title: Screening Colonoscopy among Uninsured and Underinsured Urban Minorities.
abstract: OBJECTIVE
  Uninsured individuals have lower rates of screening colonoscopy (SC), and little is known regarding the pathology results obtained when they undergo colonoscopies. Since 2004, we have participated in a program that offers SC to uninsured New Yorkers; herein, we report our findings.
  
  
  METHODS
  Uninsured, average-risk patients who were at least 50 years of age underwent SC at our institution between April 2004 and June 2011. We analyzed polyp pathology, location, size, incidence of adenomas, and incidence of adenomas with advanced pathology (AAP) with respect to ethnicity, gender, and age.
  
  
  RESULTS
  Out of 493 referrals, 222 patients completed the colonoscopies. Polyps were identified in 21.2% of all patients; 14% had adenomas, and 4.5% had AAP. The rates of adenomas among African-Americans, Hispanics, and Whites were 24.3%, 12.1%, and 11.6%, respectively, and the corresponding rates of AAP were 10.8%, 3.5%, and 2.3%. Differences in the polyp type, location, and AAP did not reach statistical significance with respect to ethnicity or gender. Patients aged 60 and older were found to have a higher rate of advanced adenomas compared with younger patients (8.6% vs. 2.6%, p=0.047).
  
  
  CONCLUSIONS
  Further efforts to fund screening colonoscopies for uninsured individuals will likely result in the identification of advanced lesions of the colon before they progress to colorectal cancer.
authors.affiliation: Departments of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Tyson H
authors.initials: TH
authors.lastname: Collazo
authors.affiliation: Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Lina
authors.initials: L
authors.lastname: Jandorf
authors.affiliation: Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Thelemaque
authors.affiliation: Departments of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Kristen
authors.initials: K
authors.lastname: Lee
authors.affiliation: Departments of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.|Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Steven H
authors.initials: SH
authors.lastname: Itzkowitz
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000453:epidemiology; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D003106:Colon / Q000473:pathology; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000453:epidemiology; D003111:Colonic Polyps / Q000175:diagnosis / Q000453:epidemiology; D003113:Colonoscopy / Q000706:statistics & numerical data*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data*; D009519:New York City / Q000453:epidemiology; D015397:Program Evaluation; D014505:Urban Population; D044465:White People / Q000706:statistics & numerical data
keywords: Adenoma; Colonoscopy; Medically uninsured; Minorities; Patient navigator