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BACKGROUND: Colon cancer screening rates have increased significantly in Kentucky since 1999 from 34.7% to 65.9% in 2012. In order to continue to increase screening rates, barriers to screening need to be identified and addressed. This research attempts to understand the greatest barriers to colon cancer screening in Kentucky.
METHODS: A state added question that focused on barriers to screening was added in the 2012 Kentucky Behavioral Risk Factor Survey (KyBRFS) for respondents (ages 50 and over)who answered “no” to ever being screened by colonoscopy or sigmoidoscopy. The question had 19 potential responses which were combined into the four categories: attitudes and beliefs, healthcare provider and systems barriers, cost and other. Prevalence estimates for barriers were calculated using raking weights and stratified by race, gender, education, income, and health insurance coverage. Logistic regression was used to estimate odds ratios (OR’s) for barriers to screening.
RESULTS: The most common barriers in all areas were related to attitudes and beliefs (62.4%, CI: 59.2-65.5) followed by healthcare provider and systems (15.9%, CI: 13.5-18.2) and finally cost (11.7%, CI: 9.5-13.9). Those with more than a high school education were more likely to choose attitude and beliefs (OR=1.7, CI: 1.2-2.3) as a barrier than those with less than a high school education. Blacks were 44% less likely to choose attitudes and beliefs than Whites. Respondents with low income were significantly less likely (OR=0.55, CI: 0.4-0.8) to select attitude and belief as compared to those with high income. Respondents with low income were also significantly more likely (OR=4.1, CI: 2.1-7.9) to select cost as a barrier. Only five percent of the respondents with a health plan stated that cost was a barrier versus 41% of those with no health plan (OR=13, CI: 8.3-20.5). No significant associations were observed between the selection of healthcare provider and systems as a barrier and the demographic variables (race, gender, education, income, or health insurance coverage).
CONCLUSIONS: Although colon cancer screening rates have increased considerably over time, there are significant differences in barriers based on educational status, race, income and insurance status that need to be considered. Implementation of expanded Medicaid and the Affordable Care Act in Kentucky could have a major impact on reducing some of these barriers.