title: Reducing income-related inequities in colorectal cancer screening: lessons learned from a retrospective analysis of organised programme and non-programme screening delivery in Winnipeg, Manitoba.
abstract: OBJECTIVE
  We examined organised colorectal cancer (CRC) screening programme and non-programme faecal occult blood test (FOBT) use from 2008 to 2012 for individuals living in Winnipeg, Manitoba, by area-level income.
  
  
  METHODS
  Winnipeg, Manitoba, a region with universal healthcare and an organised CRC screening programme.
  
  
  METHODS
  Individuals who had a non-programme FOBT were identified from the Provincial Medical Claims database. Individuals who had a programme FOBT were identified from the provincial screening registry. Census data were used to determine average household income based on area of residence.
  
  
  METHODS
  Trends in age-standardised FOBT rates were examined using Joinpoint Regression. Logistic regression was performed to explore the association between programme and non-programme FOBT use and income quintile.
  
  
  RESULTS
  FOBT use (non-programme and programme) increased from 32.2% in 2008 to 41.6% in 2012. Individuals living in the highest income areas (Q5) were more likely to have a non-programme FOBT compared with those living in other areas. Individuals living in areas with the lowest average income level (Q1) were less likely to have had programme FOBT than those living in areas with the highest average income level (OR 0.80, 95% CI 0.77 to 0.82). There was no difference in programme FOBT use for individuals living in areas with the second lowest income level (Q2) compared with those living in areas with the highest. Individuals living in areas with a moderate-income level (Q3 and Q4) were more likely to have had a programme FOBT compared with those living in an area with the highest income level (OR 1.12, 95% CI 1.09 to 1.15 for Q3 and OR 1.10, 95% CI 1.07 to 1.13 for Q4).
  
  
  CONCLUSIONS
  Inequities by income observed for non-programme FOBTs were largely eliminated when programme FOBTs were examined. Targeted interventions within organised screening programmes in very low-income areas are needed.
authors.affiliation: Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Decker
authors.affiliation: Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Alain A
authors.initials: AA
authors.lastname: Demers
authors.affiliation: Department of Internal Medicine, University of Manitoba, Health Sciences Centre, Winnipeg, Manitoba, Canada Medical Oncology and Haematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Zoann
authors.initials: Z
authors.lastname: Nugent
authors.affiliation: Screening Programs, CancerCare Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Natalie
authors.initials: N
authors.lastname: Biswanger
authors.affiliation: Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada Department of Internal Medicine, University of Manitoba, Health Sciences Centre, Winnipeg, Manitoba, Canada Medical Oncology and Haematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Harminder
authors.initials: H
authors.lastname: Singh
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000191:economics*; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D008350:Manitoba; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D009780:Occult Blood; D012189:Retrospective Studies; D012923:Social Class; D019472:Universal Health Insurance / Q000191:economics
keywords: ONCOLOGY; PREVENTIVE MEDICINE; PUBLIC HEALTH