with screening; high socioeconomic status: 65.9% (referent), medium-socioeconomic status: 60.1% (odds ratio 0.81, 95% confidence interval 0.80–0.82), low-socioeconomic status: 59.0% (odds ratio 0.75, 95% confidence interval 0.74–0.75); Jews: 61.9% (referent), Arabs: 59.7% (odds ratio 0.91, 95% confidence interval 0.90–0.92), Ultraorthodox-Jews: 51.7% (odds ratio 0.77, 95% confidence interval 0.75–0.78). Out of 21,308 with a positive fecal occult blood test, the colonoscopy completion rate was 51.8%; high-socioeconomic status: 59.8% (referent), medium-socioeconomic status: 54.1% (odds ratio 0.79, 95% confidence interval 0.73–0.86), low-socioeconomic status: 45.5% (odds ratio 0.60, 95% confidence interval 0.56–0.65); Jews: 54.7% (referent), Ultraorthodox-Jews: 51.4% (odds ratio 0.91, 95% confidence interval 0.90–0.92), Arabs: 44.7% (odds ratio 0.77, 95% confidence interval 0.75–0.78). In 2020–2021, there was a slight drop in the rate of being up to date with screening, while most of the discrepancies were kept or slightly increased with time. Conclusions: We report significant inequalities in colorectal cancer screening before and during the coronavirus disease 2019 pandemic in Israel, despite a declared policy of equality and universal insurance.

    Original languageEnglish
    Pages (from-to)85-90
    Number of pages6
    JournalJournal of Medical Screening
    Volume31
    Issue number2
    DOIs
    StatePublished - 1 Jun 2024

    Keywords

    • Racial
    • colorectal cancer
    • coronavirus disease 2019
    • disparities
    • ethnic
    • insurance
    • screening
    • socioeconomic

    ASJC Scopus subject areas

    • Public Health, Environmental and Occupational Health
    • Health Policy

    Fingerprint

    Dive into the research topics of 'Racial/ethnic and socioeconomic disparities in colorectal cancer screening in a large organization with universal insurance before and during the coronavirus disease 2019 pandemic'. Together they form a unique fingerprint.

    Cite this