Utilization of Census Tract-Based Neighborhood Poverty Rates to Predict Non-adherence to Screening Colonoscopy

  • Philip Vutien
  • Rucha Shah
  • Karen Ma
  • Nasir Saleem
  • Joshua MelsonEmail author
Original Article



Efforts to improve colorectal cancer (CRC) screening rates include recognizing predictors of colonoscopy non-adherence and identifying these high-risk patient populations. Past studies have focused on individual-level factors but few have evaluated the influence of neighborhood-level predictors. We sought to assess the effect of census tract-based neighborhood poverty rates on scheduled screening colonoscopy non-adherence.


In this prospective observational cohort study, data from electronic medical records and appointment tracking software were collected in 599 patients scheduled to undergo outpatient CRC screening colonoscopy at two academic endoscopy centers between January 2011 and December 2012. Non-adherence was defined as failure to attend a colonoscopy appointment within 1 year of the date it was electronically scheduled. Neighborhood poverty rate was determined by matching patients’ self-reported home address with their corresponding US census tract. Individual factors including medical comorbidities and prior appointment adherence behavior were also collected.


Overall, 17% (65/383) of patients were non-adherent to scheduled colonoscopy at 1-year follow-up. Neighborhood poverty rate was a significant predictor of non-adherence to scheduled screening colonoscopy in multivariate modeling (OR 1.53 per 10% increase in neighborhood poverty rate, 95% CI 1.21–1.95, p < 0.001). By incorporating the neighborhood poverty rate, screening colonoscopy non-adherence was 31% at the highest quartile compared to 14% at the lowest quartile of neighborhood poverty rates (p = 0.006).


Census tract-based neighborhood poverty rates can be used to predict non-adherence to scheduled screening colonoscopy. Targeted efforts to increase CRC screening efficiency and completion among patients living in high-poverty geographic regions could reduce screening disparities and improve utilization of endoscopy unit resources.


Colonoscopy Geocoding Neighborhood socioeconomic status Organizational efficiency 



American College of Gastroenterology


American Community Survey


Area under the receiver operating curve


Colorectal cancer


Fecal immunochemical testing


Socioeconomic status


US Preventative Services Task Force


Author’s contribution

PV collected and interpreted the data, contributed to statistical analysis, and drafted the manuscript. RS collected and interpreted the data. KM interpreted the data and drafted the manuscript. NS collected and interpreted the data. JM planned and conducted the study, interpreted the data, and edited the manuscript. All authors approved the final draft of this manuscript.


Some study support was provided by the American Cancer Society of Illinois (Grant No. 255086).

Compliance with ethical standards

Conflict of interest

Philip Vutien, Rucha Mehta, Karen Ma, Nasir Saleem have no conflicts of interest. Joshua Melson has received research grants from the American Cancer Society of Illinois (Grant No. 255086).


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Philip Vutien
    • 1
  • Rucha Shah
    • 1
  • Karen Ma
    • 1
  • Nasir Saleem
    • 1
  • Joshua Melson
    • 1
    Email author
  1. 1.Division of Digestive Diseases, Department of MedicineRush University Medical CenterChicagoUSA

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