Demographic predictors of multi-target stool DNA test completion in an underserved primary care population: A retrospective analysis.

Abstract

30 Background: Colorectal cancer screening remains crucial for early detection, with multi-target stool DNA(Exact Sciences, Madison, WI, USA) serving as a non-invasive option. However, adherence to test completion may vary across different demographic groups. This study aims to assess the association between patient demographics and the completion of Cologuard testing in an underserved primary care population in order to further explore the disparities that exist. Methods: We conducted a retrospective analysis of 12071 eligible patients, aged 45-75, across Hartford Healthcare Primary Care Clinics across Connecticut, USA, between November 2022 and April 2024 for whom an order for this test was placed. Demographic data including gender, age, English proficiency, and insurance status(public/private vs no insurance) were analyzed. The outcome of interest was whether patients had results available within 120 days of placing the order. Logistic regression was used to examine the relationship between these variables and the likelihood of Cologuard test completion. Results: 11704(96.9%) of all patients were insured. Among insured patients, 6945 (59.9%) had results available, while 4759 (41.1%) did not have results at the 120 day mark. Among uninsured patients, 46 (12.5%) had results, while 321 (87.5%) did not. Insured patients were more likely to have test results available compared to uninsured patients (OR = 10.184, 95% CI: 7.460-13.901, p < 0.01). 10977(90.9%) patients were English proficient. They were more likely to have results compared to Non-English proficient patients (OR = 3.474, 95% CI: 3.038-3.972, p < 0.01). Gender was not a significant predictor of test completion (OR = 0.964, 95%CI: 0.895-1.039, p = 0.341), and older age demonstrated a small, non-significant effect (OR = 1.004, p = 0.094), with a test for non-linearity confirming a linear relationship between age and test completion (p = 0.162). Conclusions: Insured status and English proficiency are significant predictors of Cologuard test completion in this primary care cohort and are more likely complete testing. These findings underscore the need for targeted interventions to increase colorectal cancer screening adherence, particularly among this population.