Disparities in time to completion of multi-target stool DNA testing: A retrospective study across a statewide population.

Abstract

e13762 Background: Colorectal cancer screening using non-invasive methods like the multi-target stool DNA test(Exact Sciences, Madison, WI) is an emerging alternative to colonoscopy as a first step for colon cancer screening. Current guidelines recommend colorectal cancer screening for adults aged 45 to 75 years, emphasizing early detection to improve prognosis and reduce mortality. Timely return of this test is important for planning repeat testing or scheduling colonoscopy referrals for positive results. Our ongoing study evaluates the influence of various demographic factors on the timing of test completion to identify potential barriers within different patient subsets. Methods: We conducted a retrospective analysis of 12,366 patients aged 45-75 across Hartford Healthcare clinics in Connecticut who were ordered the Cologuard test between November 2022 and April 2024. Using Kaplan-Meier survival analysis, we assigned a fixed completion time at the 95th percentile for non-returnees to effectively handle censoring. This allowed comprehensive assessment of median test completion times. We analyzed disparities in test completion by age(stratified into age groups), gender, insurance status, and English proficiency. Chi-square tests confirmed the significance of these disparities, with a p-value < 0.05 considered statistically significant. Results: 7,320(59.1%) patients returned their tests with a mean completion time of 37.06 days, median of 22 days,(SD: 47.91). 5046 patient did not have available results(40.9%). The demographic breakdown included 11,243(90.9%) English speakers, 1,123(9.1%) non-English speakers, 4,720(38.1%) males, 7,646(61.9%) females, 12,001(97%) insured, and 365(3%) uninsured patients. Insured patients exhibited a shorter median test completion time of 42 days compared to 223 days for uninsured patients (p < .001). English speakers completed the test at a median of 40 days versus 140 days for non-English speakers (p < .001). The survival analysis delineated clear age-related trends, with the extremes of age groups generally exhibiting quicker test completion (Table 1). Half of males completed the test by 42 days, whereas half of females by 49 days(p = 0.063). Conclusions: This study illustrates that insurance coverage, language proficiency, and age are significant determinants of the timeliness of Cologuard test completion. These findings underscore critical gaps and emphasize the importance of targeted interventions to enhance screening uptake in this underserved population. Age group analysis. Age Group (Years) Median (Days) 95% Confidence Interval (Lower-Upper) 45-50 41 35.6 - 46.3 51-55 51 32.5 - 69.4 56-60 74 56.1 - 91.8 61-65 45 34.1 - 55.8 66-70 44 31.0 - 56.9 71-75 38 32.3 - 43.6 Overall p-value: <0.001.