Colonoscopy access and utilization – urban-rural disparities in South Carolina, 2000-2010

Background and Purpose: Timely access to and utilization of screening colonoscopy has been shown to decrease colorectal cancer incidence and severity. However, barriers exist that can delay/prevent patients from seeking care.  Such barriers include lack of insurance, poor knowledge of screening guidelines, and distance to care. The objective of this study was to identify disparities in colonoscopy utilization and access to care across urban-rural populations in South Carolina (SC).

Methods:  We used the SC Ambulatory Surgery Discharge database (2000-2010), restricted to individuals between the ages of 50 to 75 who had a colonoscopy (N=628,814). Residence was measured at the county level using the Rural-Urban Continuum Codes. We produced descriptive studies for the utilization of colonoscopy over the study period, overall and by area of residence. Spatial accessibility to colonoscopy facilities by area of residence was also assessed.  

Results:  Over the study period, 62% of SC population between the ages of 50 to 75 years underwent at least one colonoscopy procedure.  The increase in annual utilization was modest, from 4.3% in 2000 to 4.9% in 2010. Disparities were noted by area of residence with only 48.6% rural residents received a colonoscopy, as compared to 67.4% of their urban counterparts.  Only 37% rural residents had their colonoscopy performed in their own county of residence, versus 75% urban residents.

Conclusion: Rural residents have lower utilization rates of colonoscopy, and limited spatial access to facilities that provide colonoscopy services. Effective programs and policies are needed to improve access to screening colonoscopy for rural residents.